Printed patient education interventions to facilitate shared management of chronic disease: A literature review

Abstract

Background: Printed materials for patient self-education are a comparatively low cost, flexible and potentially useful aid for dealing with the growing burden of chronic disease in our society. A comprehensive review of existing trials is required. Aims: We conducted a comprehensive review which aimed to (i) evaluate the evidence for effectiveness of print-only interventions in increasing patient participation in chronic disease management and (ii) identify disease or intervention characteristics associated with success. Methods: Medline, the Cochrane Central Register of Controlled Trials, EMBASE and CINAHL were searched for the period 1992 to January 2005 for reports of controlled trials of printed patient materials in chronic disease. The quality of both studies and interventions was assessed. Results: Seven studies were found. They focussed on inflammatory bowel disease, arthritis, asthma and diabetes. Few studies named primary outcomes, continued beyond 6 months or included process evaluations. Few reports gave the behaviour-change rationale of the intervention. Few interventions were reported as having been designed using testing and improvement, psychosocial theory, checks of patient understanding or other patient input. A variety of outcomes was measured. Statistically significant change was found for few. Knowledge improved in three studies, adherence improved in two and quality of life declined in one. Conclusions: We found that printed interventions as currently designed appear to produce, at best, modest benefits. The design of interventions, studies and study reports all need improvement before decisions can be made about effectiveness and characteristics associated with success.