ReviewExploring the value of audiotapes for health literacy: a systematic review
Introduction
Information is of critical importance in helping people make informed health decisions. These decisions can relate to matters such as incorporating health behaviors into a lifestyle or making a decision about their own health care. However, some people may find it difficult to understand and remember information due to communication barriers. Hogbin and Fallowfield [1] have identified several reasons for communication barriers causing patient dissatisfaction with the information received; these include time constraints of health professionals; health professionals’ poor communication skills; or, patients’ incapacity to understand, whether due to a mental, physical or cognitive impairment. In the past 15 years, there has been increased interest in literacy as a barrier to patients’ understanding. Literacy affects the ability of people to use written information to function in society, to achieve goals and to develop their knowledge and potential. Research has shown that patients with low-literacy skills are generally less healthy [2], [4], [5]. Agencies such as Health Canada have now included literacy among the determinants of health [3]. Recent concern has also begun to emerge about a larger concept of “health literacy” which has been defined by the US Department of Health and Human Services as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions [2].
Two studies by The Centre for Literacy of Quebec [2] set out to identify the communication needs of low-literate patients in a major urban hospital in Montreal. They found that patients identified as being “hard-to-reach” by health care professionals might seem to have literacy problems, but on closer examination, their difficulties could also have been caused by learning, physical or cognitive disabilities, or by language or cultural barriers, as well as by low education [2]. These barriers can interfere with communication and put these patients at risk [2].
Since nurses and other health professionals rely heavily on print to communicate health-related information, the literacy level of their clientele becomes important. Current literature on health literacy suggests that written information alone may not always meet the needs of patients in general, and can exclude certain patient groups; to reach some of these groups, the literature recommends the use of alternative media in health education such as audiotapes, videotapes, computer technology, pictograms and plain language.
This review originated as one of a series that examined these recommended interventions. The authors originally set out to examine the literature on the use of audiotapes for health education directed at the “hard-to-reach” populations that had been identified by The Centre for Literacy of Quebec [2]; however, the empirical literature did not address any of these groups specifically. Therefore, this systematic review examines the use of audiotape recording of health-related information for patients and family members, with the intention of identifying strategies that might be adapted for “hard-to-reach” populations. Previous literature reviews [6], [7], [8] examining the use of audiotapes as an educational intervention focused mainly on audio-recordings of consultations with oncology patients. This review has broadened the scope to include all aspects of health education in order to identify common outcome criteria (i.e. knowledge, compliance, anxiety, self-care, and satisfaction) to provide possible new insight into patient education. The use of audiotapes may well provide a suitable alternative learning tool for the “hard-to-reach” population. However, since “hard-to-reach” patients were systematically excluded from the majority of the studies examined in this review, the claim cannot currently be substantiated. Further research is required.
Section snippets
Method
A computer search was done in Medline (1966 to May week 2, 2003); CINAHL (1982 to May week 3, 2003); ERIC (1966 to April 2003); Cochrane Library (issue 1, 2003); and Dissertation Abstracts (1861 to week 2, 2003), using terms applied to a hearing medium such as ‘audiotape’, ‘audio recording’, ‘tape recording’, and ‘cassette,’ along with educational terms such as ‘patient education’ and ‘health education’. Additional articles were identified from bibliographies and reference lists, as well as by
Results
The initial search resulted in 283 articles, of which 35 were considered relevant. The majority of the articles were irrelevant to this study because they dealt with tape recordings for the purpose of analyzing a health professional's interaction with patients. Of the 35 articles chosen, 4 were descriptive articles on the efficacy of audiotapes [10], [11], [12], [13], and 3 were literature reviews on recording oncology consultations [6], [7], [8]. The remaining 28 articles [1], [14], [15], [16]
Advantage of the intervention
This systematic review demonstrates that using tape recordings to educate patients in a variety of health situations, from cancer diagnosis to lower extremity reconstruction, has several potential advantages. The patient can listen to the tape as many times as he/she wants or needs to. The patient can share the information tape with family [1], [15], [16], [18], [19], [21], [22], [24], [25], [26], [27], [31], [33], [37], [38], [39], thereby decreasing misunderstandings and forgotten details [1]
Intervention
As with all other educational interventions, audiotapes have their limitations. Some of the information provided by audiotapes was found to be too general by patients and not personalized enough [1]. The need for a tape recorder to listen to the tape is a possible limitation to this intervention, although few people found it to be a problem [39]. Physicians who oppose recording consultations find that the taping inhibits open discussion [8], and may expose them to malpractice litigations [16],
Discussion
No clear conclusions can be established about using audiotapes as an educational intervention. It would be an immense step forward in health education to be able to conclude that a tape recording, either of a consultation or of medical information, reduces patient anxiety, for example. But that is not what this systematic review has determined. While some studies show that audiotapes produce a remarkable reduction in anxiety level of patients [20], [35], perhaps through attained knowledge,
Conclusion and practice implications
In terms of the initial purpose of this review, the literature is limited on the use of audiotapes with patients who have specific barriers to communication. No studies were found which analyzed the effects of recorded information on any specific “hard-to-reach” patient subgroup. Audiotape and information aid research needs to move in the direction of specifically addressing the needs of low literacy patients and other “hard-to-reach” or disadvantaged groups.
It is important to recognize that
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