► Information technology has the potential to offer hope of consistent treatment across settings and populations while nurses begin to utilize and integrate it into practice. ► Patient education is a key feature in addressing patients’ individual needs. ► Patient education sessions using information technology need to be planned in advance. ► Patients’ mental state ought to be considered and nurses need to be educated in the use of patient education using information technology.
The importance of information technology (IT) in treatment has increased [1]. This is related to the needs for information to promote patient self-management [2] and for patients’ self-awareness and empowerment [3]. There is evidence that IT is a promising method in health care services [4] to fill a gap regarding patients’ need to know and understand their own illness [5], [6], [7] and to support patients in coping with this [7], [8]. Both issues are acknowledged problems among patients with mental health illnesses [9], [10].
Patient education (PE) has a positive effect on a patient's well being and promotes social functioning among patients with severe mental health problems [11]. Providing patients with information has been a focus of interest for decades, yet there are unanswered questions about such basics as appropriate timing of the education with ill patients and about the most appropriate methods of PE [12]. Nurses’ pessimistic attitudes towards mental health patients have been associated with patients’ poor functioning, outcomes, benefits, treatment approaches [13]. An association has also been shown between capability to negotiate about care plans in acute inpatient mental health [14] and the general notion that it is not worth educating them.
Adequate and timely information about patients’ diseases provided by health care professionals is considered a key feature in addressing their individual needs [15]. This also applies to patients with schizophrenia, who may suffer from loss of will or drive [10] and need extra support from their nurses [16] to cope with their disease [7].
Patients with mental health problems have shown interest in Internet use [17] and have expressed interest in web-based portals [18]. They are best supported by methods which are up-to-date and easy to use [19] and with regular support [20], [21]. The personnel involved should also have IT competence [22] and an interest in IT [23].
There is evidence that multiple and structured sessions are better than single education sessions in addressing patients’ informational needs [24]. Various IT tools have been integrated into treatment protocols (e.g. videodisk technology, the Internet, touch-screen technology). Since these tools may be located separately, PE is provided during separate office visits or using home-based computers [25]. All in all, PE and especially PE with IT, has not been systematically studied or used [26], [27].
There are several barriers to implementing web-based PE in clinical settings. From the patient's point of view, it may seem impersonal [21] compared to conventional face-to-face sessions [19]. Optimal quantity of information [28] or what is an appropriate intervention [24] also raise discussion. Nurses’ lack of energy or motivation to learn or use IT skills [29], [30] lack of IT facilities and resources [30] support [30], [31] and time [29], [30] are also related to patients’ IT use. The nurses may have heavy workloads and no access to computers [31].
A web-based system was developed for clinical practice aiming to provide patients with schizophrenia with information, to support their self-management skills and nurses’ PE skills using IT [32] in a structured way [30], [33]. There is a lack of a more profound understanding of what takes place during those web-based PE sessions. In the future, IT will be able to provide evidence [21], [34] and has the potential to offer hope of consistent treatment across settings and populations [19] while nurses begin to utilize and integrate it into practice [22], [35].
The purpose was to evaluate the use of web-based PE in daily clinical practice and to identify factors associated with it. The following specific questions were formulated:
How are PE sessions used (frequency, length, interruptions/disturbances and their reasons, number of nurses involved)?
How do nurses report use of PE sessions?
Additionally, how are length, number and success of PE sessions associated with patients’ background characteristics and use of sessions?
The study was conducted on nine
In total 508 PE sessions were used with 93 patients during their hospital treatment. Of these, 73 (79%) had attended all six PE sessions, and the remaining 20 patients had attended fewer sessions: 9% had attended 5 sessions and another 9% even fewer. There were four patients whose PE sessions did not comply with a structured sequence. The mean for the PE per patient was 194.4 min (Sd 77.2, range 10–360) and the median total length per person was 10 days (range 1–70). Regarding the nurses, the
Contrary to previous experiences [13], [21], [24] this study showed that PE sessions can be used with patients with serious mental disorders. Out of all possible sessions (n = 508), the six sessions planned were held for 79% of patients and only 1% of sessions were interrupted. This finding is very encouraging in acute psychiatric care, where nurses may have concerns that patients cannot be educated because of their poor condition [10], [13] or lack of insight in an acute state [24]. Burda [43]
To use structured web-based PE sessions with patients with serious mental disorders requires that the whole nursing staff has been trained for PE and are motivated, it is integrated into the personal nurse’ work, technical equipment is available together with a peaceful room. When patients’ mental state, IT skills, vocational education and diagnoses are considered individually, every single patient is provided with an opportunity to gain insight in his/her illness and to know coping options via
All the authors (Minna Anttila, Maritta Välimäki, Heli Hätönen, Tiina Luukkaala, Minna Kaila) have made substantial contributions to all of the following: (1) the conception and design of the study (MV, HH), or acquisition of data (MA), or analysis (MA) and interpretation of data (MA, MV, HH, TL, MK), (2) drafting the article (MA, MV) or revising it critically for important intellectual content (MA, MV, HH, TL, MK), (3) final approval of the version to be submitted (MA, MV, HH, TL, MK).
Authors declare that they have no conflicts of interest. Summary table What was already known on the topic: There is evidence that information technology is a promising method in health care services. Adequate and timely information about patients’ diseases is considered a key feature in addressing their individual needs. However, patient education has not been systematically used. What this study added to our knowledge: Patient education sessions need to be planned in advance, to ensure availability
The authors wish to thank the patients and the staff who participated in this study. The Yrjö Jahnsson Foundation, the Academy of Finland (207384, 8214245), and the Medical Research Fund of Tampere University Hospital (Research Unit) provided funding for the study.
Attitudes and beliefs about digital interventions were crucial implementation factors for both staff and users. Positive beliefs that the intervention would help management of symptoms,40,44 enthusiasm and interest in the intervention,28,36,53 trust in the team delivering the intervention, and the knowledge that it had been developed by other service users42 were cited as factors in increasing end-user engagement. However, negative attitudes towards IT generally,53 the preference for face-to-face interventions, and lack of interest in digital interventions meant that although users could formally complete sessions, these sessions were less successful since users were more interested in browsing other websites, did not interact with staff during sessions, and did not use the available peer support.28
Importantly, this will inform the next generation of Internet-based interventions for psychosis and pave the way for a better understanding of what works and for whom in this rapidly expanding field. Third, although a number of studies provided details on the procedures employed to develop the interventions, only four intervention studies reported involving end-users at some point in the design process (Rotondi et al., 2007, 2010; Anttila et al., 2012; Granholm et al., 2012; Alvarez-Jimenez et al., 2013). These findings are at odds with general calls to involve patients in all stages of the design process in order to develop engaging, meaningful and clinically relevant interventions (Hagen et al., 2012).
The clinical trial registration number is ISRCTN 74919979.
