Tailored DVDs: A novel strategy for educating racially and ethnically diverse older adults about their medicines

https://doi.org/10.1016/j.ijmedinf.2012.09.007Get rights and content

Abstract

Introduction

The availability of comprehensive and accurate medication history information in electronic medical records and through electronic prescribing provides the opportunity to create tailored interventions based on individuals’ particular medication information needs. To meet the challenges of providing medication information to low-literate English and Spanish speaking older adults, we sought to create individualized, culturally and linguistically inclusive medication education materials for older adults from diverse backgrounds.

Methods

We used a mixed-method design including a systematic review, analysis of existing data, a telephone survey (n = 326), and exploratory focus groups stratified by race/ethnicity and language spoken (11 focus groups; n = 106) to identify what information about medications older adults need, want to learn, and in what format. We evaluated reactions to three DVDs at low-income senior community centers (2 focus groups; n = 16).

Results

Exploratory focus groups provided insights on areas for improvement in patient–provider communication, and suggested use of vignettes and testimonials. Upon viewing, participants could relate to the testimonials in which actors portrayed people who have problems with their medications and were interested in the medication advice presented, especially when it was presented by a healthcare professional.

Discussion

Tailored medication education materials in English and Spanish DVD and print material format are suitable for low-literate audiences, acceptable to older adults, and feasible to implement using health IT. Virtually all households in the United States have a television, with most having a DVD player. DVD segments can be used in Internet links, physician office-based television, and consumer health IT applications.

Highlights

► We have demonstrated that e-prescribing and electronic medical record information can be harnessed to create low-tech consumer health informatics products. ► Patients were receptive to receiving medication information via DVD format. ► DVDs offer a potential solution to the challenges of providing medication information to low literature audiences.

Introduction

The Institute of Medicine landmark report entitled Health Literacy: A Prescription to End Confusion documents that ninety million people in the United States (U.S.) have difficulty understanding and using health information [1]. Among persons over 65 years, 29% have below basic health literacy abilities [2]. By 2020 in the U.S., 16% will be 65 or older [3], [4]. Considering that over 85% of adults 65 and older use prescription drugs on a regular basis [5], polypharmacy may indeed be the new paradigm for quality drug therapy [6]. Given issues of low health literacy coupled with increasingly complex drug regimens, it is not surprising that the incidence of adverse drug events has been estimated to be 27.4% amongst community dwelling adults [7]. Further, 40–75% of older adults have difficulty taking medication as prescribed [8] with costs of poor adherence estimated to be approximately $100 billion dollars per year [9].

The availability of comprehensive and accurate medication history information in electronic medical records and through electronic prescribing provides the opportunity to create tailored interventions based on individuals’ particular medication information needs. To meet the challenges of providing medication information to low-literate English and Spanish speaking older adults, we developed a novel approach to providing consumers with medication information tailored to their specific drug regimen. That is, the information regarding medications included in either an electronic medical record or electronic prescribing system is used to select specific video segments resulting in an individualized educational video for a patient. Tailoring educational materials entails working from scratch to develop an appropriate communication mechanism, as well as appropriate content organization, illustration and motivation for each audience [10]. This strategy has been recommended to improve communication and comprehension among low-literate patients [11]. We used a DVD format because low-literate individuals in the U.S. frequently depend on non-written means of communication to obtain health-related information and at the time of the study most low income racially/ethnically diverse participants had DVD players, but not necessarily access to the Internet. However, once the content is developed, the format can be easily changed for new media including the Internet. Indeed, the number of Internet users is growing rapidly [12] providing an alternative modality for this approach.

The purpose of this study was to develop strategies using health information technology to create novel, individualized, culturally and linguistically inclusive education materials for older adults managing multiple conditions. We describe our multi-method research process for developing our tailored educational DVDs and provide preliminary findings regarding reactions to the DVDs.

Section snippets

Funder and ethics

The Agency for Healthcare Research and Quality funded this large 3-year study to evaluate the feasibility of developing educational DVDs whose specific content is defined by medications included in a patient's electronic medical record or electronic prescribing information. The study protocol was approved by the Human Subjects Institutional Review Boards of the Virginia Commonwealth University and Memorial Hospital of Rhode Island. The mixed-methods study incorporated elements of

Results

Table 1 provides an overview of the various methodological approaches taken during the development phase of the DVDs. We concurrently performed systematic reviews of the literature, exploratory focus groups, and data analysis of existing data sources. The survey was implemented following these formative activities. After analysis of the survey data, we developed and tested algorithms to trigger content delivery of DVDs. Simultaneously, evidence-based scripts were developed, followed by DVD

Discussion

A paradox exists in how health care providers educate their patients. Owing to reduced time for face-to-face interactions, health care providers often give written educational materials which require 9th–14th grade reading levels to comprehend [20]. Patients with low literacy have difficulty with warnings on prescription labels [21], let alone lengthy medication information leaflets. We found that tailored medication education materials, both print and DVD, in English and Spanish are suitable

Author contributions

All authors qualify for authorship by substantial contributions to the research and production of the manuscript. Dr. Quilliam led the systematic review and survey. Dr. Goldman completed the analysis and interpretation of the qualitative data and gave final approval of the final version of the submitted manuscript. Dr. Lapane provided substantial input in the conception and design of the study and acquisition of the data, wrote the first draft, revised the draft critically, and gave final

Conflict of interest statement

All authors declare that they have no conflicts of interest, financial or otherwise to disclose.

Summary points

What is known about the topic:

  • Ninety million people in the United States (U.S.) have difficulty understanding and using health information.

  • Given issues of low health literacy coupled with increasingly complex drug regimens, it is not surprising that the incidence of adverse drug events has been estimated to be 27.4% amongst community dwelling adults.

  • Providing medication information to

Acknowledgments

This study was funded by the Agency for Healthcare Research and Quality, Department of Health and Human Services. The funder had no role in the study design, collection, analysis and interpretation of data, writing of the manuscript and decision to submit for publication.

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