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USING INFORMATION THERAPY TO PUT PATIENTS FIRST
( By Dr Aniruddha Malpani )

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Chapter 23 - Creating content in India on a shoestring budget

Mr Parag Vora, CEO,

PEAS. www.peasonline.com

Ram Khare, a security guard in a Mumbai suburban society, visits a doctor for his chronic cough, which is diagnosed as 'bronchitis'. His doctor gives him medicines along with printed material on how bronchitis can be managed effectively. This handout is in three languages - English, Hindi, and Marathi. However, that doesn't solve the issue. Ram Khare can't read or write. How does Information Therapy come to the rescue here?

'Effective patient education ensures that patients have sufficient information and understanding to make informed decisions regarding their care.'

American Academy of Family Physicians' Guidelines for Patient Education

In order for Information Therapy to be effective, the patient education materials used must be both accessible and understandable. Whenever I pose a simple question to doctors about their approach towards patient education and what tools they use for this purpose, their knee-jerk response is - 'We use print material.' Printed material indeed is one of the most commonly used forms of patient education worldwide.

They are either in the form of typical handouts given to patients by healthcare professionals or can be accessed via various health websites. These materials are and always will continue to be one of the most cost-effective methods of patient education for the masses. I am not contesting the efficacy of printed material, but I am sure that this is not always the best solution in poor countries where health illiteracy is so widespread, and where many health education materials are difficult to understand. This is especially true in India which is many countries within a country! As a result, we miss out on harnessing the power of patient education. Hence it is important to apply a patient-centered approach to developing patient educational material.

As a company involved in developing effective patient education material, we have come across various challenges and situations which have helped us create some simple yet effective ways of delivering patient education material using various media. High-quality patient education material respects the principles of adult learning and should be able to:

  • Adapt teaching to the patient's level of readiness, past experience, cultural beliefs and understanding;
  • Create an environment conducive to learning with trust, respect and acceptance;
  • Involve patients throughout the learning process by encouraging them to establish their own goals and evaluate their own progress;
  • Provide motivation by presenting material relevant to the patient's needs; and
  • Provide opportunities for patients to demonstrate their understanding of information and to practice skills.

Barriers in creating patient education material

To overcome the communication barriers created by poor health literacy, it is important to put the patient first when developing educational materials. In India, patient education is still a comparatively new field. While designing engaging patient education material, we come across various issues, practical problems and challenges. The most important of these problems are:

  • Financial considerations;
  • Misconceptions about disease and treatment;
  • Low literacy and comprehension skills;
  • Fear of doctors;
  • Language barriers;
  • Negative past experiences with doctors; and
  • Denial of personal responsibility and a sense of fatalism.

Over time, we have been able to build a team of doctors, artists, and digital graphic specialists. We can tap into our experience and expertise in this niche area to produce a wide variety of materials which are adapted to Indian conditions. We have made a conscious decision to use the animated format. This is universally understood, so we do not have to reinvent the wheel every time we create new content.

We now have a library for over 150 hours of unique content; and given the fact that skilled computer professionals charge much lesser for their time in India, we can produce high- quality graphic digital patient educational materials for Information Therapy at a fraction of what it would cost in western countries. Since we are addressing a neglected market, but are using high-tech tools to do so inexpensively, we feel the future is very bright.

Elements of successful patient education:

Interactivity

  • Educational materials should be engaging and leave an impact on the patient's mind, thus increasing patient confidence and fostering fast recovery.
  • Ease of access and navigation also forms a key feature of patient education programs, thus facilitating easy understanding of the healthcare plan.
  • It should help the patient to develop a positive approach towards his/her health-related problems and not scare him.
  • It should help to dispel common myths and misconceptions.

Language

Verbal communication between patients and doctors should ideally be in the same language. But in a country like India, it is impossible for a doctor to know all the regional languages and dialects. A knowledge-rich patient education material dubbed in multiple regional languages can solve this problem for doctors.

Cultural beliefs

Culture affects how people communicate, understand, and respond to health information. To produce positive health outcomes, it is important for health organizations and doctors to recognize the local cultural beliefs, values, attitudes, traditions, language preferences, and health practices. This means that it's often necessary to customise patient education materials for local needs. The use of modern digital media allows us to do this easily.

Infrastructure requirement

Multimedia patient education materials can be used with a wide variety of devices. The good news is that many doctors own smartphones which can be easily used to facilitate one- on-one dialogue with the patient. Print materials should be placed where they can be accessed easily and the visuals are not distorted.

Types and tools to deliver patient education material: Oral communication

Communicating one-to-one with the patient is and always will be the cornerstone of effective patient education. In today's scenario, it is very important the doctor spends enough time answering all of the patient's queries. Quality is more important than quantity.

Print

As I mentioned earlier, print material is the most economical and effective way of teaching patients. It is always good to give patients written explanations of their conditions and treatments. One should always look out for materials containing trusted content but at the same time make sure that the materials are suitable for everyone. When choosing printed materials, one should remember that the layout and graphics play an important role. We have used a wide variety of printed materials, including:

  • Handouts;
  • Leaflets;
  • Posters;
  • Flashcards;
  • Pop-up books;
  • Comic books; and
  • Illustrated books.

Multimedia material

Video and other multimedia presentations are more effective than traditional, printed patient education methods in increasing short-term retention of information. However, they should be used as a supplemental part of the patient education process. Even the most well-produced multimedia patient education material will not be effective if there is no window to discuss the content with the doctor.

  • Since multimedia uses visuals and graphics, it helps overcome language barriers. The new clever touch screens are very user friendly, and allow even illiterate patients to assimilate information efficiently!
  • A doctor may sometimes forget to provide some information about a condition/procedure during a consultation, but multimedia content is always consistent.
  • Multimedia material is a better choice than print when patients have low literacy levels.
  • One major advantage of video is that it's possible for the doctor to document that the patient was adequately educated and the consent which the patient gave for the treatment was truly informed consent. This can help in risk management!

A major advantage of modern audiovisual media is that it is all produced in a digital format. This means that it can be delivered through a wide variety of channels and platforms, to a large number of devices, including TVs, PCs, and smartphones. This means that it's possible to deliver the content inexpensively, no matter where the patient is - whether he is in a hospital bed or in a small village.

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