Research ArticleMedia and memory: The efficacy of video and print materials for promoting patient education about asthma
Introduction
In recent years, the use of video-based educational tools has become increasingly common among healthcare practitioners as a strategy for improving patients’ understanding and recall of information related to their health status and self-care. As video becomes more pervasive, print-based materials may become a less popular choice for health-related educational tools. However, such decisions are not always motivated by theory or evidence. This study attempts to inform designers’ choices of optimal media for promoting patient education through a theoretically grounded experiment examining the impact of presentation style on middle-aged and older adults’ immediate and delayed recall of information.
Empirical evidence from both basic science and applied research conflicts regarding video's efficacy relative to other types of media. Theories of learning science highlight why the choice between print and video to promote comprehension and recall is not always obvious. Specifically, cognitive learning theories suggest that learners possess a limited amount of cognitive resources to apply towards encoding new concepts [1]. To the extent that effective design of materials can reduce the amount of cognition that must be directed towards processing extraneous aspects like format, wording, and presentation style, these materials will free resources to process the central messages that such materials are attempting to convey. Regarding the choice of medium, print and video each have been theorized to have potential advantages and disadvantages for prioritizing resources to encode incoming content [2], [3], [4], [5], [6], [7].
In addition to the complexities that cognitive learning theories highlight, results of previous research vary regarding which medium is more effective for promoting understanding and retention. Some studies suggest that learners retain more information after reading print than viewing video [6], [8], [9], [10], while others have found a benefit for video over print [11], [12], [13] or an equivalence between the two [14], [15], [16], [17]. Applied research from the field of medicine provides a similar array of findings, including results that support better retention of print than video among patients [18], the reverse finding [19], [20], [21], or a lack of significant difference between the two presentations [22], [23], [24], [25]. Results have been variable even when literacy levels have been taken into account. For example, Murphy et al. [20] found that patients with limited literacy benefited more from seeing video-based materials than print, while Campbell et al. [23] and Agre and Rapkin [26] both found a benefit for print over video in low-literacy groups. These results suggest that while the ideal medium for conveying information may be unclear, the choice may be especially important for patients with limited literacy, who are already likely to experience difficulties understanding health-related information [27], [28], [29] and adhering to medical regimens [30], [31].
The inconsistent results of previous research indicate the need for thorough, theoretically grounded explorations regarding the optimal medium through which to convey information to patients. Many of the studies cited included only younger adults or non-patient populations or failed to directly control for confounding variables such as length of presentation time or use of analogous materials across print versus video media. The current study attempts to inform the design of educational materials by directly comparing print-based and video-based tools among middle-aged and older adults with varying literacy levels in a healthcare context. Further, it also explores the impact of giving patients tangible support materials to take home. Specifically, participants were shown either print brochures, videos, or no information about managing asthma symptoms and were then queried regarding their knowledge about asthma both immediately after viewing these items and one week later. Print participants and half of those initially shown video were also given print materials to take home after the initial encounter, and the delayed impact of having these tangible supports was also measured. We hypothesized that while any immediate benefits found for one medium over the other might favor video and might be greater for patients with limited literacy, after a one week delay the effects of taking home and being able to review tangible print materials would outweigh the importance of initial medium and lead to better delayed recall of the information.
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Participants
Participants included 450 middle-aged and older adults who were patients at either Northwestern Memorial Hospital's General Internal Medicine Clinic in Chicago, Illinois or the Saint Francis/University of Connecticut Primary Care Center at the Burgdorf/Bank of America Health Center in Hartford, Connecticut. All participants were at least 40 years old and reported speaking English as their main language. In Chicago, physicians identified eligible patients, who were then recruited by mail and
Results
Four hundred fifty patients participated in the in-person interview. Of these, 15 subjects were excluded from all analyses because of an MMSE score indicative of possible cognitive impairment (<18), incomplete data, or interviewer error. Characteristics of all participants included in the analyses (n = 435) are summarized in Table 1. The mean age of participants was 53.3. About one in four reported having received a diagnosis of asthma (27.6%), and about one in five reported helping care for a
Discussion
The findings of this study suggest that print and video interventions are highly effective at promoting immediate and delayed retention of both relatively declarative content about ways to avoid asthma triggers and relatively procedural content about techniques for proper inhaler usage. Participants in the intervention groups performed significantly better than control participants, suggesting they learned a marked amount of information about triggers and inhalers relative to controls who
Conflicts of interest
The authors have no conflicts of interest to disclose.
Funding
The data collected for this paper was gathered with financial support from the Foundation for Informed Medical Decision Making. Beyond financial support, the funding source had no active involvement in study design, collection, analysis, or interpretation of data, writing of the manuscript, or decision to submit this paper for publication.
Acknowledgements
The authors would like to thank Ashley Bergeron, Elisha Friesema, Joseph Fusco, Alex Gagnon, Maya Harper, Sumati Jain, Elissa Oh, Emily Ross, Rina Sobel, Jason Thompson, and Katherine Waite for their assistance with various aspects of this project.
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