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. 2013 Apr 30;2013(4):CD008416.
doi: 10.1002/14651858.CD008416.pub2.

Multimedia educational interventions for consumers about prescribed and over-the-counter medications

Sabina Ciciriello  1 , Renea V Johnston, Richard H Osborne, Ian Wicks, Tanya deKroo, Rosemary Clerehan, Clare O'Neill, Rachelle Buchbinder
Affiliations

Multimedia educational interventions for consumers about prescribed and over-the-counter medications

Sabina Ciciriello et al. Cochrane Database Syst Rev. .

Abstract

Background: Health consumers increasingly want access to accurate, evidence-based information about their medications. Currently, education about medications (that is, information that is designed to achieve health or illness related learning) is provided predominantly via spoken communication between the health provider and consumer, sometimes supplemented with written materials. There is evidence, however, that current educational methods are not meeting consumer needs. Multimedia educational programs offer many potential advantages over traditional forms of education delivery.

Objectives: To assess the effects of multimedia patient education interventions about prescribed and over-the-counter medications in people of all ages, including children and carers.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2011, Issue 6), MEDLINE (1950 to June 2011), EMBASE (1974 to June 2011), CINAHL (1982 to June 2011), PsycINFO (1967 to June 2011), ERIC (1966 to June 2011), ProQuest Dissertation & Theses Database (to June 2011) and reference lists of articles.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs of multimedia-based patient education about prescribed or over-the-counter medications in people of all ages, including children and carers, if the intervention had been targeted for their use.

Data collection and analysis: Two review authors independently extracted data and assessed the risk of bias of included studies. Where possible, we contacted study authors to obtain missing information.

Main results: We identified 24 studies that enrolled a total of 8112 participants. However, there was significant heterogeneity in the comparators used and the outcomes measured, which limited the ability to pool data. Many of the studies did not report sufficient information in their methods to allow judgment of their risk of bias. From the information that was reported, three of the studies had a high risk of selection bias and one was at high risk of bias due to lack of blinding of the outcome assessors. None of the included studies reported the minimum clinically important difference for the outcomes that were measured. We have therefore reported results from the studies but have been unable to interpret whether differences were of clinical importance.The main findings of the review are as follows.Knowledge: There is low quality evidence that multimedia education was more effective than usual care (non-standardised education provided as part of usual clinical care) or no education (standardised mean difference (SMD) 1.04, 95% confidence interval (CI) 0.49 to 1.58, six studies with 817 participants). There was considerable statistical heterogeneity (I(2) = 89%), however, all but one of the studies favoured the multimedia group. There is moderate quality evidence that multimedia education was not more effective at improving knowledge than control multimedia interventions (i.e. multimedia programs that do not provide information about the medication) (mean difference (MD) of knowledge scores 2.78%, 95% CI -1.48 to 7.0, two studies with 568 participants). There is moderate quality evidence that multimedia education was more effective when added to a co-intervention (written information or brief standardised instructions provided by a health professional) compared with the co-intervention alone (MD of knowledge scores 24.59%, 95% CI 22.34 to 26.83, two studies with 381 participants).Skill acquisition: There is moderate quality evidence that multimedia education was more effective than usual care or no education (MD of inhaler technique score 18.32%, 95% CI 11.92 to 24.73, two studies with 94 participants) and written education (risk ratio (RR) of improved inhaler technique 2.14, 95% CI 1.33 to 3.44, two studies with 164 participants). There is very low quality evidence that multimedia education was equally effective as education by a health professional (MD of inhaler technique score -1.01%, 95% CI -15.75 to 13.72, three studies with 130 participants).Compliance with medications: There is moderate quality evidence that there was no difference between multimedia education and usual care or no education (RR of complying 1.02, 95% CI 0.96 to 1.08, two studies with 4552 participants).We could not determine the effect of multimedia education on other outcomes, including patient satisfaction, self-efficacy and health outcomes, due to an inadequate number of studies from which to draw conclusions.

Authors' conclusions: This review provides evidence that multimedia education about medications is more effective than usual care (non-standardised education provided by health professionals as part of usual clinical care) or no education, in improving both knowledge and skill acquisition. It also suggests that multimedia education is at least equivalent to other forms of education, including written education and education provided by a health professional. However, this finding is based on often low quality evidence from a small number of trials. Multimedia education about medications could therefore be considered as an adjunct to usual care but there is inadequate evidence to recommend it as a replacement for written education or education by a health professional. Multimedia education may be considered as an alternative to education provided by a health professional, particularly in settings where provision of detailed education by a health professional is not feasible. More studies evaluating multimedia educational interventions are required in order to increase confidence in the estimate of effect of the intervention.Conclusions regarding the effect of multimedia education were limited by the lack of information provided by study authors about the educational interventions, and variability in their content and quality. Studies testing educational interventions should provide detailed information about the interventions and comparators. Research is required to establish a framework that is specific for the evaluation of the quality of multimedia educational programs. Conclusions were also limited by the heterogeneity in the outcomes reported and the instruments used to measure them. Research is required to identify a core set of outcomes which should be measured when evaluating patient educational interventions. Future research should use consistent, reliable and validated outcome measures so that comparisons can be made between studies.

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Conflict of interest statement

The authors SC, RO, IW and RB have been involved in the development of a multimedia patient education program about methotrexate treatment for rheumatoid arthritis and two outcome measures for use in the evaluation of patient education interventions: the Medication Education Impact Questionnaire (MeiQ) and the Methotrexate in Rheumatoid Arthritis Knowledge test (MiRAK). The authors have, or have had in the past, affiliations with The University of Melbourne, Monash University and Deakin University, and these institutions have taken steps to protect intellectual property rights associated with the above.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Multimedia education versus usual care or no education, outcome: 1.1 Knowledge (mean score, %).
4
4
Forest plot of comparison: 2 Multimedia education versus written education, outcome: 2.3 Skill acquisition (N who improved).
5
5
Forest plot of comparison: 3 Multimedia education versus education by a health professional, outcome: 3.2 Skill acquisition (mean score, %).
6
6
Forest plot of comparison: 5 Multimedia education versus control multimedia, outcome: 5.1 Knowledge (mean score, %).
7
7
Forest plot of comparison: 6 Mulitmedia education and a co‐intervention versus co‐intervention alone, outcome: 6.1 Knowledge (mean score, %).
1.1
1.1. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 1 Knowledge (mean score, %).
1.2
1.2. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 2 Knowledge (N who improved).
1.3
1.3. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 3 Skill acquisition (mean score, %).
1.4
1.4. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 4 Compliance with medication (% who complied).
1.5
1.5. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 5 Compliance with monitoring (% who complied).
1.6
1.6. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 6 Pain rating (mean score, range 0 to 10).
1.7
1.7. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 7 Risk of drug abuse (mean score).
1.8
1.8. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 8 Satisfaction with care (mean score).
1.9
1.9. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 9 Perception of care (mean score).
1.10
1.10. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 10 Self‐efficacy (mean score).
1.11
1.11. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 11 Beliefs about medication (mean score, range 1 to 5).
1.12
1.12. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 12 Beliefs about medication (N who answered correctly).
1.13
1.13. Analysis
Comparison 1 Multimedia education versus usual care or no education, Outcome 13 Perception of the education (N who learnt something new).
2.1
2.1. Analysis
Comparison 2 Multimedia education versus written education, Outcome 1 Knowledge (N who improved).
2.2
2.2. Analysis
Comparison 2 Multimedia education versus written education, Outcome 2 Skill acquisition (mean score, %).
2.3
2.3. Analysis
Comparison 2 Multimedia education versus written education, Outcome 3 Skill acquisition (N who improved).
2.4
2.4. Analysis
Comparison 2 Multimedia education versus written education, Outcome 4 Beliefs about medication (N who would not inappropriately request Rx).
2.5
2.5. Analysis
Comparison 2 Multimedia education versus written education, Outcome 5 Perception of the education (N who learnt something new).
3.1
3.1. Analysis
Comparison 3 Multimedia education versus education by a health professional, Outcome 1 Knowledge (mean score, %).
3.2
3.2. Analysis
Comparison 3 Multimedia education versus education by a health professional, Outcome 2 Skill acquisition (mean score, %).
3.3
3.3. Analysis
Comparison 3 Multimedia education versus education by a health professional, Outcome 3 Bronchial obstruction (FEV, litres).
4.1
4.1. Analysis
Comparison 4 Multimedia education versus written education and education by a health professional, Outcome 1 Skill acquisition (N who improved).
5.1
5.1. Analysis
Comparison 5 Multimedia education versus control multimedia, Outcome 1 Knowledge (mean score, %).
5.2
5.2. Analysis
Comparison 5 Multimedia education versus control multimedia, Outcome 2 Skill acquisition (mean change score, %).
5.3
5.3. Analysis
Comparison 5 Multimedia education versus control multimedia, Outcome 3 Compliance with medication (mean score, range 18‐90).
5.4
5.4. Analysis
Comparison 5 Multimedia education versus control multimedia, Outcome 4 Use of medication (N who used medication).
5.5
5.5. Analysis
Comparison 5 Multimedia education versus control multimedia, Outcome 5 Peak flow reading (litres per second).
5.6
5.6. Analysis
Comparison 5 Multimedia education versus control multimedia, Outcome 6 Self‐efficacy (mean score, range 27 to 189).
5.7
5.7. Analysis
Comparison 5 Multimedia education versus control multimedia, Outcome 7 Quality of life (mean score).
5.8
5.8. Analysis
Comparison 5 Multimedia education versus control multimedia, Outcome 8 Beliefs about medication (N with more positive beliefs).
5.9
5.9. Analysis
Comparison 5 Multimedia education versus control multimedia, Outcome 9 Perceived stress (mean score, range 10 to 50).
6.1
6.1. Analysis
Comparison 6 Mulitmedia education and a co‐intervention versus co‐intervention alone, Outcome 1 Knowledge (mean score, %).
6.2
6.2. Analysis
Comparison 6 Mulitmedia education and a co‐intervention versus co‐intervention alone, Outcome 2 Skill acquisition (mean score, %).
6.3
6.3. Analysis
Comparison 6 Mulitmedia education and a co‐intervention versus co‐intervention alone, Outcome 3 Non‐compliance (mean score, range 0 to 160).
6.4
6.4. Analysis
Comparison 6 Mulitmedia education and a co‐intervention versus co‐intervention alone, Outcome 4 Compliance with medication (N).
6.5
6.5. Analysis
Comparison 6 Mulitmedia education and a co‐intervention versus co‐intervention alone, Outcome 5 Compliance with follow‐up (N).
6.6
6.6. Analysis
Comparison 6 Mulitmedia education and a co‐intervention versus co‐intervention alone, Outcome 6 Medical complication (N).
6.7
6.7. Analysis
Comparison 6 Mulitmedia education and a co‐intervention versus co‐intervention alone, Outcome 7 Adverse medication behaviour (mean score, range 0‐40).
6.8
6.8. Analysis
Comparison 6 Mulitmedia education and a co‐intervention versus co‐intervention alone, Outcome 8 Self‐efficacy (mean score, range 0 to 5).
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References to other published versions of this review

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