Testing a Photo Story Intervention in Paper Versus Electronic Tablet Format Compared to a Traditional Brochure Among Older Adults in Germany: Randomized Controlled Trial

Shu Ling Tan, Amanda Whittal, Sonia Lippke, Shu Ling Tan, Amanda Whittal, Sonia Lippke

Abstract

Background: To increase effective communication in primary care consultations among older adults in Germany, the photo story is considered to be a useful tool based on Bandura's social cognitive theory. With information technology helping to increase effective communication, the use of tablets is gaining attention in health care settings, especially with older adults. However, the effectiveness of tablet technology and photo stories has rarely been tested.

Objective: The aim is to compare the effectiveness of a photo story intervention to a traditional brochure. Both were delivered either in paper or tablet format.

Methods: A trial was conducted with 126 older adults, aged 50 years and older, who were approached and recruited by researchers and administrative staff from senior day care, doctors in rehabilitation centers, and trainers in sports clubs in Germany. Open and face-to-face assessment methodologies were used. Participants were randomly assigned to one of four intervention conditions: traditional brochure in paper format (condition 1) and tablet format (condition 2), and photo story in paper format (condition 3) and tablet format (condition 4). Each participant received a questionnaire and either the traditional brochure or photo story in a paper or tablet version. To evaluate the effectiveness of each intervention, participants completed evaluation questionnaires before and after each intervention. The second part of the questionnaire measured different indicators of health literacy, communication skills, health measurements, and possible underlying mechanisms.

Results: Compared to the traditional brochure, participants considered the photo story easier to understand (t124=2.62, P=.01) and more informative (t124=-2.17, P=.03). Participants preferred the paper format because they found it less monotonous (t124=-3.05, P=.003), less boring (t124=-2.65, P=.009), and not too long (t124=-2.26, P=.03) compared to the tablet format. Among all conditions, the traditional brochure with a tablet (condition 2) was also perceived as more monotonous (mean 3.07, SD 1.08), boring (mean 2.77, SD 1.19), and too long to read (mean 2.50, SD 1.33) in comparison to the traditional brochure in paper format (condition 1). Moreover, the participants scored significantly higher on self-referencing on the traditional brochure in paper format (condition 1) than tablet format for both types of the brochure (conditions 2 and 4).

Conclusions: Traditional brochures on a tablet seem to be the least effective communication option in primary care consultations among all conditions for older adults. The findings might be specific for the current generation of older adults in Germany and need to be replicated in other countries with larger sample sizes. Although information technology brings advantages, such as effective interventions in different fields and settings, it may also come with several disadvantages, such as technical requirements of the users and devices. These should be considered when integrating information technology into wider situations and populations.

Trial registration: ClinicalTrials.gov NCT02502292; https://ichgcp.net/clinical-trials-registry/NCT02502292 (Archived by Webcite at http://www.webcitation.org/747jdJ8pU).

Keywords: communication; electronic/information technology; health literacy; older adults; photo story; primary care consultation; tablet intervention; traditional brochure.

Conflict of interest statement

Conflicts of Interest: None declared.

©Shu Ling Tan, Amanda Whittal, Sonia Lippke. Originally published in JMIR Aging (http://aging.jmir.org), 06.12.2018.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) flow chart.

References

    1. Ekdahl AW, Andersson L, Wiréhn A, Friedrichsen M. Are elderly people with co-morbidities involved adequately in medical decision making when hospitalised? A cross-sectional survey. BMC Geriatr. 2011 Aug 18;11:46. doi: 10.1186/1471-2318-11-46.
    1. Clayman ML, Pandit AU, Bergeron AR, Cameron KA, Ross E, Wolf MS. Ask, understand, remember: a brief measure of patient communication self-efficacy within clinical encounters. J Health Commun. 2010;15 Suppl 2:72–79. doi: 10.1080/10810730.2010.500349.
    1. Hinyard LJ, Kreuter MW. Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Educ Behav. 2007 Oct;34(5):777–792. doi: 10.1177/1090198106291963.
    1. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall; 1977.
    1. Lippke S. Self-efficacy theory. In: Zeigler-Hill V, Shackelford TK, editors. Encyclopedia of Personality and Individual Differences. Switzerland: Springer International Publishing ; 2017 (forthcoming).
    1. Hernandez MY, Organista KC. Entertainment-education? A fotonovela? A new strategy to improve depression literacy and help-seeking behaviors in at-risk immigrant Latinas. Am J Community Psychol. 2013 Dec;52(3-4):224–235. doi: 10.1007/s10464-013-9587-1.
    1. Burke D, Evans J. Embracing the creative: the role of photo novella in qualitative nursing research. Int J Qual Meth. 2011 Jun;10(2):164–177. doi: 10.1177/160940691101000205.
    1. Hinojosa MS, Nelson D, Hinojosa R, Delgado A, Witzack B, Gonzalez M, Elliott W, Steiner J, Fontanez M, Farias R. Using fotonovelas to promote healthy eating in a Latino community. Am J Public Health. 2011 Feb;101(2):258–259. doi: 10.2105/AJPH.2010.198994.
    1. Koops van 't Jagt R, de Winter AF, Reijneveld SA, Hoeks JCJ, Jansen CJM. Development of a communication intervention for older adults with limited health literacy: photo stories to support doctor-patient communication. J Health Commun. 2016;21(sup2):69–82. doi: 10.1080/10810730.2016.1193918.
    1. McNicol S. The potential of educational comics as a health information medium. Health Info Libr J. 2017 Mar;34(1):20–31. doi: 10.1111/hir.12145.
    1. Van-Volkom M, Stapley JC, Amaturo V. Revisiting the digital divide generational differences in technology use in everyday life. N Am J Psychol. 2014;16(3):557–574.
    1. Ramprasad C, Tamariz L, Garcia-Barcena J, Nemeth Z, Palacio A. The use of tablet technology by older adults in health care settings-is it effective and satisfying? A systematic review and meta analysis. Clin Gerontol. 2017 Jun 09;:1–10. doi: 10.1080/07317115.2017.1322162.
    1. Wang DS, Jani AB, Sesay M, Tai CG, Lee DK, Echt KV, Goodman MG, Kilbridge KE, Master VA. Video-based educational tool improves patient comprehension of common prostate health terminology. Cancer. 2015 Mar 01;121(5):733–740. doi: 10.1002/cncr.29101. doi: 10.1002/cncr.29101.
    1. Mueller SK, Giannelli K, Boxer R, Schnipper JL. Readability of patient discharge instructions with and without the use of electronically available disease-specific templates. J Am Med Inform Assoc. 2015 Jul;22(4):857–863. doi: 10.1093/jamia/ocv005.
    1. Jayasinghe N, Isabel Moallem B, Kakoullis M, Ojie M, Sar-Graycar L, Wyka K, Reid MC, Leonard JP. Establishing the feasibility of a tablet-based consent process with older adults: a mixed-methods study. Gerontologist. 2018 May 11; doi: 10.1093/geront/gny045.
    1. Koops van 't Jagt R, Hoeks JC, Jansen CJ, de Winter AF, Reijneveld SA. Comprehensibility of health-related documents for older adults with different levels of health literacy: a systematic review. J Health Commun. 2016;21(2):159–177. doi: 10.1080/10810730.2015.1049306.
    1. Zarin DA, Keselman A. Registering a clinical trial in . Chest. 2007 Mar;131(3):909–912. doi: 10.1378/chest.06-2450.
    1. Fransen MP, Van Schaik TM, Twickler TB, Essink-Bot ML. Applicability of internationally available health literacy measures in the Netherlands. J Health Commun. 2011;16 Suppl 3:134–149. doi: 10.1080/10810730.2011.604383.
    1. Lippke S, Fleig L, Pomp S, Schwarzer R. Validity of a stage algorithm for physical activity in participants recruited from orthopedic and cardiac rehabilitation clinics. Rehabil Psychol. 2010 Nov;55(4):398–408. doi: 10.1037/a0021563.
    1. Lippke S, Fleig L, Wiedemann AU, Schwarzer R. A computerized lifestyle application to promote multiple health behaviors at the workplace: testing its behavioral and psychological effects. J Med Internet Res. 2015;17(10):e225. doi: 10.2196/jmir.4486.
    1. Ziegelmann JP, Lippke S, Schwarzer R. Adoption and maintenance of physical activity: planning interventions in young, middle-aged, and older adults. Psychol Health. 2006;21(2):145–163. doi: 10.1080/1476832050018891.
    1. Dunlop S, Wakefield M, Kashima Y. Pathways to persuasion: cognitive and experiential responses to health-promoting mass media messages. Commun Res. 2009 Dec 04;37(1):133–164. doi: 10.1177/0093650209351912.
    1. Moyer-Gusé E. Toward a theory of entertainment persuasion: explaining the persuasive effects of entertainment-education messages. Commun Theory. 2008;18:407–425. doi: 10.1111/j.1468-2885.2008.00328.x.
    1. Mitzner TL, Boron JB, Fausset CB, Adams AE, Charness N, Czaja SJ, Dijkstra K, Fisk AD, Rogers WA, Sharit J. Older adults talk technology: technology usage and attitudes. Comput Human Behav. 2010 Nov 1;26(6):1710–1721. doi: 10.1016/j.chb.2010.06.020.
    1. Vaportzis E, Clausen MG, Gow AJ. Older adults perceptions of technology and barriers to interacting with tablet computers: a focus group study. Front Psychol. 2017 Oct 04;8:1687. doi: 10.3389/fpsyg.2017.01687. doi: 10.3389/fpsyg.2017.01687.
    1. Hill R, Betts LR, Gardner SE. Older adults’ experiences and perceptions of digital technology: (dis)empowerment, wellbeing, and inclusion. Comput Human Behav. 2015 Jul;48:415–423. doi: 10.1016/j.chb.2015.01.062.
    1. de Graaf A. The effectiveness of adaptation of the protagonist in narrative impact: similarity influences health beliefs through self-referencing. Hum Commun Res. 2013 Oct 03;40(1):73–90. doi: 10.1111/hcre.12015.
    1. Field A. Discovering Statistics Using IBM SPSS Statistics. Los Angeles, CA: Sage Publications; 2017.
    1. Suresh K, Chandrashekara S. Sample size estimation and power analysis for clinical research studies. J Hum Reprod Sci. 2012 Jan;5(1):7–13. doi: 10.4103/0974-1208.97779.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel