Design and development of an e-learning patient education program for self-management support in patients with rheumatoid arthritis.

Objective: To develop an e-learning education program targeting patients with rheumatoid arthritis. Methods: The development process involved content specification and creative design. It was theoretically framed within theories of multimedia learning and entertainment-education and empirically based on evidence of patient education in rheumatoid arthritis and focus group discussions with stakeholders. We conducted a feasibility test among ten patients to assess the acceptability and usability of the program, and to identify areas to be adjusted. Results: The following themes for educational needs were found in focus group discussions: "Knowledge of rheumatoid arthritis," he disease course and prognosis," "Medical treatment," "A new life situation" and "Daily life with rheumatoid arthritis." Based on this, an e-learning program covering the disease course, examinations, treatment, and daily life, was created. It combines animations, videos, podcasts, text, speech, and tests. Test persons found the program feasible-that is, clear in content and easy to understand with a suitable pace and coherence between graphics, speech, and text. Conclusion: This e-learning program is based on solid theoretical knowledge that meets users' needs and is easy to use. Innovation: This study contributes to the innovation of health care by the development of a new digital tool for patient education.

The effectiveness of e-learning in patient education delivered to patients with rheumatoid arthritis: The WebRA study-protocol for a pragmatic randomised controlled trial.

BACKGROUND: Patient education is integral to the treatment and care of patients with rheumatoid arthritis. Change is taking place in the organisation of healthcare systems because of a demographic shift towards ageing populations, an increasing use of technology and advancements in digital technologies, allowing for new interventions. This study will aim to evaluate the effectiveness of a newly developed e-learning patient education programme based on self-management that targets patients with rheumatoid arthritis. METHODS: A pragmatic multi-centre randomised controlled trial is planned. We intend to recruit approximately 200 patients with a new diagnosis (< 3 months) of rheumatoid arthritis. Participants will be randomised 1:1 to web-based patient education delivered through an e-learning programme at home or standard face-to-face patient education provided at the hospital. The primary outcome is self-efficacy. Secondary outcomes are improved knowledge of rheumatoid arthritis, adherence to medication, health literacy level and quality of life. Outcomes will be measured at baseline and follow-up occurring 1, 3, 6 and 12 months after enrolment. Furthermore, data on healthcare utilisation and utilisation of the e-learning programme will be assessed at the 12-month follow-up. Statistical analysis, including differences between groups, will be evaluated using the chi-square and Kruskal-Wallis tests. Statistical analysis will follow the intention-to-treat principle, and analysis of variance will be used to evaluate the within- and between-groups differences testing the hypothesis of the 'superiority' of web-based patient education over standard face-to-face education provided at the hospital. Per protocol analysis will be used to assess the impact of missing data. Enrolment started in February 2021 and will end in June 2022. DISCUSSION: The study is expected to contribute to the evidence on the effectiveness of web-based patient education within rheumatic diseases. If the e-learning programme is effective, it will be incorporated into existing services to improve the self-management of patients with rheumatoid arthritis. Further, this mode of providing patient education may impact the organisation of health care for both rheumatic diseases and other chronic diseases by offering different modes of delivering patient education based on the needs and preferences of patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04669340. Registered on November 27, 2020. https://www.clinicaltrials.gov/ct2/show/NCT04669340?term=e-learning&cond=Rheumatoid+Arthritis&draw=2&rank=1 . See Additional file 1 for detailed information on the dataset according to the World Health Organization Trial Registration Data Set.

A Web-Streamed Yoga Intervention for Breast Cancer Survivors.

BACKGROUND: Current research indicates that structured yoga practice may improve physical and emotional symptoms related to cancer treatment. Yoga is recommended for patients with cancer, yet there are barriers to participation in community- and hospital-based classes. Wellness interventions such as yoga are easy to access via the internet, but information can be overwhelming and not tailored to people with cancer. PURPOSE: The purpose of this study was to develop a nurse-led, breast cancer-specific, web-based gentle yoga video for home use, and to understand the feasibility, utilization, and safety of the video in a sample of breast cancer survivors. METHOD: Data was collected via open-ended telephone interviews three times over a 4-week period. RESULTS: The 14 women participating in the study reported that the web-based video was safe in that it resulted in no injury, and was easy to use, and convenient to access. However, most did not continue to practice the video for the full 4 weeks of the study. A knowledge deficit about gentle yoga as a structured mindful movement-based practice rather than a vigorous exercise was identified. IMPLICATIONS: Nurses can provide tailored wellness interventions for cancer survivors via video stream. Future work should include instruction that yoga is a mindfulness-based self-care activity requiring regular practice.

An interactive web-based educational program improves prescription opioid risk knowledge and perceptions among parents.

Aim: This study evaluated the effect of an interactive, web-based educational program on parents' opioid risk knowledge, risk perceptions, analgesic self efficacy and decision-making. Patients & methods: Totally, 64 parents from a tertiary care pediatric healthcare setting were assessed for risk understanding at baseline, immediately and 3 days after receiving the educational program. Results: Participants gained increased opioid risk knowledge, enhanced risk perceptions as well as enhanced analgesic self efficacy after program exposure. The program had no effect on parental decisions about when to give or withhold a prescribed opioid. Conclusion: The interactive web-based program improved parental knowledge about opioid risks. Program enhancements may be needed to improve pain management decisions about when it is safe to use opioids and when they should be withheld.

The impact of a primary care e-communication intervention on the participation of chronic disease patients who had not reached guideline suggested treatment goals.

OBJECTIVE: To evaluate the efficacy of two web-based educational approaches on doctor-patient communication. The study focused on chronic disease (CD) patients in a lengthy relationship with their family physician (FP) who had not reached guideline suggested treatment goals (off-target) for their CDs. METHODS: 322 hypertensive, diabetic, or dyslipidemic patients of 18 FPs were randomised into three groups: Usual Care (UC), e-Learning (e-L) and e-Learning+Workshop (e-L+W). Interventions were based on Cegala's PACE system: Prepare, Ask questions, Check understanding, Express concerns. Communication was evaluated using the Roter Interaction Analysis System (RIAS), MEDICODE and questionnaires. RESULTS: Encounter length was similar across groups. RIAS showed that e-L+W group engaged in more socio-emotional talk and PACE-like utterances. MEDICODE showed that interventions increased frequency, initiative and dialogue for selected CD medication themes. Quality of communication was perceived as satisfactory at baseline and did not change. CONCLUSION: Following interventions, CD patients were more activated even in well-established doctor-patient relationships. PRACTICE IMPLICATIONS: PACE web-based interventions are accessible and effective at increasing CD patients' participation. They increase legitimacy to express the patient experience. FPs should present this type of training to CD patients as an integral part of their routine practice and consider referring patients to complete it.

A systematic review of web-based educational interventions.

A complement to in-hospital educational interventions is web-based patient education accessed during the home recovery period. While findings demonstrate the effectiveness of web-based patient education interventions on patient outcomes, they fall short of identifying the characteristics that are associated with desired outcomes. The purpose of this systematic review was to determine the characteristics of web-based patient education interventions that are associated with producing changes in self-care behaviors. A systematic review involving 19 studies was conducted to determine the most effective components of a web-based intervention. Findings suggest that the most effective form of web-based patient education is one that is interactive and allows patients to navigate the online system on their own. The findings from this systematic review allow for the design of a web-based educational intervention that will promote increased performance of self-care behaviors during the home recovery period.

Web-based education and attitude to delivery by caesarean section in nulliparous women.

OBJECTIVE: To measure the effect of a web-based educational tool on baseline knowledge of the risks and benefits of delivery by Caesarean section in healthy nulliparous women. METHODS: We constructed a web-based educational tool to provide evidence-based information on the potential benefits and risks of CS for healthy nulliparous women in the second trimester. We included women with an uncomplicated singleton pregnancy who were receiving antenatal care at Mount Sinai Hospital. Eligible women logged into the website to undertake a pre-test survey. After completing this survey, they received access to the educational tool, followed by a link to a second survey. The surveys collected baseline demographics and assessed participants' knowledge of the perceived safety and risks of vaginal delivery and CS, their sources of information, and the influence of these sources on their views. RESULTS: Seventy-three participants completed both surveys. Participants had a high baseline preference (84%) for vaginal delivery. The mean score for knowledge about vaginal delivery and CS increased significantly between the surveys, from 47% to 76% (P < 0. 001). There was no significant change in preference for mode of delivery between the two surveys. In both surveys, more participants responded that they were a "little fearful" or "not fearful at all" of vaginal deliveries. In the second survey, significantly more responded that they were "very fearful" or "fearful" of CS (P < 0.05). Increased knowledge about specific risks of vaginal delivery did not deter participants from preferring a vaginal delivery. However, knowledge of risks associated with CS made them more likely to have "very favourable" or "somewhat favourable" views of vaginal delivery. Ethnicity and country of birth were not found to have a significant effect on preferred mode of delivery. CONCLUSIONS: We demonstrated that a web-based educational tool significantly increased knowledge of the risks and benefits of vaginal delivery and CS. However, the educational intervention did not significantly change preferences.

Objectif : Mesurer l'effet d'un outil pédagogique Web traitant des connaissances de base sur les risques et les avantages de la césarienne chez les nullipares en santé. Méthodes : Nous avons créé un outil pédagogique Web visant à fournir des renseignements factuels sur les risques et les avantages possibles de la césarienne chez les nullipares en santé pendant le deuxième trimestre. Nous avons inclus des femmes présentant une grossesse monofœtale sans complications qui recevaient des soins prénatals au Mount Sinai Hospital. Les femmes admissibles ont ouvert une session sur le site Web afin de remplir un sondage prétest. Une fois le sondage rempli, elles ont obtenu accès à l'outil pédagogique et ont reçu un lien menant à un deuxième sondage. Ces sondages ont permis de recueillir des données démographiques de référence et d'évaluer les connaissances des participantes quant à l'innocuité et aux risques perçus de l'accouchement vaginal et de la césarienne, leurs sources d'information et l'influence qu'avaient ces sources sur leurs opinions. Résultats : Soixante-treize participantes ont rempli les deux sondages. Elles présentaient, au départ, une préférence élevée (84 %) pour l'accouchement vaginal. Le score moyen quant aux connaissances sur l'accouchement vaginal et la césarienne a augmenté considérablement entre les sondages, passant de 47 % à 76 % (P < 0,001). Aucun changement appréciable n'a été constaté entre les sondages en ce qui concerne la préférence en matière de mode d'accouchement. Dans les deux sondages, plus de participantes ont dit ne ressentir « aucune crainte ¼ ou ressentir « une légère crainte ¼ relativement à l'accouchement vaginal. Dans le deuxième sondage, par contre, un nombre considérablement plus élevé de participantes ont dit ressentir « de la crainte ¼ ou « beaucoup de crainte ¼ en ce qui concerne la césarienne (P < 0,05). L'amélioration des connaissances à propos des risques propres à l'accouchement vaginal n'a pas empêché les participantes de continuer de privilégier l'accouchement vaginal. Toutefois, le fait d'en connaître plus au sujet des risques associés à la césarienne les rendait plus susceptibles d'avoir une opinion « relativement favorable ¼ ou « très favorable ¼ à l'égard de l'accouchement vaginal. L'ethnicité et le pays d'origine n'ont eu aucun effet appréciable sur la préférence en matière de méthode d'accouchement. Conclusions : Nous avons démontré que l'utilisation d'un outil pédagogique Web améliorait considérablement les connaissances sur les risques et les avantages de l'accouchement vaginal et de la césarienne. Toutefois, l'intervention pédagogique n'a pas modifié les préférences de façon marquée.

Development and evaluation of an educational website for adults with cystic fibrosis.

BACKGROUND: The high prevalence of internet use among adults with cystic fibrosis (CF) provides an opportunity for healthcare professionals to use the internet as a tool for patient education. The Toronto Adult Cystic Fibrosis website was developed, implemented, and evaluated (www.torontoadultcf.com). METHODS: The website structure and content were developed following a needs assessment questionnaire. The website was evaluated with a satisfaction survey and through examination of compliance to American Medical Association (AMA)'s guidelines for health information sites. RESULTS: Users showed a high prevalence of internet usage (98.7%), described a need for more information about CF and provided content suggestions. A satisfaction survey revealed that CF patients compose the highest proportion of site users (57.5%), and users perceive the site as useful, with a mean score of 4.3 on a five-point satisfaction scale. Key areas for improvement have been identified. Website compliance with AMA guidelines was excellent at 80%. CONCLUSIONS: The Toronto Adult CF website provides needed information for our patients. Future directions include ongoing improvement of the website as a patient resource and assessment of the ability of the website to improve patient knowledge and outcomes.