No, really – patient education that’s actually useful!

by Carolyn Thomas  ♥  @HeartSisters

I think I’ve seen just about every “healthy lifestyle” informational brochure out there. You’ve seen them, too:  Eat better! Lose Weight! Quit Smoking! Get More Exercise! BlahBlahBlah!  None that I’ve found so far, however, mention anything that we don’t already know. Behaviour change is notoriously challenging – otherwise we’d all be doing it already.  It seems to me that the issue is not so much about raising awareness of something that isn’t well understood (Really? Smoking is bad for us?) but more about presenting information in a way that seeks to somehow meaningfully interact with the reader.

In my eternal quest for good solid take-home resources to hand out to the audiences at my women’s heart health presentations, I happened upon one – at last! – that caught my eye.  It’s called Living Well, simply sub-titled “tips for health and happiness”.

I loved the concept of this booklet so much that I immediately ordered 300 of them.* In fact, I was so impressed that I contacted Dr. Miriam Korn personally to thank her for creating such fantastic educational material. She’s the Dalhousie and Harvard-trained psychiatrist who came up with the concept, wrote the content, took all the charming photos in this booklet, and happens to live and practice in my town. You can see the full content of the Living Well booklet online by visiting Dr. Korn’s excellent website, Laughing Sherpa: A Happy Guide for Healthy Living*

But first, here’s why patient education material is so important.

Even if I’d never become a heart patient myself, I can tell you with utter confidence (based on over three decades of experience in public relations, communications and marketing) that no matter how brilliant your advice, if you can’t entice others to read it, listen to it or watch it, it is – trust me! – useless information.

Some of the patient education material I received upon hospital discharge following my heart attack, for example, consisted of barely legible photocopies of photocopies of photocopied brochure reprints.  You’d have to really want to plough through this stuff in order to finish it . . .

Good quality patient education turns out to be more important than many health care providers might imagine.

Dr. John Jakicic’s  2010 study on weight loss and exercise is a stellar example.(1) 

In this study, he and his team wanted to look at the effects of exercise on about 250 sedentary, overweight/obese subjects. One group studied was assigned to be a self-help group only – just some informational pamphlets and newsletters about the benefits of regular exercise; the study authors offered neither specific goals nor any personal contact to these folks for the 18 month duration of the study. 

But other subjects received targeted and intense prescriptive help throughout: cheerleading phone calls, weekly behavioural intervention sessions, regular and ongoing follow-up, on-site exercise facilities to help each group member reach specific exercise goals as set for them by the study authors.

The results were astonishing.  It turns out that by the end of the study, the self-help group (informational pamphlets only) exercised more (75 minutes/week on average) than the carefully monitored and personally supported group (just 66 minutes of exercise per week compared to their 150 minute goal as instructed).

That’s a pretty powerful endorsement of the wisdom in providing people good basic information (and a surprising result from those who had the luxury of all that hand-holding personal support!)

So here’s what makes Dr. Korn’s Living Well booklet equally impactful.  For each of the 10 lifestyle topics she covers in this little publication, she asks a series of questions that essentially ask:

• Where are you now?
• Where would you like to go?
• How will you get there?

She includes in the early pages of her booklet some sample answers that aim to spark ideas in the reader who answers the questions listed.  For example, in the Eat Well section, we see this page that includes some possible sample answers:

Now, packing veggies for your lunch this week may not sound nearly as impressive a goal as your doctor’s advice to “Lose 20 pounds!”, but when it’s a small self-directed goal that the patient personally comes up with, it might well be a small, successful step to far bigger steps down the road.  As the late tennis legend Arthur Ashe once advised:

“Start where you are. Use what you have. Do what you can.”

When we met in person recently, Dr. Korn explained to me that the focus throughout Living Well reflects the same way she approaches behaviour change challenges that her own clients go through every day.

For people living with heart disease, an approach like this that helps us plan and achieve our own health goals is critically important.

The reality is that one of the biggest risk factors for having a heart attack is having already had one. And we’re far more likely to suffer another cardiac event if we don’t make permanent improvements to our diet, our exercise routines, our stress management skills, our sleep/smoking habits – and so much more.

The self-directed Living Well format reminds me of Dr. Victor Montori and his Mayo Clinic-based team’s approach to what they call Minimally Disruptive Medicine. This innovative concept differs significantly from the current medical trend of treating to numbers: your diagnostic test numbers are too high, you need to _____ (fill in the blank: take a different drug, take more of your existing drug, see a specialist, have more tests done, come back for more appointments, etc.)  – each “solution” adding to what Dr. Montori calls your “burden of treatment“.

Patients treated like this are thus typically on the receiving end of doctors’ orders.  If you fail to follow orders, you’re labelled “non-compliant“, a patronizing term that makes many patients cringe. 

Minimally Disruptive Medicine, by comparison, does note diagnostic test results but only as a starting point from which to ask: “What are the treatment goals of this particular patient?” 

That’s also what Dr. Korn’s Living Well booklet focuses on, too: “What are the patient’s goals?” –  instead of “What can I convince the patient to do in order to get the results I want to see?”

She reminds us that every self-directed goal that we individually come up with should be a SMART goal:

• Specific – not just ‘get more exercise’, but narrow that down: “walk after lunch”
• Measurable – how much? how many? – this helps you make adjustments if necessary to help you meet the goal, e.g. “walk Monday/Wednesday/Friday after lunch for 15 minutes”
  
• Attainable – you want to aim to accomplish something that’s not too easy, not too challenging – but as Dr. Korn suggests, what will “help you grow positively”
• Realistic – don’t set goals based on what you “should” be doing, but rather on what you’ll have a reasonable chance of achieving, or on what needs minor adjustment
• Timely – a start date to get going, and an end date to work towards

The Living Well booklet is a practical take-home resource that helps to involve patients in the same way Dr. Korn essentially approaches helping them in her practice.

Besides their immediate health issues, for example, she likes to ask her patients:

• about how they’re connecting with family or friends
• about how they’re coping with stress
• about how they’re sleeping at night

She offers these samples of how conversations with her patients might go, using the Living Well booklet as a resource:

Patient A:  “I’d like to run a road race some day.”

Dr. Korn: “What could you do today to get one step closer to that goal?”

Patient A:  “I could go for a walk with my dog.”

or

Patient B:   “I want to start painting again.”

Dr. Korn: “What could you do today to get one step closer to that goal?”

Patient B:  “I could get out my paints, and paint for 10 minutes.”

Dr. Korn encourages us to use Living Well like a mini-workbook to write about each personal goal. Setting clear goals is better than having no goals, but writing these goals down in a workbook format is widely considered to be even better.

Most of us have years of experience rehearsing the poor habits that we say we’d like to change or stop someday.  It’s tempting to view these (especially after repeated failed attempts to change the habits) like this:

• “I guess this is simply the way things are.”
• “I just don’t have any willpower.”
• “I’ve tried before to do this – but failed.” 

That flawed perspective can convince us our strengths and abilities are in fact fixed, and incapable of improvement over time.  The way we are is just the way we’re doomed to remain forever.

This is also why diets don’t work.

It’s why New Year’s resolutions are so often abandoned.

It’s why you see all those barely-used stationary bikes at yard sales.

And it’s also why Dr. Korn says she’d love to see copies of the Living Well booklet in every doctor’s office:

“I hope to provide information and inspiration to help foster positive growth, step by step.

“Small changes can have a big impact!“

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♥  Thanks to Victoria’s Island Heart To Heart Program Coordinator Bernadette Carson for giving me my first copy of Dr. Korn’s Living Well booklet!

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(1) Jakicic, J., Otto, A., Lang, W., Semler, L., Winters, C., Polzien, K., & Mohr, K. (2010). The Effect of Physical Activity on 18-Month Weight Change in Overweight Adults. Obesity, 19 (1), 100-109 DOI: 10.1038/oby.2010.122

(2) Schippers, M.  Scheepers, A.  Peterson, J.  A scalable goal-setting intervention closes both the gender and ethnic minority achievement gap. Palgrave Communications. Article number: 15014 doi:10.1057/palcomms.2015.14.  Published online 09 June 2015.

*  The full content of Living Well is online at her website, Laughing Sherpa (on which you’ll also find intriguing extras like “Why I Prescribe Chocolate“ and recipes for Simple Tasty Treats, including my favourite yummy AND healthy Chocolate Avocado Mousse).

Q:  What has your experience been so far with patient education brochures?

See also:

Why don’t patients take their meds as prescribed?

Non-inspirational advice for heart patients

Why you’ll listen to me – but not to your doctor

Why don’t patients listen to doctors’ heart-healthy advice?

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