1. Introduction
In choosing outcome measures for this evaluative work, we have targeted patients with either acute or chronic disease, because they are the ones most likely to receive education focused on managing a condition or its treatment. Because educational interventions may vary in intensity and duration, and because changes in knowledge and skills may be either transient or enduring, we have considered using the time frame of an educational intervention and its effects. This led to the idea of assessing cumulative effects on outcomes, with changes in knowledge and skills serving as mediators to changes in health status. Coming from Epidemiology, the concept of mediation deals with the understanding of how an exposure causes a change in health status. An educational intervention can be considered an exposure to a new treatment, patients who acquire knowledge and skills are changing their proximal outcomes, and the ultimate change in health status is a distal outcome. Drawing a causal diagram and specifying hypotheses for such mediation based on an educational intervention may be useful to Priority RCTs that compare 2 or more methods of the same intervention. Because changes in knowledge and skills are proximal outcomes for an educational intervention, we will consider them as effects of an outcome measure if we are able to assess their strength using patient education methods.
The difficulty of assessing knowledge acquisition, the most common method of evaluating patient education, our primary concern, has been described in the patient education literature through the use of immediate recall or short-term recognition or by simply assuming that if patients do as they are told, they have understood what to do. The focus of our work stems from the belief that evaluation research should assess effects on outcomes that are of most interest to other medical researchers, health care providers, health care organizations, teachers, and patients. Outcomes of educational interventions, which can be defined as a change in state of an individual or population occurring as a result of the passage of time or an event, may be positive or negative and unintended or intended. The Task Force on Taxonomy of the American Educational Research Association has detailed three categories for outcomes: cognitive, affective, and psychomotor, corresponding to changes in knowledge, attitude, and skills. These categories mesh well with a model of successful acquisition of a health behavior, from the formation of an intention, to maintenance of the behavior over time. Because the strongest explication of the model of intention comes from cognitive psychology theories, and because trials to change patient health behaviors often involve teaching patients how to manage a condition or its treatment, investigating whether patient education influences intentions and behaviors may best be accomplished by assessing changes in patients’ knowledge and skills. Given the importance of such changes in patient behaviors to subsequent health status, educational interventions should be evaluated for their effects on health outcomes. Like the effects of such interventions on economic or utilization outcomes, linking educational interventions to changes in health status may best be accomplished by Controlled Trials. The most rigorous evaluation research should measure all of these types of outcomes, to ensure that evaluative findings do not take into account only a portion of what has happened as a result of the education.
2. Importance of Patient Education
3. Factors to Consider in Evaluating Patient Education
4. Common Evaluation Methods
5. Assessing Patient Comprehension
6. Measuring Behavior Change
7. Evaluating Patient Satisfaction
8. Using Technology for Evaluation
9. Challenges in Evaluating Patient Education
10. Future Directions in Patient Education Evaluation
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