Article from the Boston Globe’s On Call Magazine, January, 2002

By Helen Osborne, MEd, OTR/L
President of Health Literacy Consulting

You have a wide range to choose from when you need patient educational materials. You can create handouts or select a brochure or videotape from a commercial vendor. You can get materials from healthcare associations, government agencies, or pharmaceutical companies. You can access information on the Internet. Regardless of the source, the challenge is to find materials that are not only accurate, up-to-date, and affordable but also meet the learning and literacy needs of you patients.

When you are looking for patient education material, Taryn Pittman, RN, MSN, and Ellen Pothier, MS, RN, CPHQ, have some tips and strategies you can use. Both are patient education specialists. Part of their job is to choose print and Web-based materials for their respective consumer health libraries. For Pittman, that’s the Patient and Family Learning Center at the Massachusetts General Hospital (MGH). For Pothier, it’s the Blum Patient and Family Resource Center at the Dana-Farber Cancer Institute.

The first thing to keep in mind is that there is a broad spectrum of materials to choose from. Also, much of it can be obtained for little or no cost. Two good sources for low-cost and free materials are government agencies and national associations. Another is pharmaceutical companies. Pothier recommends, however, that you be prudent and selective when considering materials from pharmaceutical companies. The information can be useful and may be presented well. It might also, however, be advertising a particular product or advocating a point of view. When this is the case, Pothier recommends going over the material with the patient to discuss the source. She also recommends supplementing the information with material from unbiased sources such as the National Cancer Institute.

Both Pittman and Pothier regularly review materials from commercial publishers. While you can find excellent patient education products this way, those products can also be costly. Before Pittman purchases such materials, she tries to meet with sales representatives to discuss her needs. Sometimes, companies will offer discounts for large orders or as an incentive for future business.

You can also adapt materials from sources such as magazines, journals, or books. Or you can create your own material. However, you need to weigh the advantages and disadvantages of these options. For instance, adapting material can be an efficient way to meet a specific need. But it takes both time and money to obtain reprint permission. Creating a new document also takes time and money. But sometimes the benefits of creating your own document can justify those costs. When Pittman wanted a new resource for patients who had recent heart attacks, she found the effort it took to create and print it was offset by the unanimous “buy-in” and support from the nurses, therapists, and educators who helped create it.

Here are additional tips you can use to ensure the quality and effectiveness of the patient education material you choose.

Always assess patients’ learning needs first. Learning needs vary from patient to patient and from situation to situation. So it’s important to find out exactly what patients and their families need to know. At the Dana-Farber Cancer Institute, for example, Pothier sees many patients and families who have come from other countries. When she helps them find information, she looks for resources not only about their specific disease but also about how to access and use the US health system.

Have materials available in a range of formats. In order to use print and Web-based materials, people need to be able to see and read. To accommodate those who have difficulty in these areas, Pothier offers information in alternative formats. For instance, she might offer to make audiotape versions of written materials. This way, patients can listen to the information at their convenience and replay the tape as often as needed.

Assess the suitability and reliability of Web-based information. Providing access to materials from the Internet can be an efficient way of offering information. Materials can be printed out on an as-needed basis and do not need to be stored or displayed. Currently, the MGH Patient and Family Learning Center links to more than 500 Web-sites. Before Pittman links to a new site, however, she makes sure that the information is accurate and credible and that the site is easy-to-navigate. She starts by looking for sites with an address that end in “.edu,” “.gov,” or “.org” rather than “.com.” While the first three endings do not guarantee the site’s material is totally reliable, the content is less likely to be determined by commercial interests. She then reviews the site’s “About Us” page and checks out the credentials of the writer(s) or contributor(s) as well as the credentials of those on the editorial board.

Ask other people to help choose materials. If your organization has a patient education committee, ask its members to assess materials from the perspective of both subject-matter experts and professionals who understand the learning needs of patients and families. Seek the opinion of clinicians who recommend educational materials to patients. Most importantly, ask patients for their input. Patients not only can tell you which materials are easy to understand, but also which they find meaningful and personally uplifting.

Use a tool to assess the quality of materials. When Pittman asks others to assess patient education materials, she gives them a one-page “Media Evaluation Form.” Developed at MGH, this form highlights five specific areas you need to consider when assessing the quality of patient education materials:

• Content. Assess whether information is accurate, comprehensive, patient-oriented, readable, logical, and relevant. For example, does the information flow in a logical sequence beginning with an introduction and overview followed by more specific discussion about diagnosis and treatment?
• Cultural Appropriateness. Determine whether the terminology used and examples given match the logic, language, and experience of the intended users. Make sure that the cultural images and examples are realistic and present the culture in a positive way, and that the material is available in the needed languages. When assessing a Spanish version of a diabetes booklet, for example, find out if it includes foods commonly used in the specific Hispanic culture the patient is from.
• Usability. Look at how easy Web sites, CD-ROMs, and videotapes are to use and understand. When assessing videotapes, for example, make sure that the picture quality is good and that the voices are clear and understandable.
• Authorship. Look not only at the author’s credentials but also those of the sponsoring organization. Make sure that the information is from a dependable source, that authors have expertise in the subject, and that references are cited.
• Currency. Find out when the material was published and when it was last reviewed or revised. Pittman uses the following guidelines to determine what is up-to-date: Web Sites — updated within the past year; CD-ROM — produced within the past 5 years; Videos — produced within the past 5 years; Books — published within the past 5 years; Pamphlets — published within the past 2 to 3 years. These guidelines are purposely flexible, however. Sometimes older material can still be an excellent source of basic information while a newer resource may quickly be out of date.

How to Find Out More:

Taryn Pittman, RN, MSN, is the patient education specialist at Massachusetts General Hospital.

Ellen Pothier, MS, RN, CPHQ, is the patient and family education specialist at the Blum Patient and Family Resource Center at Dana-Farber Cancer Institute.