Computer-based education for patients with chronic heart failure: A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life
Introduction
Heart failure is already a major public health problem in the western world and the incidence and cost are expected to continue to increase. Chronic heart failure is often caused by ischaemic heart disease and hypertension. It develops gradually and is associated with a poor prognosis [1], reduced quality of life [2] and frequent hospital admissions [3]. Patient education is an important component in enabling the patient to comply with the prescribed treatment and carry out self-care. The life-style changes needed for patients with heart failure are adherence to an often complex medical treatment, restricted intake of salt and fluids, alcohol restriction, modified physical activity, infection prophylaxis and monitoring of symptoms indicating deterioration, such as increased shortness of breath, weight and oedema [4].
The use of computers in patient education has developed during the last decades. There are educational tools available both over the Internet and through multimedia software on a CD-ROM. It has been shown that elderly patients can manage to run a computer program without earlier experience [5], [6]. This is essential in the heart failure population since the majority of the patients are elderly and prevalence of heart failure rises from approximately 1% in persons of 50 years of age to over 10% in persons older than 80 years [1].
Fewer persons over 65 years of age have access to computers in their homes compared to younger individuals in the population. In addition barriers to computer use among the elderly such as low self-esteem, visual, hearing and mobility problems, which have to be addressed when creating programs for them [7]. A disadvantage of computer-based education for the elderly is that some of the personal interaction with health care professionals in the educational situation is lost. However, the advantages of using a computer are that the patient has to be active during the educational sessions and choose areas of interest and the information can be repeated [8], [9]. The patients have control over the flow of information and attention is focused through synchronized multimedia using text, photos, animation and speech [6].
The majority of the publications about computer-based education are related to patients with chronic illness [8]. Two different interactive programs on CD-ROM have been described for patients with heart failure [6], [10]. In Sweden, computer-based education for heart failure patients is available at 1/3 of all the hospitals [11], but evaluations of the effects of interactive education in this patient group are scarce. To our knowledge, only one previous trial has evaluated the effects of interactive education on knowledge in patients with heart failure. Björck Linné et al. [5] evaluated an interactive program in combination with a systematic nurse- and pharmacist-led education, and compared it with standard education including a booklet and a single educational session. They showed that knowledge about heart failure was increased with the intervention compared to standard education. However, the isolated effect of the interactive program could not be evaluated since it was part of an extensive educational program [5]. The aim of the present trial was therefore to evaluate the effects of a single-session, interactive computer-based educational program on knowledge, compliance and quality of life in heart failure patients with special emphasis on gender differences.
Section snippets
Design and setting
A prospective, randomised multicentre trial with a 6-month follow-up was conducted. Permission was obtained from the Regional Ethics Committees for Human Research at the Universities of Gothenburg, Linköping, Stockholm and Uppsala, Sweden. The setting was five nurse-led heart failure clinics in southern and central Sweden, situated at two university hospitals, two county hospitals and at one primary health care clinic. These clinics were selected on the basis that they had an established heart
Study patients
A total of 154 consecutive patients gave informed consent and were enrolled in the trial. Patient flow is shown in Fig. 1. The patients were randomised to either the control group (n = 72) receiving standard education or to the intervention group (n = 82), which in addition to standard education also received computer-based education through an interactive multimedia program on CD-ROM. None of the patients in the intervention group had problems with using the computer or to handle the multi-media
Discussion
The accessibility of personal computers has increased rapidly and they can be used systematically in patient education. We found that additional education through a computer-based program gave increased knowledge about heart failure. All of the study patients received the same nurse-led education, after which the intervention group additionally used the computer. We could therefore evaluate the isolated effect of the computer-based education through a CD-ROM, which has not been done before in
Acknowledgements
The County Council of Östergötland, Linköping, Sweden and Aventis Pharma, Stockholm, Sweden for financial support. Heart failure nurses: Inga Jernberg, Inger Levin, Kerstin Nydahl, Inger Petz, Annika Tjäder-Olofsson, Ylwa Wallström and Åsa Åkesson for their involvement in the trial.
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