Videos designed to help patients understand and manage chronic rheumatologic diseases can lead to gains in clarity about the disease duration, symptoms, medications, and the importance of regular visits with a physician.
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Explore This IssueJuly 2018
A study published in a recent issue of Arthritis Care & Research looks at the development and impact of three educational videos for patients with a diagnosis of knee osteoarthritis (OA), osteoporosis (OP) and rheumatoid arthritis (RA).1 The videos are each about 20 minutes in length and were recorded in both English and Spanish language versions. The developers used an edutainment model that is particularly suited for patients who have low or limited health literacy, have limited access to written materials about their condition or whose reading ability is not high enough to fully comprehend written patient information.
“Knowledge about a condition plays a big role in successful disease management,” says Maria Lopez-Olivo, MD, PhD, assistant professor in the Department of General Internal Medicine at the University of Texas, MD Anderson Cancer Center in Houston, and a study author.
“Different methods can impact learning. We wanted to make sure that those patients who have difficulty understanding written information will gain information from these videos, which use low-level vocabulary and are also fun and entertaining,” she says.
Poor health literacy has been identified as having a negative effect on health outcomes, including an increased risk of hospital admission and poorer disease management.2,3 The main objective of Dr. Lopez-Olivo and colleagues’ study, supported by the Agency for Healthcare Research and Quality (AHRQ), was to translate consumer guide information about the three conditions available from AHRQ into a multimedia format. The AHRQ information, although readily available to most patients, does not always reach those who have limited access or limited literacy, according to the researchers.
The edutainment model used for the videos presents factual information about options within a framework that includes engaging stories presented as soap operas or telenovelas. These stories depict a main character with OA, OP or RA. Each soap opera-style episode is linked to continuous learning modules of approximately one to two minutes. The episodes give a real-life context for the information, as well as a narrator who emphasizes the key learning points.
Each video includes an overview of the condition; a description of the treatment options; a patient story or testimonial; description of the harms, risks and benefits of various treatment or management options; a second testimonial; review of the key facts; and the final testimonial. In each video, patient testimonials highlight the confusion patients initially may have about their condition, the medication options, and why they need to show up for regular appointments with their doctor.
The video about RA explains that it is a lifelong disease, highlights the importance of taking medications as prescribed, and emphasizes that symptoms can improve with exercise and a healthy diet, and by giving up smoking.4
In the video about OA, patients are informed about the development of OA; the types of pain relievers; the importance of activity, exercise and weight control; and the procedures and treatments patients may have heard about but are not recommended for the condition.5
In the video related to osteoporosis in women, patient scenarios explain what OP is and why building bone through weight-bearing exercise is vital, and it outlines the differences among the types of medications used to treat the condition.
‘We wanted to make sure that those patients who have difficulty understanding written information will gain information from these videos, which use low-level vocabulary & are also fun & entertaining.’ —Dr. Lopez-Olivo
All of the videos follow the same sequence: overview of the condition, then patient stories, description of the risks and benefits of the treatment, and then back to the patient story to highlight the benefits of that particular segment, Dr. Lopez-Olivo explains. “We then review the key facts for patients to remember. At the very end, we give a final patient story that emphasizes even more the key points in that segment.”
For initial pilot testing of the videos, researchers recruited participants from community clinics in the county’s health system and the MD Anderson Cancer Center. There were 20 participants per disease, with at least five Spanish-speaking participants within each group. Each patient’s health literacy was evaluated with a single question: “How confident are you filling out medical forms by yourself?”
All participants in the OA and OP groups were at least 50 years old, and they were 18 or older in the RA group. Those in the RA group had had the disease for 10 years or less because the content of that video is more appropriate for patients with early disease. Within the entire cohort, 85% were women, 54% were Hispanic, 73% had less than a high school diploma, and 70% had adequate health literacy.
Participants answered a questionnaire related to their disease prior to watching the video and then completed another questionnaire immediately after viewing the video. The questionnaires measured knowledge about disease and therapeutic options, and the degree to which a participant was conflicted or unclear about particular healthcare choices (decisional conflict) and disease management.
Researchers reported statistically significant improvements in knowledge scores, with patients in the inadequate health literacy group showing improvement across the three diseases, with borderline significance for the OP group. Among RA and OP patients with adequate literacy, there was significant improvement, but there was no increase in the OA group. Clinically important improvement in knowledge was noted in both health literacy groups of RA patients, in the inadequate health literacy group of OA patients and in the adequate health literacy group of OP patients. No differences were observed for decisional conflict (except in the OP group).
The videos are not yet used in clinical practice, but they can currently be viewed online. According to Dr. Lopez-Olivo, a randomized controlled trial was conducted after this pilot test and included a larger cohort of patients with longer follow-up. The trial is comparing results of patients assigned to watch the videos with patients assigned to read written materials. Initial analysis indicates that patients assigned to the video are retaining information longer when compared with patients assigned to the written information, according to Dr. Lopez-Olivo. The final analyses of the trial will soon be completed, she says.
- Lopez-Olivo MA, Ingleshwar A, Volk RJ, et al. Development and pilot testing of multimedia patient education tools for patients with knee osteoarthritis, osteoporosis, and rheumatoid arthritis. Arthritis Care Res (Hoboken). 2018;70(2):213–220.
- Baker DW, Gazmararian JA, Williams MV, et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health. 2002;92(8):1278–1283.
- Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475–482.
- MD Anderson Cancer Center. What are the treatments for rheumatoid arthritis?.
- MD Anderson Cancer Center. Osteoarthritis of the knee: Choosing the right pain medicine.
- MD Anderson Cancer Center. Osteoporosis treatments for women.