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Health Education and Health Promotion: Key Concepts and Exemplary Evidence to Support Them

• First Online: 09 October 2018

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• Hein de Vries 8 ,
• Stef P. J. Kremers 8 &
• Sonia Lippke 9  

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Health is regarded as the result of an interaction between individual and environmental factors. While health education is the process of educating people about health and how they can influence their health, health promotion targets not only people but also their environments. Promoting health behavior can take place at the micro level (the personal level), the meso level (the organizational level, including e.g. families, schools and worksites) and at the macro level (the (inter)national level, including e.g. governments). Health education is one of the methods used in health promotion, with health promotion extending beyond just health education.

Models and theories that focus on understanding health and health behavior are of key importance for health education and health promotion. Different classes of models and theories can be distinguished, such as planning models, behavioral change models, and diffusion models. Within these models different topics and factors are relevant, ranging from health literacy, attitudes, social influences, self-efficacy, planning, and stages of change to evaluation, implementation, stakeholder involvement, and policy changes. Exemplary health promotion settings are schools, worksites, and healthcare, but also the domains that are involved with policy development. Main health promotion methods can involve a variety of different methods and approaches, such as counseling, brochures, eHealth, stakeholder involvement, consensus meetings, community ownership, panel discussions, and policy development. Because health education and health promotion should be theory- and evidence-based, personalized interventions are recommended to take empirical findings and proven theoretical assumptions into account.

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Hein de Vries & Stef P. J. Kremers

Department of Psychology and Methods, Bremen International Graduate School of Social Sciences, Jacobs University Bremen, Bremen, Germany

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Department of Psychological and Brain Sciences and Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA

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Ulrike Ehlert

School of Public Health, Peking University Health Science Center, Beijing, China

Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia

Brian Oldenburg

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de Vries, H., Kremers, S.P.J., Lippke, S. (2018). Health Education and Health Promotion: Key Concepts and Exemplary Evidence to Support Them. In: Fisher, E., et al. Principles and Concepts of Behavioral Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-93826-4_17

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Health promotion and health education: advancing the concepts

Affiliation.

• 1 School of Health Sciences, College of Humanities and Social Sciences, Massey University, Palmerston North, New Zealand. [email protected]
• PMID: 15238126
• DOI: 10.1111/j.1365-2648.2004.03095.x

Background: Health education and health promotion activities are a fundamental requirement for all health professionals. These two paradigms are closely related but are not inter-dependent. Despite this, it is known that many nurses confuse the terms and use them interchangeably. With this in mind, it is necessary to re-conceptualize the terms in an attempt to bring them to a current form of 'maturity'.

Aim: The aim of the paper is to provide an up-to-date analysis of health promotion and health education that serves as a conceptual and operational foundation for clinicians and researchers.

Method: A concept analysis following the criterion-based methods described by Morse and her colleagues was applied to the terms health education and health promotion, using generic and nursing-related literature.

Results: The conceptual literature on health education is consistent between generic and nursing-related sources. On the contrary, earlier nursing literature on health promotion is now at odds with more recent socio-political and community action models of health promotion, in that it focuses on individualistic and behavioural forms of 'health promotion'. A significant proportion of later nursing-related literature, however, suggests a maturing of the concept that brings it further in line with a socio-political health promotion agenda.

Conclusion: While the theoretical and conceptual literature surrounding health education has remained relatively constant and unchanged over the last decade or so, the same cannot be said for the health promotion literature. The evolving dominance of socio-political action in health promotion has overtaken individualistic and behaviourally-related forms. While the recent nursing literature addresses and acknowledges the place of socio-political activity as the mainstay of health promotion interventions, this is largely from a theoretical stance and is not applied in practice.

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CURRICULUM, INSTRUCTION, AND PEDAGOGY article

Teaching health education through the development of student centered video assignment.

• Public Health Department, Grand Valley State University, Grand Rapids, MI, United States

The purpose of this study was to explore the ways in which a student centered video assignment enhanced student learning about developing and teaching a health education plan designed to address a complex public health problem. The objectives of the assignment included (1) to explore a complex public health problem, (2) practice developing a corresponding health education plan, and (3) develop and fully execute a multimedia video to deliver high impact health education and or promotion to a diverse audience. The assignment referred to as the student centered video assignment was developed and piloted at Grand Valley State University and included students participating in a 200 level undergraduate introductory public health course. Students working in groups of 3, worked through the project in multiple phases with corresponding elements: problem identification, problem solving, plan development and the creation of the video, which included four primary elements: Dig Deeper, Think, Discuss, and Watch. Upon completion of the video, students were asked to voluntarily complete a 10-question survey about the benefits of learning through a video creation assignment. A total of 15 students completed the survey with the majority either strongly agreeing or agreeing that the video assignment enhanced learning. Survey results suggest that the assignment is beneficial and favored over other assignment types. Additionally, students reported that the project was beneficial in learning the concepts and competencies associated with public health education. Finally, students indicated that the creation of videos as a means to explore and apply course concepts was favored as an assignment format in future coursework. Instructor assessment of learning outcomes occurred through ongoing grading of and feedback on the project elements. The findings reveal that students enjoyed the opportunity to engage in real world problem solving, gained insight, perspective and scope through group discussion and collaboration, and felt that they learned new skills in created the video.

Background and Rationale: Multimedia Technology and Higher Education Pedagogy in Public Health and Health Science

Changes in technology are rapidly changing our culture ( 1 ). New teaching and learning formats that rely on digital and web-based technologies have greatly influenced how instructors teach as well as how students learn ( 2 ). Resnick ( 3 ) of Massachusetts Institute of Technology's Media Laboratory (MIT Media Lab) describes our society as rapidly transforming into a creative society, one in which the skilled and expert workers of the past century are replaced by creative workers adept at problem-solving. Such a trend suggests the importance of creativity in student learning and emphasizes that problem solving is not only a critical skill, but also one that can be facilitated through technological tools. Technology can enhance effective learning in many ways ( 4 – 6 ), such as providing greater depth of functionality, feedback, interactivity and simulation ( 2 ). A bank of empirical research demonstrates that blogging, video blogging (vlogging) and podcasting, when used as a part of classroom instruction, can enhance student performance, foster reflection, creativity, and knowledge construction ( 7 , 8 ). Likewise, students can be instructed to create their own multimedia work as part of a learning activity or assignment. The work of Fredenberg ( 9 ) and Armstrong et al. ( 10 ) provide examples of how students can create podcasts, rather than listening to them as an instructional tool. Fredenberg ( 9 ) reported that students are more engaged and felt more confident in their skills and abilities after mastering a podcast assignment. Armstrong et al. ( 10 ) required student-created podcasts (students could elect audio vs. video) as a means to learn objective driven business communication. Having students produce their own podcasts provided a novel way for students to disseminate information while also developing communication and literacy skills through teamwork, organization, time management, technical literacy, and overall planning ( 10 ).

The core competencies for public health professionals and other health care providers rest heavily on communication skills, literacy, creativity, problem solving, and the appropriate use of technology. Having students explore, create, and disseminate through video and other multi- media formats, such as podcasts and vlogging, may offer a novel and effective tool for enhancing these skills. Despite the growing body of research and popularity of multimedia in higher education, health education, and society, little scholarship has addressed the use of student created video and the pedagogical benefits specifically for health science students. This paper seeks to offer a starting point for exploring how student created videos can enhance health science and public health education.

Pedagogical Framework and Principles: Student Created Videos in Problem Based Learning

Students engaged in health profession education encounter numerous “wicked problems” that require teaching and learning strategies that allow for flexibility, trial and error, and engagement beyond text book and lecture based learning. The student centered video assignment was developed, in part, as a strategy to facilitate this type of learning in undergraduate courses with a public health focus, such as Introduction to Public Health. The course was taught by a faculty member from the Grand Valley State University, College of Health Professions, Master's of Public Health (MPH) Program (MPH). The student centered video assignment was developed jointly by the authors, each having over 10 years of teaching experience in the health professions. The course is offered each semester in multiple sections and has been taught multiple times by each of the authors. The class utilized a traditional in seat format while using inquiry based learning as the pedagogical approach. This approach challenges students to learn through directed questions, problems, and challenges that students work to address. Additionally, the courses incorporated Problem Based Learning (PBL) which is known as a teaching and learning approach that facilitates cultivation of knowledge, critical thinking, assessment and evaluation in solving complex, real world problems. Students engaged in PBL set to exploring and solving problems in small groups with the objective of promoting “constructive, self-directed, collaborative and contextual activity” ( 11 ). PBL research in nursing and clinical education showed improvement in critical thinking and critical reasoning ( 12 ), while research on the process of PBL reflects gains in collective and collaborative knowledge building ( 13 ).

Principles and Competencies in Health Education and Promotion

The Council on Education for Public Health (CEPH) is the accrediting body for all schools and programs of public health in the United States. They have identified 22 primary core competencies for public health students and professionals. Of the 22 competencies identified by CEPH, 6 were used in the organization of the two courses in which the student centered video assignment was implemented ( Table 1 ). The competencies selected align with the course objectives and public health program concepts. Execution of the student centered video assignment provides ample opportunity for students to practice and build competency in these areas. For example, competency 16, 21, and 22 is addressed through group collaboration and working with a complex public health issue. Competency 18, 19, and 20 is achieved through the creative development of the video, in which a public health message and health promotion tool are developed for a target population ( Table 1 ).

Table 1 . CEPH competencies used in course and assignment development.

Achieving competency requires meaningful student learning and mastery of skills related to analysis, assessment, planning, communication, management, and systems thinking ( 14 ). Video creation using a problem based learning approach allows for students to practice these skills through engaging with a real world problem in small groups and to explore and practice mastering a new technology.

Learning Environment

Grand Valley State University is a midsize, teaching intensive University located in the Midwest. The College of Health Professions houses 17 undergraduate and graduate health profession programs. The Department of Public Health offers a Master's Degree in Public Health (MPH) and includes several introductory undergraduate courses. The student centered video assignment was created by the authors who are faculty from the MPH program who teach undergraduate and graduate public health courses. The goal was to create a novel course learning activity that facilitated innovative and collaborative development of course work that is student centered, linked to real world public health issues, problem focused and outside of traditional course projects, such as research papers and or presentations. This assignment was developed and piloted in a 200-level undergraduate introductory public health course Students are generally traditional undergraduate college students at the sophomore or junior level interested in exploring a health related degree and or career. The undergraduate public health courses provide a valuable opportunity for undergraduate students to gain awareness and knowledge of the public health profession and the MPH degree. The students in the course that utilized the student centered video assignment are representative of the larger undergraduate student body. Further, students enrolled in the course as well as the students that completed the course evaluation and assignment evaluation reflect a general health professions student body that is disproportionately female.

Video Creation Assignment

The video creation assignment was developed and piloted in the 15 weeks fall semester of 2017. The overall purpose of the assignment was to provide students with a robust, collaborative, innovative, learning opportunity in which a complex public health problem are identified, explored, and responded to through the creation of a culturally appropriate health education video. The assignment was completed in four phases over a 12 weeks period, with each phase having an associated learning element. The phases and elements for the assignment are informed through the PBL pedagogical approach of the course as well as the CEPH competencies listed in Table 1 . The following sections describe the objectives and course work associated with each phase and for phase 4, each element of the student centered video assignment.

The objective of phase 1 is to introduce and facilitate student exploration of real world public health problems. In order to achieve this objective students are randomly assigned to groups of 3–4 depending on the number of students in the course. Over a 3–4 weeks period of time, students are given access to course materials through the University learning platform which include scholarly research articles, journalistic documentaries, and web resources that reflect ongoing and emergent public health problems that are salient to health promotion and or health education. For example, students review topics like vaccine preventable infections and outbreaks, drug use during pregnancy, harm reduction measures among homeless and drug addicted youth, vaping, and sleep hygiene among college students. Students explored the problems together in class and through consensus, elected a problem of interest that is explored and analyzed in Phase 2.

A second learning activity in Phase 1 is the introduction of and experimentation with video creation technology. Students viewed professionally developed TED-Ed video talks, which served as an exemplar and model for the structure of the student created video. Students were asked to watch health related Ted-Ed talks and to reflect upon the message, format, effectiveness, and efficiency of the message.

Class time during weeks 4–6 is used to discuss and describe how to explore, evaluate, and assess root causes and systems level factors related to the selected public health problem. The objective of Phase 2 is to use principles of descriptive Epidemiology, such as time, place and person, to explore the natural history, context, and scope of the selected public health problem. In this phase, the first element, “Dig Deeper,” is introduced.

The public health problem identified in Phase 1 becomes the focus of the Dig Deeper Element introduced in Phase 2. Students are asked to dig deeper into their problem by searching for and evaluating relevant and credible literature and web resources. Students were provided with a website evaluation tool, the CRAAP, to assist in reviewing web information ( 15 ). Each group member composed a single paragraph between 250 and 500 words that included a minimum of three credible references and summarized their search and evaluation. Group members then worked collaboratively to combine the paragraphs into a concise health education or health promotion message relevant to their public health problem. As an introductory undergraduate course, gaining scope and depth of resources accessed and utilized was not the intention. Rather, the dig deeper element was considered a skill building opportunity for group collaboration and health information seeking, assessing and summarizing. Basic instructions for the Dig Deeper Element are provided in Appendix A .

The development of a video health education or health promotion plan is the objective of Phase 3. The plan becomes the framework for the actual video that the students produce in Phase 4. The basic format of the plan is aligned with the TED-Ed lesson creation guide and consists of a short informative message derived from the Dig Deeper element, thinking questions related to the message, a learn more section and a discussion section ( 16 ). The first step of Phase 3 is to complete the “Think Element,” in which students were required to create a series of multiple choice and true or false questions, which addressed the content from the Dig Deeper Element. The questions check for understanding of the content presented in the Dig Deeper element. Students were encouraged to develop thought-provoking questions at a Bloom's level of Analysis or higher. Basic instructions for the Think Element are provided in Appendix B .

The second step of Phase 3 is the Discuss element. The Discuss element required each student within the group to compose a thoughtful discussion question pertaining to the information provided in the Dig Deeper element and complimentary to the Think element. The purpose of the Discuss element is to provide an opportunity for viewers of the video to discuss and further explore the topic of the video. Students were encouraged to review Guidelines for Developing Juicy Discussion Questions ( 17 ). Groups were also encouraged to create a Google Doc so that each student could peer review and edit the discussion questions. Students were limited to 750-character limit. Basic instructions for the Think Element are provided in Appendix C .

In phase 4, student groups developed and executed TED-Ed like educational videos using the Watch element. Student groups were required to create an original video incorporating the Dig Deeper, Think, and Discuss elements they had completed in phases 1–3. Groups applied their topic research, questions, and discussion content to a storyboard template provided by the instructor. The instructor provided students with access to PowToons for Education as the medium or technology used for creating the actual video. PowToons offers a free educational subscription to web-based animation software designed to create animated videos ( 18 ). The videos were ~5 min long and were presented in class on the last day Basic instructions for Phase 4 or the Watch Element are provided in Appendix D .

Setting and Participants

The setting for the student centered video assignment was an in seat undergraduate introduction to public health course with 48 students. Two of the 48 students were male and 46 were female. All students in the course completed the assignment as part of the course work.

Student feedback and learning related to the student centered video assignment was gathered through an evaluation. As the assignment was part of the course, informed consent for participating in the assignment was not needed nor obtained. Informed consent was obtained for the evaluation of the assignment that took place following the viewing of the videos in the last class meeting. The Grand Valley State University Institutional Review Board (IRB) approved the evaluation and deemed the study exempt. The evaluation of student perception of the student-centered video assignment included 10 Likert scaled questions (rating questions 1–7, 1 strongly disagree-−7 strongly agree.) Forty-eight students were emailed the survey following the last day of class. Fifteen students completed the survey for a 31% return rate.

Of the 15 students who completed the survey the majority either strongly agreed or agreed that the video assignment enhanced learning. Survey results suggest that the assignment is beneficial and favored over other assignment types, such as traditional course research papers and or oral paper or poster presentations. Likewise, students would prefer the video assignment over other types of assignments in future classes. Additionally, students reported that the project helped them to apply and develop understanding of the concepts and CEPH competencies associated with introductory public health education. A total of 86% of the students indicated that the student-created video lesson enhanced their learning of public health content. Additionally, 73% of the students thought that creating videos to address a public health issue was a useful experience. Seventy-three percent also indicated that the student-centered video assignment was an important exercise in helping them better understand critical public health issues. Table 2 and reflect the survey questions and student response regarding the student centered video assignment.

Table 2 . Student responses to the TED-Ed student-centered video assignment.

It is not clear whether the video format or the PBL learning approach associated with the assignment influenced student preferences and responses. However, this initial evaluation along with instructor evaluation of the assignment elements completed by the groups, suggests that students enjoyed the opportunity to engage in real world problem solving, gained insight, perspective and scope through group discussion and collaboration, and felt that they learned new skills in created the video.

Overall, this project received strong and positive evaluations from students that serve as a starting point for further development, use and evaluation of similar video creation assignments. A primary strength of this assignment and preliminary evaluation is that it offers credibility and feasibility of student-created videos as a learning tool in higher education. In addition to offering a fun, innovative and novel skill set in the way of video creation, the assignment may offer valuable means for students to develop skills in problem solving and collaboration. Such skills are necessary in the modern workplace where sophistication and complexity of problems is evolving and changing. Furthermore, the video assignment was perceived to be useful in addressing key competencies related to public health and health education which are also becoming more ambiguous and complex. Limitations to the study include the moderately sized sample of students as well as the limited number of students who completed the survey. Furthermore, the generalizability of these findings is limited by the fact that this research was conducted within a single university and a single course.

This assignment serves as an example of an innovative and complex assignment with implications and consequences related to learning but also to achieving high impact learning at the undergraduate level. In other words, undergraduates undertaking this assignment are forced to confront uncomfortable and often controversial public health issues that have no clear good or bad, right or wrong answers. Success is not dependent upon memorization of course concepts but on a students ability and willingness to identify and confront their own learning styles, expectations, and collegiality in working with the instructor, class mates, group members and tangentially, the population of people their video is meant to address.

Recommendations for Educators

The experience of the assignment from the perspective of the instructor offers guidance and caution for other educators willing or curious to take on such an assignment. First, explicit instructions along with a rationale should be given to students at the outset of the semester or work period. The basic components of a student groups, a real life problem related to the course topic and or discipline and a strategy for the development of video contents and video creation are all that are needed to develop a similar assignment. However, it should be noted that students in the course conveyed concern over the timeline, uncertainty in understanding assignment expectations, and in some cases, wanted to jump ahead in creating a video without utilizing the phases and elements. Providing a detailed map of the project ahead of time may ease student concern and better facilitate dedicated in class work time. In this regard, instructors should be willing and able to dedicate a significant portion of in seat class time (45–60 min per element) to group work in completing the elements of assignment. Other aspects of the assignment, such as accessing and viewing TED-Ed lessons and public health resources can be facilitated through an online course delivery platform, such as Moodle or Blackboard. A second recommendation for educators is to seek ways to extend the work of the video creation outside of the classroom. The ability to showcase and “test out” the video with a real target population was requested by the students. The ability to self-select a problem and to work on it in a deliberate way appears to raise interest and investment in the project among students. Finally, as an assignment fully entrenched in collaborative group work, care and consideration should be given to address students who are either uncomfortable or unwilling to engage fully and fairly in group work. Likewise, the instructor should acknowledge, address, and provide a model for handling disagreement within groups. A policy, for example, included in the course syllabus could provide a pathway for students to address concerns among themselves prior to contacting the instructor. The use of a self and peer evaluation that is included in the final course grade may also provide incentive or meaningful consequence for students who do not participate fully or underperform in the group work.

Instructor Reflection on Evaluation of the Assignment

The instructor reviewed and provided feedback to groups upon completion and submission of each element within each phase of the project. The video assignment work was intentionally designed to be low stakes, meaning that groups received a complete or incomplete for each element with the expectation that feedback given would be considered in the ongoing work, resulting in a strong and appropriate video. Only the final video was scored and included the self and peer evaluation. In this way, each group member receives his or her own unique score rather than a base score for the group. The evaluation matrix used for the final video displayed in class included assessment based on the 4 elements and the CEPH competencies. This included the representativeness of the information provided in the Dig Deeper element; the complexity and appropriateness of the Think element and Discussion questions; and the overall aesthetic value and quality of the video, it's length, and it's overall message. Graduate level courses could significantly increase the complexity and scope of the evaluation matrix to include elements, such as health and cultural literacy, sophistication, timeliness and appropriateness of the literature and resources used to develop the health education plan, and pre- and post-test elements to gauge viewer learning. Finally, anectodal evidence from student work, comments and discussion offer further support for this type of assignment. Students provided thoughtful, well-written, well-supported work that reflected the healthy struggle of reaching group understanding and agreement and to conceptualize difficult and complex problems.

Further studies should examine more closely the specific characteristics of the assignment that may cultivate benefit in learning and how student centered, problem based, collaborative course work around a short, audio visual rather than written assignment can be useful in attaining high level learning outcomes.

The use of a student centered video assignment may be a novel and innovative strategy to approach the development of problem solving and group work in the classroom. The assignment described here was received positively by students and offers insight into the myriad complexities of teaching about difficult, evolving, and sophisticated issues both in and outside of the health professions. The small but positive results of the student survey as well as the assessment of student learning witnessed by the instructor should encourage other educators to develop similar assignments and to undertake additional studies to evaluate the effectiveness, merits, and strengths of creating video in public health coursework.

Ethics Statement

This study was carried out in accordance with the recommendations of Grand Valley State University Institutional Review Board with written informed consent from all subjects. All subjects gave written informed consent in accordance with the Declaration of Helsinki. The Grand Valley State University Institutional Review Board approved the protocol.

Author Contributions

JV contributed to the conception and design of this study. JV managed the data collection of this study. JV organized the data. HW and JV wrote the first draft of the manuscript. JV and HW wrote the sections of the manuscript. HW wrote the second draft of the manuscript and completed all revisions.

Grand Valley State University will cover the open access publication fee.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2019.00312/full#supplementary-material

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Keywords: health education, pedagogy, undergraduate education, multimedia, public health competencies

Citation: Wallace H and VanderMolen J (2019) Teaching Health Education Through the Development of Student Centered Video Assignment. Front. Public Health 7:312. doi: 10.3389/fpubh.2019.00312

Received: 04 May 2019; Accepted: 14 October 2019; Published: 01 November 2019.

Reviewed by:

Copyright © 2019 Wallace and VanderMolen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Heather Wallace, wallaceh@gvsu.edu

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Literature for Life: Teaching Health Literacy with Picture Books and Novels

Book Links: October/November 2002 (v.12, no.2)

by Chris Liska Carger, Sally Conklin, and Francine Falk-Ross

No curriculum content is more crucial for life—literally—than that of health education. Alcohol, tobacco, and other drug use, low levels of physical fitness, poor nutrition, injuries, stress, and mental illness (all on the rise in our nation's youth) can impede learning and reduce quality of life. The American Medical Association has designated school health education as the most important factor in future improvements in our nation's health-even more valuable than biomedical breakthroughs. Health education in schools is essential to enable students to apply health-related knowledge in their own lives successfully and meaningfully.

Traditionally, attempts at health education have emphasized memorization of science-based facts and societal prescripts. Research (not to mention the current health of American youth) tells us that this approach has not been particularly successful. This reactive approach is best replaced by a proactive one based on the strengths, talents, and resiliency that children possess. The American School Health Association, the Association for the Advancement of Health Education, and the American Cancer Society worked jointly to generate National Health Education Standards that encourage what they term health literacy. These standards provide flexible, conceptually anchored parameters within which educators may find a meaningful health education curriculum.

The seven health standards (see sidebar) blend well with critical literacy principles and reader-response teaching techniques. The power of a good novel, well-written poetry, or creative biography could reach an adolescent struggling with critical health-impacting decisions more effectively than a textbook. With novels in particular, it is harder for students to distance themselves from health issues and behaviors exemplified through a compelling story and well-developed characters. Holt's When Zachary Beaver Came to Town , the moving story of a community's reaction to an obese orphan, conveys the devastating effects of poor nutrition and a sedentary lifestyle more powerfully than could any edict about proper nutrition and exercise. Pedro and Me deals with the complex issues precipitated by author Winick's fellow MTV's The Real World cast member Pedro's battle with HIV/AIDS in an accessible graphic art format. Even White's classic fantasy novel The Trumpet of the Swan can provide concrete examples of goal setting and applying a decision-making process to a health issue as Louie struggles to adapt to being mute. Readers clearly see the consequences of not addressing health issues when the title character in Gantos' Joey Pigza Loses Control stops taking medication for his attention deficit disorder. Even books that may not appear to address health issues (such as DiCamillo's Because of Winn-Dixie ) integrate health literacy characteristics into the plot. Small group discussions of responses to books like these with authentic questioning and interpretation will help students to personalize facts and use them to develop health beliefs that consider the interconnected physical, mental, emotional, and societal dimensions of their decisions. Nonfiction health and science reading materials can also be made available in learning centers to link to fiction selections.

The goal of health literacy is to train children to become critical thinkers; responsible, productive citizens; self-directed learners; and effective communicators. The following reading suggestions may help all teachers-not just those specifically trained in health-to encourage these assets.

Books for Younger Readers

Browne, Anthony. Piggybook . 1986. 32p. Dragonfly, paper, $7.99 (0-679-80837-X). K-Gr. 2. Mrs. Piggott is sick and tired of doing all the laundry, all the cooking, and working full-time, while her husband and two sons don't lift a finger. She leaves for a few days, and, in her absence, the three actually become pigs as their home turns into a colossal mess. Only when everyone learns to pitch in and help do they resume human form. Personal hygiene and the importance of a clean and healthy home environment are literally illustrated in this amusing story.

Carle, Eric. The Very Hungry Caterpillar . 1969; reissued 2000. 32p. Philomel, $15.99 (0-399-23641-4); board book, $9.99 (0-399-22690-7). Preschool-Gr. 1. It's never too early for children to think about health-enhancing nutrition, and this classic story of a caterpillar who eats his way to a stomachache is a perfect vehicle for discussion. The message of striving to realize one's potential can easily be linked to the caterpillar's metamorphosis. For an engaging picture book about the food pyramid, see Loreen Leedy's The Edible Pyramid: Good Eating Every Day (Holiday, 1994).

Cisneros, Sandra. Hairs/Pelitos . Illus. by Terry Ybañez. 1994. 32p. Dragonfly, paper, $6.99 (0-679-89007-6). K-Gr. 2. A vignette from Cisneros' The House on Mango Street , this picture book celebrates diversity within a family. The bilingual text is complemented by Ybañez's cheery, simple drawings, and the affection the narrator has for family members is apparent as she lovingly describes their various hair textures and other characteristics. This book can facilitate discussions on physical diversity in families, communities, and beyond.

dePaola, Tomie. Now One Foot, Now the Other . 1981. 48p. Putnam, $15.99 (0-399-20774-0); Puffin, paper, $7.99 (0-399-22400-9). K-Gr. 2. When everyone else has given up on Bob, a stroke victim, his five-year-old grandson Bobby realizes through a game that Grandpa does recognize him and is able to comprehend his surroundings. With unwavering hope and dedication, Bobby reteaches Bob how to walk, feed himself, and tell stories-all things his beloved grandfather once taught him. Through effective interpersonal communication, the two generations devise strategies that enable Bob to cope with his affliction and enjoy a highly functional life.

Martinez, Alejandro Cruz. The Woman Who Outshone the Sun / La Mujer que Brillaba aún más que el Sol . Illus. by Fernando Olivera. 1987. 32p. Children's Book Press, $15.95 (0-89239-043-3); paper, $7.95 (0-89239-112-X). Gr. 1-3. The story of the "wonderful yet so strange" Lucía may cause children to think about the consequences of mean-spirited gossip. When villagers cruelly drive the lovely Lucía out of town, her beloved river leaves with her. This bilingual tale is excellent for discussing the importance of emotional well-being and a community's role in supporting the diversity and individualism of its members.

Polacco, Patricia. Thank You, Mr. Falker . 1998. 40p. Philomel, $16.99 (0-399-23166-8). Gr. 4-6. Through poignant prose and emotionally expressive illustrations, Polacco presents a girl eager to read but unable to figure out the jumbled mess she sees on the page. After she suffers the teasing of classmates, her fifth-grade teacher, Mr. Falker, discovers her problem and helps her overcome it. Health themes include relationships with grandparents, dealing with death, overcoming adversity, and advocating for personal health needs, including mental and emotional needs.

Seuss, Dr. Hunches in Bunches. 1982. 48p. Random, $14.95 (0-394-85502-7). K-Gr. 3. When many choices exist, selecting only one can be difficult. The message to readers in this rhyming, easy-to-read book is "Get it done! Only you can make your mind up!" Teaching decision-making skills works well when a humorous example is used to illustrate the steps of defining the problem, weighing alternatives, and finally making a choice. In this case, "six hot dogs for lunch" may not be the best hunger hunch answer! Explore other alternatives, and perhaps follow up the discussion with a nutritious snack for the whole class.

Sís, Peter. Madlenka . 2000. 48p. Farrar/Frances Foster, $17 (0-374-39969-7). K-Gr. 2. Little grabs the attention of primary schoolchildren as quickly as the topic of loose teeth. Madlenka spreads the good news that her tooth is loose to several friendly merchants. With fine detail that begs interaction, Sís takes readers around a New York City block and, in doing so, around the world. (For more loose tooth titles, see the article "Primary Smiles" in the April/May 2002 issue of Book Links.)

Young, Ed. Seven Blind Mice . 1992. 40p. Philomel, $17.99 (0-399-22261-8); Puffin, paper, $6.99 (0-698-11895-2). Preschool-Gr. 2. Young's effective use of cut-paper collage on black background will delight children, in this retelling of an Indian fable in which seven blind mice try to describe an elephant. One mouse finally aggregates the clues and correctly identifies the mysterious object. The lesson about analyzing and synthesizing parts into a whole makes this picture book a good springboard for investigating more complex health issues in other readings.

Books for Older Readers

Conly, Jane Leslie. Crazy Lady! 1993. 192p. HarperTrophy, paper, $5.99 (0-06-440571-0). Gr. 3-6. Facing the prospect of failing English class and repeating seventh grade, Vernon finds a tutor in the eccentric, alcoholic Maxine Flooter, a neighborhood woman known as the "crazy lady." Despite the ridicule he fears from his friends, he gets to know Maxine and her mentally retarded son, Ronald, eventually helping Ronald participate in the Special Olympics. Vernon's relationship with Maxine and her son, as well as the personal family and learning problems he copes with, highlight issues such as the identification of community resources and working cooperatively to promote health.

Cormier, Robert. Tunes for Bears to Dance to . 1992. 112p. Laurel-Leaf, paper, $4.99 (0-440-21903-5). Gr. 5-8. In post-World War II Massachusetts, Henry takes a job working in a grocery store to help his family. At the same time, he befriends a Holocaust survivor in his community who is carving a wooden replica of his destroyed home. When Henry's employer threatens to fire him unless he destroys his friend's beloved village, he must weigh his options carefully. This novel offers several examples of decision-making dilemmas, including response to peer pressure, understanding racism, consideration of home and family responsibilities, and respect for property.

DeFelice, Cynthia. Devil's Bridge . 1992. 96p. HarperTrophy, paper, $4.95 (0-380-72117-1). Gr. 4-6. Ben's recently deceased father was Martha Vineyard's Striped Bass Derby champion for years. After he hears a local man plotting to beat his father's record using an illegally caught fish, Ben must make some difficult decisions related to competition and honesty. The influential advice and support of peers, family, and community members as Ben struggles to demonstrate his independence and self-worth are important models for young students' decision-making.

DiCamillo, Kate. Because of Winn-Dixie . 2000. 192p. Candlewick, $15.99 (0-7636-0776-2); paper, $5.99 (0-7636-1605-2). Gr. 3-5. Despite her odd name and being new in a small Florida town, India Opal Bulonni manages to improve interpersonal communication with her father, who, along with Opal, is devastated by his wife's abandonment of the family. Opal also gathers a unique assortment of friends, ranging from a scraggly stray dog to a reclusive African American woman. Opal encourages young readers to march to the beat of their own drummers, communicate across race, gender, and age barriers, practice conflict resolution, and value diversity in friendships.

Gantos, Jack. Joey Pigza Loses Control . 2000. 208p. Farrar, $16 (0-374-39989-1); HarperTrophy, paper, $5.95 (0-06-441022-6). Gr. 4-7. This sequel to Joey Pigza Swallowed the Key (Farrar, 1998) gives readers a heartfelt glimpse into the world of an attention deficit disordered (ADD) child. In this book we see the consequences of the poor health-related decisions both Joey and his father make, not to mention the severe impact that an ongoing smoking habit has had on his grandmother's lifestyle. As Joey spirals out of control by going off his medication, children dealing with this condition themselves or those with ADD classmates can clearly see the importance of appropriately controlling its devastating effects.

Giff, Patricia Reilly. All the Way Home . 2001. 176p. Delacorte, $15.95 (0-385-32209-7). Gr. 3-5. Mariel, a polio victim living in post-Depression Brooklyn, wonders about the identity of her birth mother. Brick, a struggling upstate New York student, worries about tough times due to a fire in his family's apple orchard. The two meet and share their love for the Brooklyn Dodgers and their understanding of each other's plights. Both characters offer many admirable traits as they deal with physical, emotional, and educational challenges in the pursuit of healthy lives for themselves and their loved ones.

Holt, Kimberly Willis. When Zachary Beaver Came to Town . 1999. 240p. Holt, $16.95 (0-8050- 6116-9); Yearling, paper, $5.50 (0-440-22904-9). Gr. 4-6. "Nothing ever happens in Antler, Texas," declares Toby Wilson, until a 600-pound boy in a trailer pulls into his sleepy town. Toby and his friend Cal move from curiosity regarding the new boy in town to compassionate friendship as they begin to comprehend what life is like for this orphaned and immobile young man. Health connections abound as readers see concrete ways in which lifestyle affects health, and the importance of effective interpersonal communication. Holt's writing is filled with memorable, moving images.

Jiménez, Francisco. The Circuit . 1999. 144p. Houghton, $15 (0-395-97902-1). Gr. 5-up. This episodic semi-autobiographical novel by a former migrant worker gives readers many examples of perseverance in the face of physical, emotional, and educational challenges. The protagonist's family's struggle with the illness of its baby also offers the opportunity to discuss traditional and nontraditional health care and cultural beliefs. Panchito's story continues in the sequel Breaking Through (Houghton, 2001).

Kanefield, Teri. Rivka's Way . 2001. 144p. Front Street/Cricket, $15.95 (0-8126-2870-5). Gr. 4-6. It is 1778, and Rivka, who suffers from mysterious stomachaches that her doctor father is unable to diagnose, longs to see the bustling city outside the walls of Prague's cramped Jewish quarter, where she has spent all her 15 years. Disobeying her parents and risking the shame of her community, Rivka secretly explores the city; once she acts on her desire, the stomachaches disappear. Rivka's adventure provides an opportunity for students to discuss the consequences of taking risks and the importance of interpersonal communication for building positive, healthy attitudes and critical-thinking skills.

Koss, Amy Goldman. The Girls . 2000. 128p. Dial, $16.99 (0-8037-2494-2); Puffin, paper, $4.99 (0-14-230033-0). Gr. 5-8. The five middle-school friends referred to in the title ride the emotional roller coaster known as adolescence. Sometimes honesty, trust, and empathy prevail; yet, with typical youthful insecurity, real feelings are seldom fully revealed. A range of mental and emotional health issues, including phobias, is sensitively handled. This realistic and engaging book provides a powerful example of how interpersonal communication skills enhance mental health.

Naylor, Phyllis Reynolds. Alice in Lace . 1996. 144p. Simon & Schuster/Atheneum, $17 (0-689-80358-3); Aladdin, paper, $4.99 (0-689-80594-7). Gr. 7-9. When Alice's health class studies critical choices, she and her friends are faced with a range of hypothetical situations that test their ability to investigate real-life issues. An underlying theme is the tension between planning ahead and being unable to predict unexpected events. In this fictional account the parents, older siblings, teachers, and administrators all fill the roles of supportive adults.

Paulsen, Gary. Hatchet . 1987. 208p. Simon & Schuster, $16 (0-02-770130-1); Pulse, paper, $5.99 (0-689-82699-0). Gr. 5-8. When the pilot of the small plane transporting 13-year-old Brian Robeson to Canada dies mid-flight, the young teen manages to land the plane on an isolated island. Stranded with only a hatchet to help him survive the challenges of everyday living, Brian must make crucial decisions in choosing food, shelter, and priorities for action. The narrative provides suspenseful reading and useful information for young adolescents about problem solving, independence, and purposeful action in dangerous situations.

Russo, Marisabina. House of Sports . 2002. 192p. HarperCollins/Greenwillow, $15.95 (0-06-623803-X). Gr. 5-8. For Jim Malone, a seventh-grader and an avid basketball player, changes are occurring all around him. His grandmother has a stroke; his dog, once playful and energetic, is now too old and sick to move without help; and his basketball team now has a female member. As Jim tries to accept these changes, he learns more about his friends, family, and himself. This moving story of Jim's emotional growth highlights issues of health and illness, death and loss, and sacrifice in a sensitive and spiritual manner.

Van Draanen, Wendelin. Sammy Keyes and the Curse of Moustache Mary . 2000. 144p. Knopf, $14.95 (0-375-80265-7); Yearling, paper, $4.99 (0-440-41643-4). Gr. 7-9. Sleuth Sammy Keyes, along with her three friends, assist Lucinda, the 90-year-old granddaughter of Moustache Mary, an early California pioneer, in locating the hidden sack of gold coins Mary wrote about in her diary. This engaging mystery involves age-old themes of friendship and feuding, alongside the perennial teen temptations of drugs and alcohol. With its clear message, this is a perfect book for discussing staying healthy despite peer pressure.

Warner, Sally. How to Be a Real Person (in Just One Day) . 2001. 112p. Knopf, $15.95 (0-375-80434-X). Gr. 5-8. How can a sixth-grader care for her mentally ill mother all by herself? Kara tries to find comfort in her favorite book and a friendship with a classmate, until a caring and perceptive teacher contacts Kara's father and exposes her secret. Many children deal with family circumstances they are reluctant to share. This sensitively written book provides an avenue for a class to explore the steps needed to be an advocate for personal and family health.

White, E. B. The Trumpet of the Swan . Illus. by Fred Marcellino. 1970; reissued 2000. 272p. HarperCollins, $16.95 (0-06-028935-X); HarperTrophy, paper, $6.50 (0-06-440867-1). Gr. 2-4. Louis, a young male trumpeter swan, has no voice. Since trumpeter swans attract mates with their resonant voices, his parents worry about his future. But Louis determinedly makes his way in the world and finds strategies to overcome his disability. He even succeeds in courting his beloved Serena by playing a trumpet. Louis is a great example of perseverance and adaptation when facing a potentially disabling condition.

White, Ruth. Belle Prater's Boy . 1996. 208p. Farrar, $17 (0-374-30668-0); Yearling, paper, $5.50 (0-440-41672-9). Gr. 3-5. Cousins Woodrow Prater and "Gypsy" Arbutus Leemaster both find the strength to face a tragic event during their sixth-grade year in Coal Station, Virginia. In addition, Gypsy learns that physical appearances are not all that matters as she grows to appreciate and love her offbeat cousin. Facing problems, managing stress, and adjusting to loss are all touched on in this beautifully told story.

Wilhelm, Doug. Raising the Shades . 2001. 192p. Farrar, $16 (0-374-36178-9). Gr. 4-7. As 13-year-old Casey struggles to deal with his father's alcoholism, he becomes increasingly isolated and angry. Though the ending is a bit too neat and tidy, Wilhelm's novel realistically shows how devastating the disease can be for family members. Also see Colby Rodowsky's Hannah in Between (Farrar, 1994).

Winick, Judd. Pedro and Me: Friendship, Loss, and What I Learned . 2000. 192p. Holt, paper, $15 (0-8050-6403-6). Gr. 8-up. In graphic art form, Winick helps readers see the compassionate and caring man who became his friend, not just someone afflicted with AIDS. The text contains explicit sexual information regarding AIDS prevention for young adults. It also provides a tangible example of the consequences of choices and will help young adults to identify responsible and harmful behaviors. Winick's simple and forthright story breaks down negative stereotypes about those afflicted with AIDS.

Zinnen, Linda. The Truth about Rats, Rules, and Seventh Grade . 2001. 160p. HarperCollins, $14.95 (0-06-028999-3). Gr. 5-8. A studious seventh-grade girl named Larch lives with her widowed mother in a mobile home park. The mystery of how her father died is entangled with a community history project, a newspaper delivery job, and the special talents of a rat terrier. Communication-especially about a topic as sensitive as a parent's death-is the health focus. Another fine novel exploring this theme is Sis Deans' Racing the Past (Holt, 2001).

Web Connections

• Body and Mind , at http://www.bam.gov , is the kids' page maintained by the Centers for Disease Control and Prevention. With the slogan "Your questions answered--no questions asked," the site seeks to provide health information to kids who might not take their concerns elsewhere. Along with fitness tips, profiles of disease detectives, and health quizzes and games, there is a Teacher's Corner, with preassessment questions to determine what students already know, as well as activity ideas.
• Produced in conjunction with the Epidemic! The World of Infectious Disease exhibit at the American Museum of Natural History, Infection Detection Protection , http://www.amnh.org/nationalcenter/infection , features interactive games, quizzes, and stories about microbes, infections, and disease detectives.
• KidsHealth for Kids , at http://www.kidshealth.org/kid/index.html , features informative articles that provide tips on staying healthy, everyday illnesses and injuries, kids' health problems, and more. A dictionary of medical terms is also included.

Chris Liska Carger and Francine Falk-Ross are faculty members in Northern Illinois University's Department of Literacy Education. Sally Conklin is a faculty member in Northern Illinois University's Counseling, Adult and Health Education Department. Special thanks go to librarian Cleo Pappas, formerly of the Lisle Public Library in Lisle, Illinois, for her help with this article.

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Monday, September 16, 2024

Beloved professor Barbara Mertins passes away at 93

Barbara “Bobby” Jordan Mertins, a distinguished former professor of library science and children’s literature, passed away peacefully on Sept. 6 following a sudden illness. 

A cherished figure in the WVU community, Mertins served as an inspiration to countless students during her tenure from 1969 to 1996. Her passion for education and literature left a lasting impact.

During her 27 years at WVU, Mertins was known not only for her expertise in library science and children’s literature but also for her genuine care for students. She was celebrated for her engaging teaching style, mentoring students well beyond the classroom and promoting a lifelong love of learning. 

Her influence on the curriculum and her passion for children’s literature helped shape the University’s library science program and left a legacy that remains today.

Mertins will be fondly remembered by her family, friends, colleagues and former students for her dedication to education, love of the University community, and her boundless enthusiasm for learning and life. Her legacy at WVU will continue to inspire future generations of students and educators.

She earned her bachelor’s degree from Drew University, where she met her husband, Herman Mertins, former WVU vice president of administration and finance. The couple shared 57 years of marriage before his death in 2011. 

A celebration of her life will be held at 10 a.m. Saturday (Sept. 21) at Community Chapel Church of the Nazarene in Nashua, New Hampshire.

In lieu of flowers, donations may be made in her memory to the Community Hospice House or to the West Virginia University Foundation.

Read Mertins’ obituary.

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• v.14(7); 2022 Jul

Empowering Patients: Promoting Patient Education and Health Literacy

Pradnya brijmohan bhattad.

1 Cardiovascular Medicine, Saint Vincent Hospital, University of Massachusetts Chan Medical School, Worcester, USA

Luigi Pacifico

Patients are generally keen to understand and obtain more information about their medical conditions. There exists a need to develop updated and thorough yet concise patient education handouts and to encourage healthcare providers (HCPs) to use uniform patient education methods.

A thorough review of literature on patient education material was performed prior to starting the study. A comparison with different resources regarding the appropriateness of patient education was done. Educating HCPs to effectively use patient educational materials incorporated into the electronic health record system, including electronic methods, such as the use of a patient portal, to help educate patients. 

Strategies were formulated to reduce the amount of processing and attending time required for fetching appropriate materials and lead to fast, efficient, and effective patient education. To improve the physical and psychosocial wellbeing of a patient, personalized patient education handouts, in addition to verbal education by the HCPs, augment the betterment of patient care via shared decision making and by improving patient satisfaction and health literacy.

Introduction

Patients are often eager to understand and know more about their medical conditions and health situation, and educating them with the most relevant, current, consistent, and updated information helps patients and their families significantly in the medical care and decision-making process [ 1 ]. 

Patients need formal education on the disease condition; they need to know their ailment, understand their symptoms, be educated on the diagnostics, appropriate medication use, and should be taught when to call for help. Several patient education handouts for various conditions are available, and there exists a need to assess which one is better suited for a particular disease/condition encountered and provides concise information. Patient education materials help educate the patients on their health conditions, improves their health literacy, and enhances and promotes informed decision-making based on the most current and updated medical and clinical evidence as well as patient preference [ 2 ].

The aim of this study was to develop updated patient education handouts and materials in addition to verbal counseling of the patients to help them understand the disease condition, diagnostic studies, proper advice on medications, and when to call for help. And to encourage healthcare providers (HCPs) to use uniform patient education materials.

The objectives of this study are 1) the implementation of quality improvement techniques of Plan-Do-Study-Act (PDSA) cycles on patient education in clinical settings; 2) to enhance the delivery of patient education and create awareness amongst the HCPs regarding the importance of patient education and improved health literacy; 3) to verify if patient education handouts have the minimum necessary information that patient should know; 4) to compare patient education handouts from databases integrated in the electronic health record (EHR) with standard patient education database websites like the Centers for Disease Control and Prevention website, and MedlinePlus® site to make sure that they have the minimum necessary information; and 5) to educate and encourage HCPs on the use of appropriate patient education articles in the EHR and utilize an electronic patient portal for patient education, help transition the patient education to an electronic form, and increase efficacy and consistent patient education.

Materials and methods

A comprehensive review of the patient education materials on the most common medical ailments in various clinical settings was performed. We compared the existing patient education database integrated in the EHR with the standard resources such as the CDC, MedlinePlus via retrospective chart study format to ensure the minimum necessary information is available. 

A comparison of existing educational material was completed by analyzing other patient education materials from resources such as UpToDate (the basics/beyond the basics), MedlinePlus, US National Library of Medicine of NIH, CDC, and the US Department of Health and Human Services to ensure that effective, most updated, current, and evidence-based information is provided to the patients from the educational materials.

Search words were incorporated to help search for the educational articles in the existing EHR by the title of the article. Educational materials studied were relevant to the common medical ailments in various clinical settings. The patient handouts were made available in such a way that these should be able to be sent either through an electronic patient portal or printed out.

HCPs were educated in a session with pre- and post-lecture survey qualitative and quantitative questionnaires. The impact of these interventions was further assessed by pre- and post-intervention surveys after educating the HCPs.

Uniform updated patient education handouts were created after comparing them with standard resources. A pre-test survey questionnaire was obtained to discuss with HCPs regarding the current knowledge and practices of the usage of patient education handouts and the understanding of EHR to utilize uniform and standardized patient education handouts. After educating the HCPs, their knowledge regarding the use of EHR to effectively use patient education handouts was tested in a post-test survey questionnaire. After completion of the pre and post-test survey questionnaire by HCPs, analysis of the data performed (Figures ​ (Figures1 1 - ​ -20 20 ).

HCPs - healthcare providers

"Do you feel that attending and processing times required for fetching appropriate educational articles will be reduced if standard materials are outlined?"

“Do you think that efficient patient education is effective in creating and improving adherence to treatment, medication compliance, and for improving overall patient health?”

Quality improvement (QI), problem-solving, and gap analysis

QI techniques, including PDSA cycles, to improve patient education implemented in various clinical settings [ 1 ].

Reasons for Action

There is a need for updated and uniform patient education materials in addition to verbal counseling of the patient to help them understand the disease condition, diagnostic studies, proper advice on medications, and when to call for help, thereby enhancing health literacy. There exists several patient education materials for various ailments, and the need to assess which one is better suited for a disease condition and contains concise information.

Initial State

We reviewed the available patient education material from the patient education database integrated in the EHR, and compared it with current standardized resources such as MedlinePlus, US National Library of Medicine of NIH, CDC, and the US Department of Health and Human Services. A thorough review of literature on patient education material was performed prior to starting the study.

We compared more than one source regarding the appropriateness of patient education, most specifically, how to use the medications and when to call for help. The quality of educational materials regarding disease education, diagnostics education, education on medication use, and education on when to call for help was assessed. The resources described above were utilized for comparison.

Gap Analysis

A graph of the gap analysis is displayed in Figure ​ Figure21 21 below.

Solution Approach

It was noticed that the educational materials were available only in printed format. Enrolling patients on the electronic patient portal helps send educational materials to the patient as a soft copy in a faster and more efficient electronic format. 

Higher attending and processing time is required for fetching appropriate materials due to the unavailability of exact materials and using non-updated educational materials. Therefore, creating an index of educational articles on commonly encountered medical situations and ensuring that these articles are current and updated might make the process more efficient. 

There is a very limited time availability to impart specific educational elements with the limited appointment times. Appropriately detailed educational materials can be sent to the patient via a patient portal even after the patient encounter has ended. For patients with limited technology/computer use, educational materials can be mailed if they're missed during the encounter. 

Inadequate educational methods were utilized; thus, incorporating educational articles from resources other than the databases in the existing EHR, and using the index of educational articles on commonly encountered medical situations were applied.

Inefficient usage of the operational capacity of EHR for patient education, using database integrated in the EHR, and lack of training were identified. As a result, HCPs were trained on using educational materials for their patients in an efficient manner, and patient education was prioritized.

Rapid Experiment: Plan-Do-Study-Act Cycle

Plan: Plan to use appropriate patient education material from several sources made available in the index of the educational articles.

Do: Counsel and verbally educate the patients, along with providing educational materials. Obtain a verbal read-back from the patients about how to use medications and when to call for help.

Study: Use the teach-back method to make patients explain back the information provided in their own words to see if they understood the disease, diagnostics, medication use, and when to call for help to improve health literacy.

Act: If a patient has questions, address them appropriately and if need be, set up a follow-up appointment. 

Actions Taken

An index of educational materials relevant to the common medical ailments in various clinical settings was created. This index of educational materials was to guide HCPs in choosing appropriate and relevant articles in an efficient, quick, and timely manner for patients in various clinical settings. Effective use of patient educational materials in the database incorporated into the EHR, including electronic methods such as the use of the patient portal to help educate patients, was promoted. Alternate resources other than those from the database in the existing EHR were utilized. Educational materials in printed format were made available for patients with limited technology access. The amount of time required for fetching appropriate materials was reduced by creating and referencing to an index for commonly encountered medical situations.

Efficient and faster patient education was imparted with reduced processing and attending time required. Prioritized health education to improve health literacy. Efficient usage of operational capacity of database integrated in the EHR was undertaken to improve health literacy. HCPs were trained to use patient education materials efficiently. 

What Helped

Fast, efficient, and effective patient education helped patients and their families significantly in medical care and shared decision-making based on the most current and updated clinical evidence and patient preference. Creating an index of educational materials relevant to the medical conditions commonly encountered thereby reduced the amount of processing and attending time required for fetching appropriate materials. Effectively using patient educational materials in the database incorporated into the EHR, including electronic methods such as the use of a patient portal to help educate patients, using soft copy (electronic-copy) reduced requirement of printed materials. Correction of misconceptions that patients may have helped improve health literacy. 

What Went Well

Helping engage, encourage, and empower the patients in participating in their own health care and treatment decisions. Enhanced patient satisfaction and better outcomes (for instance, educating a patient on osteopenia encouraged them to continue/start the vitamin D supplementation, participate in regular exercise, healthy diet preferences, and health promotion). 

What Hindered

High HCP turnover rate with changing schedules hindered consistent use of patient education materials. Insufficient number of HCPs trained for patient education.

What Could Improve

Incorporating educational materials in the video format for patients who do not wish to read or talk about their health situations. Enhanced training of all the HCPs for effective and efficient use of patient education resources to allow consistency in effective patient education.

Personalized patient education engages, encourages, and empowers patients in participating in their own health care and treatment decisions and leading to better outcomes, decreased need for excess diagnostic testing, and enhanced patient satisfaction [ 3 , 4 , 5 ]. This needs motivation on the part of the resident doctors, nurse practitioners, physician assistants, physicians, and the allied staff. 

The Advisory Committee on Training in Primary Care Medicine (ACTPCMD) recommends that Health Resources & Services Administration’s (HRSA) Title VII, Part C, Section 747 and 748 education and training programs should prepare students, faculty, and practitioners to involve patients and caretakers in shared medical decision-making which can happen well with better patient education process [ 6 ].

We as HCPs should cultivate good habits amongst ourselves to ensure patients know about their condition and treatment well. This will help increase medication and treatment compliance amongst patients and enhance the physician-patient relationship to a higher level.

Conclusions

To improve the physical and psychosocial well-being of a patient, personalized patient education materials, in addition to verbal education by the HCPs, augment the betterment of patient care via shared decision making and by improving patient satisfaction. There is a need to reiterate that HCPs understand patients' concerns and provide effective patient education and counseling for effective health care delivery.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study

Animal Ethics

Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.