Patient Education for Chronic Patient Education for Chronic ConditionsConditions

Hana Al-Sobayel, MSc., Ph.D.Assistant Professor

King Saud Universityhsobayel@ksu.edu.sa

Objectives

• To understand the principles of patient education• To be able to assess the needs of the target

population• To be able to set goals and objectives of a

patient education programme• To understand the different educational

approaches• To be able to set up a simple educational

session for a target population

Patient Education PrinciplesPatient Education Principles

Definition

Theories

Evidence

Why patient education?Why patient education?

‘… the informed and empowered patient must be a critical part of any therapy…’

World Health Organization’s Bone and Joint Decade (WHO 2004)

The core concepts of patient education and self-management involved engagement in self-care, improved self-monitoring, interactions with health care professionals and coping with disease.

(Osborne et al. 2004).

DefinitionDefinition

"planned, organized learning experiences designed to facilitate voluntary adoption of behaviours or beliefs conducive to health"

(Lorig & Visser, 1994)

TheoriesTheories

Health Belief Model(Rosenstock & Becker)

http://www.onlineconsultation.org.uk/

Theory of Planned Behaviour(Ajzen & Feishbein)

http://www.onlineconsultation.org.uk/

Transtheoretical ModelStages of Change(Prochaska & DiClemente)

www.wipp.nhs.uk/tools_scfp/participants_hbook.

Social Cognitive Theory/Self-efficacy(Bandura)

EvidenceEvidence

Health Belief Model

• The beliefs about the seriousness of osteoarthritis and the amount of symptoms experienced were strongly associated with more utilization of medical services, poorer quality of life, and engagement in more self-management activities.

(Hampson et al. 1994)

• Patient education for patients with RA showed positive correlation between the self-efficacy construct and the adherence to medication.

(Brus et al.1999)

Health Belief Model

• Patients’ beliefs about the causes and outcomes of their condition can predict and influence patients’ health behaviour. These beliefs can also act as barriers to interventions, for example, the belief that painful, stiff joints are a normal part of aging may mean that patients do not seek medical help and treatment for their osteoarthritis

(Carr 2001)

Theory of Planned Behaviour

• Beliefs and social norms predicted intentions relevant to exercises in a group of university students.

(Lowe et al. 2003)

• A booklet was developed targeting older adults to promote healthy eating and physical activity, contained persuasive messages targeting perceived behavioural control and intention and also encourages goal-setting and planning. The study showed statistically significant increase in perceived behavioural control and intentions in the intervention group compared to the control group on follow up in relation to healthy eating but not physical activity.

(Kelly & Abraham 2004)

Transtheoretical Model

• The Pain Stages of Change Questionnaire was used with 109 subjects who were undergoing a psychological self-management treatment for chronic pain. This study compared the stages of change profile between patients who completed and those who did not complete the treatment. Overall, the completers of the self-management treatment had beliefs consistent with contemplating stage. The non-completers had beliefs consistent with precontemplation stage. None of the demographic variables, the nature or intensity of pain and disability could predict treatment completion

(Kern & Rosenberg 2000)

Self-efficacy

• The Arthritis Self-Management Programme based on the self-efficacy theory and included strategies of skill mastery, modelling process, reinterpretation of symptoms and persuasion

(Lorig et al.1984)

• Stronger self-efficacy beliefs were associated with self-reports of better functional performance

(Gaines et al. 2002)

Needs AssessmentNeeds Assessment

Definition

Process

Maslow’s Hierarchy of Needs

cit.dixie.edu/vt/reading/maslow.asp

Why need’s assessment?

• It is the first step required to ensure high quality programmes that are consistent with the patient-centred approach to medical care, when treatments are tailored to fit the needs, beliefs, and preferences of individual patients.

(Adab et al. 2004)

Why need’s assessment?

• Differences existed between patients’ and health professionals in their preferences related to quality of care.

(Van der Waal et al. 1996) • Differences in preferences related to health care

existed between patients from different ethnic background.

(Byrne et al. 2004)

• Other factors include severity of the symptoms, age, and income

(Ratcliffe et al. 2004)

Definitions

• Health need ‘what patients – and the population as a whole desire to receive from health care services to improve overall health

(Twigg & Atkin 1994)

• These desires may be physical, emotional, or social and may have a direct effect on patients’ satisfaction and quality of life

(Asadi-Lari et al. 2004)

Patient education standards

Joint Commission on Accreditation of Healthcare Organizations emphasized the need for:

‘systemic assessment of client’s learning needs, readiness, barriers, motivation, limitations, and cultural values and beliefs’

(Cravener 1996)

• This process usually preceded the development of an educational programme in order to capture individual’s beliefs, preferences, or requirements.

Procedure

• Subjects: Involving key informants: patients, family members or carers, and health professionals– Random sampling

– Purposeful sample

• Methods: – Survey– Interviews

– Focus groups

Procedure

• Tools: need to be valid and reliable for the purpose of need’s assessment

• Process: continuous to consider the changes of disease process and people’s perceptions

Educational Needs

• Patients with chronic disease regardless of the diagnosis may have similar needs; e.g. knowledge about the condition, self-care, or emotional support

(Widerman 2003)

1. What are your complaints related to your knee?2. Which of these complaints are more important to you?3. Did you have any information about this condition before the diagnosis?4. What do you know about your condition?5. Is there someone else in your family that is affected by the same condition?6. Was this person having the same complaints that you have?7. If different, why do you think?8. How does it affect your activities of daily living?9. How does it affect your state of mind?10.How does it affect your social life?

Table: Semi-structured questionnaire used to examine the needs of people with knee OA

Putting it all together!Putting it all together!

Setting priorities

• Listing all behaviours affecting the condition

• Determining which behaviours are most important in affecting health status

http://www.ahrq.gov/research/

• Determining which behaviours are the easiest to change, given a limited amount of educational time

Setting objectives

• Process objectivesProcess objectives– Determine the process of patient education

e.g. Fifty people will receive arthritis education this year

• Outcome objectivesOutcome objectives– Changes in health behaviours or health status

e.g. After 6 sessions 70% of people with arthritis will be able to self-stretch

How to write objectives

– Who will perform the behaviour – What is the specific behaviour – Under what condition the behaviour will be

performed– How the outcome will be measured

e.g. “80% of the patients will increase their score by 10 or more points on an arthritis self-efficacy scale”

Programme planning

• Tips:– Write few objectives (less than 10)– Objectives are basis of outcome evaluation

– Write objectives for each session or patient encounter

e.g. “Instructor will make sure that all participants say something at each session, ensure that 80% of the participants make commitment to some activity at the end of the sessions, and use problem-solving technique”

Educational Approaches

• Provision of information– Booklets/Brochures– Lectures– Internet– Multimedia

• Counseling– Biopsychosocial model– Group/individual– Cognitive-behavioural

Educational Approaches

• Multi-disciplinary/Inter-disciplinary

• Multi-dimensional– Self-management– Group– Individual

Putting it all together

• Set objectives• Evaluate resources: time, personnel, money,

space• Vary the activities• Use the same instructor or facilitator for every

session• Tailor teaching patient needs and beliefs• Patients always have choices• Evaluate the efficacy of the programme in

changing behaviour or health status

References

• Lorig K. (2001). Patient education: a practical approach. Sage publications, Thousand Oaks

• http://www.ahcpr.gov/research/elderdis.htm