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Open Access 03-03-2023 | Original Article

Values and tensions of a health education program based on evidence-based medicine: a qualitative study

Authors: John Vergel, Ana-Lucía Casallas-Murillo, Diana-Marcela Laverde-Robayo, Pablo Cristancho-Casallas

Published in: Journal of Public Health | Issue 5/2024

Abstract

Aim

This study explored how patients, caregivers, clinicians, designers, and funders who worked collaboratively on a health education program experienced its design. The program was based on evidence-based medicine and knowledge transmission.

Subject and methods

Through exploratory qualitative research, the authors conducted 21 semistructured interviews, collected six nonparticipatory observations, and conducted a documentary analysis. Data were analyzed using thematic analysis, producing rich descriptions about the participants’ experiences. The researchers’ interpretations were validated through peer review.

Results

Three themes were revealed by the findings: background, values, and tensions. All participants had a range of assumptions about this experience regarding which evidence-based recommendations should be prioritized and disseminated to patients/caregivers in program implementation. These assumptions were based on participants’ beliefs about how people make evidence-informed decisions, allowing them to take charge of their health. The authors found a gap between these assumptions and the purposes of the educational program.

Conclusion

Although health education programs aim to foster patients’ informed decision making and health empowerment, in our case we found some assumptions that were not in line with the objectives of the educational program. We hypothesize that some gaps in the program design, derived from different assumptions, such as (a) conflicts of particular interests, (b) knowledge gaps about health-disease processes, and (c) power asymmetries between doctors and patients/caregivers, could hinder the goals of health education (e.g., engagement) in the practice of evidence-based medicine.

Baky V, Moran D, Warwick T, George A, Williams T, McWilliams E, Marine JE (2018) Obtaining a follow-up appointment before discharge protects against readmission for patients with acute coronary syndrome and heart failure: a quality improvement project. Int J Cardiol 257:12–15. https://doi.org/10.1016/j.ijcard.2017.10.036CrossRefPubMed

Baur C, Martinez LM, Tchangalova N, Rubin D (2018) A review and report of community-based health literacy interventions. Community-based health literacy interventions: proceedings of a workshop. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK500372/ Accessed 15 July 2022

Bigi S (2016) Communication skills for patient engagement: argumentation competencies as means to prevent or limit reactance arousal, with an example from the Italian healthcare system. Front Psychol 7:1472. https://doi.org/10.3389/fpsyg.2016.01472CrossRefPubMedPubMedCentral

Bigi S (2021) Achieving shared understanding in chronic care interactions: the role of caregivers. Working With Older People 25:245–252. https://doi.org/10.1108/WWOP-06-2021-0028CrossRef

Bridges J, Flatley M, Meyer J (2010) Older people’s and relatives’ experiences in acute care settings: systematic review and synthesis of qualitative studies. Int J Nurs Stud 47:89–107. https://doi.org/10.1016/j.ijnurstu.2009.09.009CrossRefPubMed

Cohen L, Manion L, Morrison K (2017) Research methods in education. Routledge, LondonCrossRef

Dogba MJ, Dossa AR, Breton E, Gandonou-Migan R (2019) Using information and communication technologies to involve patients and the public in health education in rural and remote areas: a scoping review. BMC Health Serv Res 19:1–7. https://doi.org/10.1186/s12913-019-3906-7CrossRef

Drake C, Abadi MH, Batchelder HR, Richard BO, Balis LE, Rychener D (2022) National implementation of a group-based program promoting patient engagement and peer support in the Veterans Health Administration: a multi-methods evaluation. Int J Environ Res Public Health 19:8333. https://doi.org/10.3390/ijerph19148333CrossRefPubMedPubMedCentral

Eichbaum QG, Adams LV, Evert J, Ho M-J, Semali IA, van Schalkwyk SC (2021) Decolonizing global health education: rethinking institutional partnerships and approaches. Acad Med 96:329–335. https://doi.org/10.1097/ACM.0000000000003473CrossRefPubMed

Epstein RM, Street Jr RL (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. National Cancer Institute. http://hdl.handle.net/2027/uc1.c086898215 Accessed 07 July 2022

Favaretti C, Vandormael A, Hachaturyan V, Greuel M, Gates J, Bärnighausen T, Adam M (2022) Participant engagement and reactance to a short, animated video about added sugars: web-based randomized controlled trial. JMIR Public Health Surveill 8:e29669. https://doi.org/10.2196/29669CrossRefPubMedPubMedCentral

Ferreira P, Porto IS, Santo F, Figueiredo N, Enders BC, Cameron LE, Araújo S (2021) Health education for hospitalized patient in nursing care: a conceptual analysis. Revista Brasileira de Enfermagem 75:e20200459. https://doi.org/10.1590/0034-7167-2020-0459CrossRefPubMed

Graffigna G, Barello S (2018) Spotlight on the Patient Health Engagement model (PHE model): a psychosocial theory to understand people's meaningful engagement in their own health care. Patient Preference Adherence 12:1261–1271. https://doi.org/10.2147/PPA.S145646CrossRefPubMedPubMedCentral

Hayes C (2022) Methodology and method in case study research: framing research design in practice. In: White Watson S, Austin S, Bell J (eds) Conceptual analyses of curriculum inquiry methodologies, 1st edn. IGI Global, Hershey, pp 138–154. https://doi.org/10.4018/978-1-7998-8848-2.ch007CrossRef

Hoffmann TC, Montori VM, Del Mar C (2014) The connection between evidence-based medicine and shared decision making. JAMA 312:1295–1296. https://doi.org/10.1001/jama.2014.10186CrossRefPubMed

Jacob C, Bourke S, Heuss S (2022) From testers to cocreators-the value of and approaches to successful patient engagement in the development of eHealth solutions: qualitative expert interview study. JMIR Human Factors 9:e41481. https://doi.org/10.2196/41481CrossRefPubMedPubMedCentral

Jureidini J, McHenry LB (2022) The illusion of evidence based medicine. BMJ 376:o702. https://doi.org/10.1136/bmj.o702CrossRefPubMed

Khatib R, Schwalm J-D, Yusuf S, Haynes RB, McKee M, Khan M, Nieuwlaat R (2014) Patient and healthcare provider barriers to hypertension awareness, treatment and follow up: a systematic review and meta-analysis of qualitative and quantitative studies. PLoS One 9:e84238. https://doi.org/10.1371/journal.pone.0084238CrossRefPubMedPubMedCentral

Lorig KR, Holman HR (2003) Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 26:1–7. https://doi.org/10.1207/S15324796ABM2601_01CrossRefPubMed

Mathew A, Clase CM (2022) Conflicts of interest and the trustworthiness of clinical practice guidelines. Clin J Am Soc Nephrol: CJASN 17:771–773. https://doi.org/10.2215/CJN.04640422CrossRefPubMedPubMedCentral

Mbah M, Bang H, Ndi H, Ndzo JA (2021) Community health education for health crisis management: the case of COVID-19 in Cameroon. Int Quarterly Commun Health Educ. https://doi.org/10.1177/0272684X211031106

Nutbeam D (2021) From health education to digital health literacy – building on the past to shape the future. Glob Health Promot 28:51–55. https://doi.org/10.1177/17579759211044079CrossRefPubMed

Petersson C, Nygårdh A, Hedberg B (2022) To support self-management for people with long-term conditions - The effect on shared decision-making, empowerment and coping after participating in group-learning sessions. Nurs Open 9:2444–2453. https://doi.org/10.1002/nop2.1261CrossRefPubMedPubMedCentral

Pueyo-Garrigues M, Whitehead D, Pardavila-Belio MI, Canga-Armayor A, Pueyo-Garrigues S, Canga-Armayor N (2019) Health education: a Rogerian concept analysis. Int J Nurs Stud 94:131–138. https://doi.org/10.1016/j.ijnurstu.2019.03.005CrossRefPubMed

Quintero GA, Vergel J, Arredondo M, Ariza MC, Gómez P, Pinzon-Barrios AM (2016) Integrated medical curriculum: advantages and disadvantages. J Med Educ Curric Dev 3:JMECD.S18920. https://doi.org/10.4137/JMECD.S18920CrossRefPubMedPubMedCentral

Reynolds-Tylus T (2019) Psychological reactance and persuasive health communication: a review of the literature. Front Commun 4:56. https://doi.org/10.3389/fcomm.2019.00056CrossRef

Roaldsen KS, Walter C, Gäverth J, Dohrn IM (2022) Between commitment and avoidance - working age stroke survivors' perceptions of physical activity and sedentary behaviour: a qualitative study. BMC Neurol 22:1–9. https://doi.org/10.1186/s12883-022-02704-3CrossRef

Shim JL, Hwang SY (2017) Long-term effects of nurse-led individualized education on middle-aged patients with acute coronary synrome: a quasi-experimental study. BMC Nurs 16:59. https://doi.org/10.1186/s12912-017-0254-yCrossRefPubMedPubMedCentral

Silverstein LB, Auerbach CF, Levant RF (2006) Using qualitative research to strengthen clinical practice. Prof Psychol Res Pract 37:351–358. https://doi.org/10.1037/0735-7028.37.4.351CrossRef

Skelton A (1998) The hidden curriculum of patient education for low back pain in general practice. Sociology of Health & Illness 20:96–111. https://doi.org/10.1111/1467-9566.00082CrossRef

Stake R (2011) Program evaluation particularly responsive evaluation. J MultiDisciplin Eval 7:180–201CrossRef

Tan CS, Hassali MA, Neoh CF, Saleem F (2017) A qualitative exploration of hypertensive patients’ perception towards quality use of medication and hypertension management at the community level. Pharm Pract 15:1074–1074

van Heijster H, van Berkel J, Abma T, Boot CRL, de Vet E (2020) Responsive evaluation of stakeholder dialogue as a worksite health promotion intervention to contribute to the reduction of SEP related health inequalities: a study protocol. BMC Health Serv Res 20:1–9. https://doi.org/10.1186/s12913-020-5020-2CrossRef

Ye Q, Patel R, Khan U, Boren SA, Kim MS (2020) Evaluation of provider documentation patterns as a tool to deliver ongoing patient-centred diabetes education and support. Int J Clin Pract 74:e13451. https://doi.org/10.1111/ijcp.13451CrossRefPubMed

Yu H, Côté P, Southerst D, Wong JJ, Varatharajan S, Shearer HM, Gross DP, van der Velde GM, Carroll LJ, Mior SA, Ameis A, Jacobs CL, Taylor-Vaisey AL (2016) Does structured patient education improve the recovery and clinical outcomes of patients with neck pain? A systematic review from the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration. Spine J 16:1524–1540. https://doi.org/10.1016/j.spinee.2014.03.039CrossRefPubMed

Title: Values and tensions of a health education program based on evidence-based medicine: a qualitative study
Authors: John Vergel
Ana-Lucía Casallas-Murillo
Diana-Marcela Laverde-Robayo
Pablo Cristancho-Casallas
Publication date: 03-03-2023
Publisher: Springer Berlin Heidelberg
Published in: Journal of Public Health / Issue 5/2024
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI: https://doi.org/10.1007/s10389-023-01839-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Values and tensions of a health education program based on evidence-based medicine: a qualitative study

Abstract

Aim

Subject and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim

Subject and methods

Results

Conclusion

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