Printed educational materials: effects on professional practice and health care outcomes

Vía Sax Institute: PulsE e-bulletin evidence

Printed educational materials (PEMs) are widely used passive dissemination strategies to improve knowledge, awareness, attitudes, skills, professional practice and patient outcomes. Traditionally they are presented in paper formats such as monographs, publication in peer-reviewed journals and clinical guidelines, and appear to be the most frequently adopted method for disseminating information. The objective of this review was to determine the effectiveness of printed educational materials (PEMs) in improving process outcomes (including the behaviour of healthcare professionals) and patient outcomes, and to explore whether particular characteristics of PEMs (e.g. source, content, format, mode of delivery, timing/frequency, complexity of targeted behaviour change) can influence process outcomes. The review included RCTs, controlled clinical trials, controlled before and after studies and interrupted time series analyses that evaluated the impact of printed educational materials on healthcare professionals’ practice and/or patient outcomes. Any objective measures of professional performance (e.g. number of tests ordered, prescriptions for a particular drug), or patient health outcomes (e.g. blood pressure) were included. Twenty-three studies were included in this review. Evidence indicated that PEMs appear to have small beneficial effects on professional practice. RCTs comparing PEMs to no intervention observed an absolute risk difference median: +4.3% on categorical process outcomes (e.g. x-ray requests, prescribing and smoking cessation activities) (range -8.0%to +9.6%, 6 studies), and a relative risk difference +13.6% on continuous process outcomes (e.g. medication change, x-rays requests per practice) (range -5.0% to +26.6%, 4 studies). In contrast, the median effect size was -4.3% for patient outcome categorical measures (e.g. screening, return to work, quit smoking) (range -0.4% to -4.6%, 3 studies). Two studies reported deteriorations in continuous patient outcome data of depression score, smoking cessation attempts. One study comparing PEMs with educational workshops observed minimal differences. Two studies comparing PEMs and education outreach did not have statistically significant differences between the groups. The authors concluded that when compared to no intervention, PEMs when used alone may have a beneficial effect on process outcomes but not on patient outcomes. However the clinical significance of the observed effect sizes is not known and there is insufficient information about how to optimise educational materials. It is also not known under what circumstances and contexts PEMs are more effective or what specific characteristics of printed educational materials make them more effective.

Farmer AP, Légaré F, Turcot L, Grimshaw J, Harvey E, McGowan J, Wolf FM. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008, Issue 3.

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