Patient Education: A Role for Multimedia

Multimedia has been used as a learning resource in HE for a few years now. Whilst some early products were little more than books-on-CD-ROM, current material commonly uses the additional functionality that multimedia offers - e.g. animation. Programs intended primarily for higher education, however, still mostly lack the appeal of commercial “edutainment”. Yet one shouldn’t neglect the presentation and visual impact of educational packages because they engage the user’s motivation, attention and aesthetic sense. Stephen Heppel, Director of UltraLab [1] , often argues that: “…interactive media should delight.” After all, it is up to the learner whether or not they use this sort of resource.

When one considers health education needs, there are some striking similarities. It’s critical to get the audience interested and to maintain their attention. The advantages of interactive media over the ubiquitous printed leaflets that festoon clinics and waiting rooms are self evident. There’s another important feature in common. Effective multimedia uses much less text than books; and while this has dangers for a scholar in HE, it is spot on for many patients. (Have you tried reading an entire drug information leaflet supplied with a prescribed medicine?)

There are now several examples of health education multimedia. One, concerned with educating children about their bed wetting, was produced as part of the King’s Fund [2] Promoting Patient Participation initiative. This has produced a suite of programs - About Nocturnal Enuresis - that is being evaluated in Nottingham and Leicestershire clinics [3], [4]. Early results show that after using the program there are reliable increases in children’s knowledge about enuresis, which are preserved a year later, that there is very good take up by patients (over 90%), and that the users are positive about the medium. Work is now going on to discover what effect the package has on clinical outcomes and children’s self-esteem [5].

This is just one example of a general trend in using multimedia for health education, targeted at those people for whom it is relevant. The approach utilises the attractiveness of a new medium, with its added functionality, to engage patients’ interest and promote effective learning (about preventive behaviour, treatment, prognosis and so on). It is also using multimedia with people for whom it is relevant and who perceive it as relevant, thus avoiding the counterproductive consequences of “stuffing it (the message) down people’s throats”. In the enuresis example, the multimedia package is set up at a specialist clinic and the patients attending are invited to use the program by one of the clinic staff. Other mechanisms to achieve the same end might be prescription by a doctor (e.g. your GP advises you to look at a program because you are at higher than average risk), information from a special interest group, or just an enquiring patient.

The other key component of this trend is the delivery. Over the next five years, the delivery mode will almost certainly change from local CD-ROM to telecommunications networks. The programs will be stored at one site and down loaded when the user wants to run them. The equipment will be simpler and cheaper (than an interactive kiosk) and it will be available for many different purposes. Health centres as well as libraries will have strong incentives to invest in terminals and software producers will be able to maintain educational material easily at a central site.

In this scenario there are some real challenges. One can already get lost on the Web, so a patient wanting to learn something specific will need clear, direct guidance to the right resource. The link (to that resource) needs to give a brief outline about its contents and an indication of the time required to use it. Curriculum management software may help here [6] . Other vital concerns are disappearing pages (e.g. the Health of the Nation pages on skin cancer), and the validity of WWW information, though the latter is being met by peer- review processes operated at some sites [7] . A last one for debate is giving freedom to a patient to surf beyond the initial domains. There are advantages in health education to an approach which allows someone to discover both sides to a question, but would one want a queue for the computer as well as the physician?

References

1. Stephen Heppel, Director of UltraLab - the learning technology research centre at Anglia Polytechnic University,
   http://sol.ultralab.anglia.ac.uk/Pages/ULTRALAB/Team/stephen/Stephen_home.html
2. The King’s Fund, a UK medical charity which promotes good practice and policy initiatives in health care
   http://websurg.avonibp.co.uk/bui/misbeh/kings.htm
3. All about Nocturnal Enuresis, Details of the King’s Fund project at Behavioural Sciences, University of Nottingham.
   http://www.ccc.nottingham.ac.uk/~mczwww/enuresis.htm
4. Garrud, P., Collier, J., Crook, I., Evans, J., MacKinlay, D. and Redsell, S. (1996), Using multimedia for patient information - the nocturnal enuresis project for children. CTICM Update, CTI Centre for Medicine, Bristol, 7, 6-7.
5. Contact:
   Jacqueline.Collier@nottingham.ac.uk for further details.
6. Curriculum management software, produced under the Teaching and Learning Technology Programme by Joe Smyth at Dundee University
   http://www.icbl.hw.ac.uk/tltp/catalogue/phase1/tom14601.htm
7. America’s House call Network, a health information source set up by the American Association of Family Physicians.
   http://www.housecall.com/index.html

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