Patient education, interaction with healthcare professionals and active care are of central importance within the healthcare system. However, for patients to understand the benefits of health education, there is a great deal of engagement required. Population studies have reported gaps between expectations and actual performance of behaviours related to patient participation in preventative healthcare. Interventions to improve self-management have shown to significantly improve health outcomes, patient satisfaction, coping skills and perceptions of social support. This concept is particularly true for patients with chronic diseases.
Chronic conditions range from minor conditions (e.g. short sightedness and minor hearing loss) to debilitating and restrictive complaints (e.g., musculoskeletal conditions) to potentially life-threatening illnesses (e.g., cancer and coronary heart disease).
Chronic disease is caused by several lifestyle risk factors including tobacco use, high body mass, alcohol use, physical inactivity and high blood pressure.
Trends and burden
Global trends indicate that chronic disease is on the rise, particularly in developed countries, and this is associated with a significant socioeconomic burden to healthcare systems. Evidence in the scientific literature project this burden will grow exponentially if chronic disease trends remain stable.
In Australia, the prevalence of chronic disease is considerably high. According to self-reporting in the 2014-15 National Health Survey, 50% of Australians have at least one prominent (i.e., arthritis, asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease, diabetes or mental health conditions) chronic condition.
This is associated with a considerable burden here in Australia. In fact, chronic disease was responsible for around three-quarters of the total non-fatal burden of disease in Australia in 2011. TheAustralian Institute of Health and Welfare’s (AIHW) has estimated that in 2008-09, health system expenditure on chronic diseases included $7.74 billion for cardiovascular disease, $6.38 billion for mental health, $5.67 billion for musculoskeletal conditions, $4.95 billion for cancer, $4.59 billion for respiratory conditions, $3.39 billion for nervous system disorders and $1.52 billion for diabetes mellitus.
Interestingly, about a third of the burden experienced by the population could be prevented by improving patient education on effective and preventative interventions at reducing chronic disease.
Patient education for chronic diseases
Promoting good lifestyle choices, modifying risk factors, and active patient self-management are effective preventative health interventions to combat chronic disease. This relies heavily on good information and communication practices between clinicians and patients. For patients to understand the benefits of health education, a high level of participation and engagement is required, i.e., an action or behaviour related to improving health.
It was estimated in 1993 that 50% of the annual mortality toll in the US was premature. Importantly, these premature deaths rates could be reduced with simple modification of behaviours, such as tobacco use, good diet, increased physical activity, reduced alcohol consumption and illicit drug use.
Types of interventions
Research into interventions to improve patient education has mixed results. Recent reviews have concluded that there was no evidence to support the widespead introduction of shared care. Computer-based programs for people with chronic disease may combine health information with online peer support, decision support, or help with behaviour change. These programs have also been shown to increase knowledge, feelings of social support, and some clinical outcomes among users. These systems may also help to reduce health care costs.
Decision aids aim to assist individuals in making decisions, where the balance between benefits and harms are not absolutely clear or where there is a substantial degree of uncertainty about the scientific evidence. A systematic review found that decision aids improved knowledge and accuracy of risk perception and increased people’s involvement and degree of comfort with decision making. The effect on actual decisions is variable, although it appears that decision aids reduce the use of discretionary surgery without adverse effects on health outcomes or satisfaction.
Health literacy is defined as the capacity for patients to seek, understand and act on health information. Low health literacy means health communication is poorly understood, leading to inadequate self-management and perceptions of health responsibility and inappropriate health care utilisation. There is some evidence that shows adults with limited health literacy are less likely to ask questions to clinicians and follow through with advice. Limited health literacy is also problematic once information has been accessed. Men with lower health literacy skills were found to be 4 times more likely to refuse the offer for colorectal cancer screening, even if it was recommended by their physician.