Skip to main content
Top
Published in: BMC Geriatrics 1/2019

Open Access 01-12-2019 | Research article

An education intervention to improve decision making and health literacy among older Australians: a randomised controlled trial

Authors: Caroline A. Smith, Esther Chang, Gisselle Gallego, Afshan Khan, Mike Armour, Lynda G. Balneaves

Published in: BMC Geriatrics | Issue 1/2019

Login to get access

Abstract

Background

National policies seek to involve older Australian’s in decisions regarding their care; however, research has found varying levels of decision self-efficacy and health literacy skills. An increasing number of older Australians use complementary medicine (CM). We examined the effectiveness of a CM educational intervention delivered using a web or DVD plus booklet format to increase older adults’ decision self-efficacy and health literacy.

Methods

A randomised controlled trial was conducted. We recruited individuals aged over 65 years living in retirement villages or participating in community groups, in Sydney Australia. Participants were randomly allocated to receive a CM education intervention delivered using a website or DVD plus booklet versus booklet only. The primary outcome was decision self-efficacy. A secondary outcome included the Preparation for Decision-Making scale and health literacy. Outcomes were collected at 3 weeks, and 2 months from baseline, and analysed using an adjusted ANOVA, or repeated measures ANOVA.

Result

We randomised 153 participants. Follow up at 3 weeks and 2 months was completed by 131 participants. There was a 14% (n = 22) attrition rate. At the end of the intervention, we found no significant differences between groups for decision self-efficacy (mean difference (MD) 3.8, 95% confidence interval (CI) -2.0 to 9.6 p = 0.20), there were no differences between groups on nine health literacy domains, and the Preparation for Decision-Making scale. Over 80% of participants in both groups rated the content as excellent or good.

Conclusion

Decision self-efficacy improved for participants, but did not differ between groups. Decision self-efficacy and health literacy outcomes were not influenced by the delivery of education using a website, DVD or booklet. Participants found the resources useful, and rated the content as good or excellent. CM Web or DVD and booklet resources have the potential for wider application.

Trial registration

The trial was registered with the Australian New Zealand Clinical Trials Registry: ACTRN (ACTRN12616000135​415). The trial was registered on 5 February 2016.
Literature
2.
go back to reference Zhang AL, Xue CC, Lin V, Story DF. Complementary and alternative medicine use by older Australians. Ann N Y Acad Sci. 2007;1114:204–15.CrossRef Zhang AL, Xue CC, Lin V, Story DF. Complementary and alternative medicine use by older Australians. Ann N Y Acad Sci. 2007;1114:204–15.CrossRef
3.
go back to reference Britt HC, Harrison C, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008;189:72–7. Britt HC, Harrison C, Miller GC, Knox SA. Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008;189:72–7.
4.
go back to reference Anderson EZ. Complementary therapies and older adults. Topics Geriatr Rehabil. 2009;25:320–8.CrossRef Anderson EZ. Complementary therapies and older adults. Topics Geriatr Rehabil. 2009;25:320–8.CrossRef
5.
go back to reference Yen L, Jowsey T, McRae IS. Consultations with complementary and alternative medicine practitioners by older Australians: results from a national survey. BMC Complement Altern Med. 2013;13:73.CrossRefPubMed Yen L, Jowsey T, McRae IS. Consultations with complementary and alternative medicine practitioners by older Australians: results from a national survey. BMC Complement Altern Med. 2013;13:73.CrossRefPubMed
6.
go back to reference Ding D, Grunseit AC, Chau JY, Vo K, Byles J, Bauman AE. Retirement-a transition to a healthier lifestyle? Evidence from a large Australian study. Am J Prev Med. 2016;51:170–8.CrossRef Ding D, Grunseit AC, Chau JY, Vo K, Byles J, Bauman AE. Retirement-a transition to a healthier lifestyle? Evidence from a large Australian study. Am J Prev Med. 2016;51:170–8.CrossRef
7.
go back to reference Cartwright T. "getting on with life": the experience of older people using complementary health care. Soc Sci Med. 2007;64:1692–703.CrossRef Cartwright T. "getting on with life": the experience of older people using complementary health care. Soc Sci Med. 2007;64:1692–703.CrossRef
8.
go back to reference Andrew G. Private complementary medicine and older people: service use and user empowerment. Ageing Soc. 2002;22:343–68.CrossRef Andrew G. Private complementary medicine and older people: service use and user empowerment. Ageing Soc. 2002;22:343–68.CrossRef
9.
go back to reference Williamson AT, Fletcher PC, Dawson KA. Complementary and alternative medicine: use in an older population. J Gerontol Nurs. 2003;29:20–8.CrossRef Williamson AT, Fletcher PC, Dawson KA. Complementary and alternative medicine: use in an older population. J Gerontol Nurs. 2003;29:20–8.CrossRef
10.
go back to reference van Weert JC, van Munster BC, Sanders R, Spijker R, Hooft L, Jansen J. Decision aids to help older people make health decisions: a systematic review and meta-analysis. BMC Med Inform Decis Mak. 2016;16:45. van Weert JC, van Munster BC, Sanders R, Spijker R, Hooft L, Jansen J. Decision aids to help older people make health decisions: a systematic review and meta-analysis. BMC Med Inform Decis Mak. 2016;16:45.
11.
go back to reference Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;14(4):CD004780. Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;14(4):CD004780.
12.
go back to reference Miller SM, Hudson SV, Egleston BL, Manne S, Buzaglo JS, Devarajan K, Fleisher L, Millard J, Solarino N, Trinastic J, et al. The relationships among knowledge, self-eeficacy, preparedness, decisional conflict and decisions to participate in a cancer clinical trial. Psychooncology. 2013;22(3):481–9.CrossRef Miller SM, Hudson SV, Egleston BL, Manne S, Buzaglo JS, Devarajan K, Fleisher L, Millard J, Solarino N, Trinastic J, et al. The relationships among knowledge, self-eeficacy, preparedness, decisional conflict and decisions to participate in a cancer clinical trial. Psychooncology. 2013;22(3):481–9.CrossRef
13.
go back to reference Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–67.CrossRef Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000;15(3):259–67.CrossRef
14.
go back to reference Berkman N, Sheridan S, Donahue K, Halpern D, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.CrossRef Berkman N, Sheridan S, Donahue K, Halpern D, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.CrossRef
15.
go back to reference Tu HT, Cohen GR. Striking jump in consumers seeking health care information. In: Tracking report No 20. Washington DC: Centre for studying Health System Change; 2008. Tu HT, Cohen GR. Striking jump in consumers seeking health care information. In: Tracking report No 20. Washington DC: Centre for studying Health System Change; 2008.
16.
go back to reference Torres RY, Marks R. Relationships among health literacy, knowledge about hormone therapy, self-efficacy, and decision-making among postmenopausal health. J Health Commun. 2009;14(1):43–55.CrossRef Torres RY, Marks R. Relationships among health literacy, knowledge about hormone therapy, self-efficacy, and decision-making among postmenopausal health. J Health Commun. 2009;14(1):43–55.CrossRef
17.
go back to reference Atkin PA, Veitch PC, Veitch EM, Ogle SJ. The epidemiology of serious adverse drug reactions among the elderly. Drugs Aging. 1999;14:141–52.CrossRef Atkin PA, Veitch PC, Veitch EM, Ogle SJ. The epidemiology of serious adverse drug reactions among the elderly. Drugs Aging. 1999;14:141–52.CrossRef
18.
go back to reference Robinson A, McGrail MR. Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Complement Ther Med. 2004;12:90–8.CrossRef Robinson A, McGrail MR. Disclosure of CAM use to medical practitioners: a review of qualitative and quantitative studies. Complement Ther Med. 2004;12:90–8.CrossRef
19.
go back to reference Smith CA, Chang E, Brownhill S, Barr K. Complementary medicine health literacy among a population of older Australians. Evid Based Complement Altern Med. 2016;5672050. Smith CA, Chang E, Brownhill S, Barr K. Complementary medicine health literacy among a population of older Australians. Evid Based Complement Altern Med. 2016;5672050.
20.
go back to reference Smith CA, Chang E, Gallego G, Balneaves LG. An educational intervention to improve health literacy and decision making about supporting self-care among older Australians: a study protocol for a randomised controlled trial. Trials. 2017;18:441.CrossRefPubMed Smith CA, Chang E, Gallego G, Balneaves LG. An educational intervention to improve health literacy and decision making about supporting self-care among older Australians: a study protocol for a randomised controlled trial. Trials. 2017;18:441.CrossRefPubMed
21.
go back to reference Ciciriello S, Johnston RV, Osborne RH, Wicks I, de Kroo T, Clerehan R, O'Neill C, Buchbinder R: Multimedia educational interventions for consumers about prescribed and over-the-counter medications. Cochrane Database Sys Rev. 2013;(4):CD008416. https://doi.org/10.1002/14651858.CD008416. Ciciriello S, Johnston RV, Osborne RH, Wicks I, de Kroo T, Clerehan R, O'Neill C, Buchbinder R: Multimedia educational interventions for consumers about prescribed and over-the-counter medications. Cochrane Database Sys Rev. 2013;(4):CD008416. https://​doi.​org/​10.​1002/​14651858.​CD008416.
22.
go back to reference Wofford JL, Currin D, Michielutte R, Wofford MM. The multimedia computer for low-literacy patient education: a pilot project of cancer risk perceptions. Med Gen Med. 2001;3:23. Wofford JL, Currin D, Michielutte R, Wofford MM. The multimedia computer for low-literacy patient education: a pilot project of cancer risk perceptions. Med Gen Med. 2001;3:23.
23.
go back to reference Kalyuga S, Chandler P, Sweller J. Incorporating learner experience into the design of multimedia instruction. J Educ Psychol. 2000;92:21–36.CrossRef Kalyuga S, Chandler P, Sweller J. Incorporating learner experience into the design of multimedia instruction. J Educ Psychol. 2000;92:21–36.CrossRef
24.
go back to reference Moreno R, Mayer RE. Cognitive principals of multimedia learning: the role of modality and contiguity. J Educ Psychol. 1999;91:358–68.CrossRef Moreno R, Mayer RE. Cognitive principals of multimedia learning: the role of modality and contiguity. J Educ Psychol. 1999;91:358–68.CrossRef
25.
go back to reference Osbourne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the health literacy questionnaire (HLQ). BMC Public Health. 2013;13:658.CrossRef Osbourne RH, Batterham RW, Elsworth GR, Hawkins M, Buchbinder R. The grounded psychometric development and initial validation of the health literacy questionnaire (HLQ). BMC Public Health. 2013;13:658.CrossRef
26.
go back to reference Balneaves LG, Truant TL, Verhoef MJ, Ross B, Porcino AJ, Wong M, Brazier AS. The complementary medicine education and outcomes (CAMEO) program: A foundation for patient and health professional education and decision support programs. Patient Educ Couns. 2012;89:461–8.CrossRef Balneaves LG, Truant TL, Verhoef MJ, Ross B, Porcino AJ, Wong M, Brazier AS. The complementary medicine education and outcomes (CAMEO) program: A foundation for patient and health professional education and decision support programs. Patient Educ Couns. 2012;89:461–8.CrossRef
27.
go back to reference Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44:681–92.CrossRef Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44:681–92.CrossRef
28.
go back to reference O'Connor AM. Validation of a decisional conflict scale. Med Decis Mak. 1995;15:25–30.CrossRef O'Connor AM. Validation of a decisional conflict scale. Med Decis Mak. 1995;15:25–30.CrossRef
29.
30.
go back to reference Belkora J, Miller M, Crawford B, Coyne K, Stauffer M, Buzaglo J, Blakeney N, Michaels M, Golant M. Evaluation of the question listing at the cancer support community. Transl Behav Med. 2013;3:167–71.CrossRef Belkora J, Miller M, Crawford B, Coyne K, Stauffer M, Buzaglo J, Blakeney N, Michaels M, Golant M. Evaluation of the question listing at the cancer support community. Transl Behav Med. 2013;3:167–71.CrossRef
31.
go back to reference O'Connor AM. User manual-decision self efficacy scale. Ottawa: Ottawa Hospital Research Instiutute; 1995. O'Connor AM. User manual-decision self efficacy scale. Ottawa: Ottawa Hospital Research Instiutute; 1995.
32.
go back to reference Bennett C, Graham ID, Kristjansson E, Kearing SA, Clay KF, O'Connor AM. Validation of a preparation for decision making scale. Patient Educ Couns. 2010;78:130–3.CrossRef Bennett C, Graham ID, Kristjansson E, Kearing SA, Clay KF, O'Connor AM. Validation of a preparation for decision making scale. Patient Educ Couns. 2010;78:130–3.CrossRef
33.
go back to reference Faul F, Erdfelder E, Lang AG, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Method. 2007;39:175–91.CrossRef Faul F, Erdfelder E, Lang AG, Buchner A. G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Method. 2007;39:175–91.CrossRef
34.
go back to reference de Achaval S, Fraenkel L, Volk RJ, Cox V, Suarez-Almazor ME. Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty. Arthritis Care Res. 2012;64:229–37.CrossRef de Achaval S, Fraenkel L, Volk RJ, Cox V, Suarez-Almazor ME. Impact of educational and patient decision aids on decisional conflict associated with total knee arthroplasty. Arthritis Care Res. 2012;64:229–37.CrossRef
35.
go back to reference Sidak Z. Rectangular confidence regions for the means of multivariate normal distributions. JASA. 1967;62:626–33. Sidak Z. Rectangular confidence regions for the means of multivariate normal distributions. JASA. 1967;62:626–33.
36.
go back to reference Richardson RTE. Eta squared and partial eta squared as measures of effect size in educational research. Educ Res Rev. 2011;6:135–47.CrossRef Richardson RTE. Eta squared and partial eta squared as measures of effect size in educational research. Educ Res Rev. 2011;6:135–47.CrossRef
37.
go back to reference Shreffler-Grant J, Nichols EG, Weinert C. Bee safe, a skill building intervention to enhance CAM health literacy: lessons learned. Health Promot Pract. 2017;19(3):1–6. Shreffler-Grant J, Nichols EG, Weinert C. Bee safe, a skill building intervention to enhance CAM health literacy: lessons learned. Health Promot Pract. 2017;19(3):1–6.
38.
go back to reference Goeman D, Conway S, Norman R, Morley J, Weerasuriya R, Osborne RH, Beauchamp A. Optimising health literacy and access of service provision to community dwelling older people with diabetes receiving home nursing support. J Diabetes Res. 2016;2016:1-12.CrossRef Goeman D, Conway S, Norman R, Morley J, Weerasuriya R, Osborne RH, Beauchamp A. Optimising health literacy and access of service provision to community dwelling older people with diabetes receiving home nursing support. J Diabetes Res. 2016;2016:1-12.CrossRef
39.
go back to reference Hall AK, Bernhardt JM, Dodd V. Older adults’ use of online and offline sources of health information and constructs of reliance and self-efficacy for medical decision making. J Health Commun. 2015;20:751–8.CrossRefPubMed Hall AK, Bernhardt JM, Dodd V. Older adults’ use of online and offline sources of health information and constructs of reliance and self-efficacy for medical decision making. J Health Commun. 2015;20:751–8.CrossRefPubMed
40.
go back to reference Hoffman AS, Llewellyn-Thomas HA, Tosteson AN, O'Connor AM, Volk RJ, Tomek IM, Andrews SB, Bartels SJ. Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform. BMC Med Inform Decis Mak. 2014;14:112.CrossRefPubMed Hoffman AS, Llewellyn-Thomas HA, Tosteson AN, O'Connor AM, Volk RJ, Tomek IM, Andrews SB, Bartels SJ. Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform. BMC Med Inform Decis Mak. 2014;14:112.CrossRefPubMed
41.
go back to reference Schaller S, Marinova-Schmidt V, Setzer M, Kondylakis H, Griebel L, Sedlmayr M, Graessel EMJ, Kirn S, Kolominsky-Rabas PL. Usefulness of a tailored eHealth Service for Informal Caregivers and Professionals in the dementia treatment and care setting: the eHealth monitor dementia portal. JMIR Res Protoc. 2016;5:e47.CrossRefPubMed Schaller S, Marinova-Schmidt V, Setzer M, Kondylakis H, Griebel L, Sedlmayr M, Graessel EMJ, Kirn S, Kolominsky-Rabas PL. Usefulness of a tailored eHealth Service for Informal Caregivers and Professionals in the dementia treatment and care setting: the eHealth monitor dementia portal. JMIR Res Protoc. 2016;5:e47.CrossRefPubMed
42.
go back to reference Australian Commission on Safety and Quality in Health Care: Health literacy: Taking action to improve safety and quality. In. Sydney: ACSQHC; 2014. Australian Commission on Safety and Quality in Health Care: Health literacy: Taking action to improve safety and quality. In. Sydney: ACSQHC; 2014.
Metadata
Title
An education intervention to improve decision making and health literacy among older Australians: a randomised controlled trial
Authors
Caroline A. Smith
Esther Chang
Gisselle Gallego
Afshan Khan
Mike Armour
Lynda G. Balneaves
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2019
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-019-1143-x

Other articles of this Issue 1/2019

BMC Geriatrics 1/2019 Go to the issue