Improving Diabetes Education through Video Intervention
A Pilot for a Quality Improvement Program
As the most unique medical school in the country, SOMA offers first-year students an introduction into the standardized patient encounter process each Thursday of the semester.
This provides the basic exposure to patient interactions.
After the first year, students spend the next three years working in community health centers and directly applying medical training techniques to real-life osteopathic medical situations with patients.
The early exposure to patients makes for more informed, experienced doctors – with far more patient interactive experience than other graduates.
A. Birdi, I. Borbon, A. Brown, S. Calder, S. Larsen, A. Marchant, J. Muhlbaier, M. Raven, R. Seth, P. Shah
- Improve patient knowledge regarding diet and exercise recommendations for Type II Diabetes Mellitus (DM).
- Improve health literacy in DM patients, specifically viewing, comprehending, and applying lifestyle changes presented in a diabetes education video.
- Improve overall health of DM patients.
Research Design and Methods
We presented an educational video on diet and exercise pertaining to DM, available in English and Spanish from Healthy Roads Media, during a routine office visit at El Rio Community Health Center. Each consenting patient took a pre- and post-survey to measure the efficacy of the video. Demographic information, education level, and date of DM diagnosis were collected in the surveys. To limit variability, only one provider’s patients participated and the nursing staff administered the videos and surveys to patients. Results were compiled into a database for analysis. During the analysis, each patient’s score was compared pre- to post-survey.
An increase in the overall number of correct post-survey responses was seen in three of the survey items, with a corresponding decrease in the standard deviation (SD) from pre-survey to post-survey responses (0.89 to 0.35; 1.06 to 0.0; and 1.19 to 0.71). An increase in variance in responses was seen in two survey items (1.41 to 1.43; and 0.21 to 0.27). Regardless of years since DM diagnosis, 87.5% patients showed an improvement in their post-survey scores after viewing the video.
While we did not collect sufficient patient data to achieve statistical significance in testing the value of the DM educational video, we can make some basic assumptions about the results. Results across all educational levels, and the average scores, increased among those patients who were diagnosed with DM 1 to 20 years ago. Overall, this project warrants further study for improving patient health literacy to explore if there are more engaging methods to enhance patient learning in Community Health Centers.
There are several limitations that interfered with the data collection. First, and perhaps most importantly, we had a restricted timeline. An appropriate number of surveys could not be administered within the given timeframe, leading to small sample population. Another significant limitation was our inability to implement data collection in multiple locations. We chose to collect our data at one location and with one provider to limit variability. This had a great impact on both, the quantity and quality of the surveys we received. We came across some additional hurdles with the nursing staff implementing the program, as they were on vacation and other staff members were not trained in their replacement. Unfortunately, not having a staff member who could consistently offer and administer the surveys also led to a small sample population.
Other sources of limitations came from our specific patient population. Patients were given the option to refuse participation, without it affecting their medical care, and many took this option, thinking this video would not provide any additional information they were not already aware of. A large number of patients believed their knowledge of DM was sufficient and did not desire to watch the educational video. The attitude of the patients could have affected the quality of the surveys collected; that is, if the patient was apathetic to the information presented in the video, the surveys could be filled out carelessly. Furthermore, there was potential for human error at different points, ranging from logistical aspects in the administration of the surveys to the actual collection and analysis of the obtained data. For future improvement, this program would yield greater success if some of these limitations are addressed initially.
Due to the time constraints on this project, we were unable to collect sufficient data to adequately observe and test the impact of the video on patient knowledge. For a future study, this project could have greater success if IRB approval is obtained in the fall and data collection begins in January, giving the various IRB committees sufficient time to approve our project. We would also recommend extending the time period for data collection, as well as incorporating data from more than one clinic location and more than one physician’s patient pool. We would recommend administering the surveys ourselves to ensure consistency in how the video is offered to patients and to better control the frequency with which it is offered to different patients. This would also allow us to more accurately gauge patient interest in receiving information on their diabetes care, rather than relying on anecdotal evidence from nursing staff members who were otherwise uninvolved with the study. This video might have greater success if shown to newly diagnosed DM patients who might be more interested in non-pharmacologic ways of managing their disease. This project has the potential to be very successful in educating patients on DM in the future.