This document provides guidance on developing patient education programs for chronic conditions. It discusses principles of patient education including definitions, theories like the Health Belief Model and Social Cognitive Theory, and evidence supporting patient education. The document also covers needs assessment, setting objectives and priorities, educational approaches, and program planning. The overall goal is to empower patients through education tailored to their specific needs and beliefs.

1. Patient Education for Chronic
Conditions
Hana Al-Sobayel, MSc., Ph.D.
Assistant Professor
King Saud University
hsobayel@ksu.edu.sa

2. Objectives
• To understand the principles of patient education
• To be able to assess the needs of the target
population
• To be able to set goals and objectives of a
patient education programme
• To understand the different educational
approaches
• To be able to set up a simple educational
session for a target population

3. Patient Education Principles
Definition
Theories
Evidence

4. Why patient education?
‘… the informed and empowered patient must be
a critical part of any therapy…’
World Health Organization’s Bone and Joint Decade (WHO 2004)
The core concepts of patient education and self-
management involved engagement in self-care,
improved self-monitoring, interactions with health
care professionals and coping with disease.
(Osborne et al. 2004).

5. Definition
"planned, organized learning experiences
designed to facilitate voluntary adoption of
behaviours or beliefs conducive to health"
(Lorig & Visser, 1994)

6. Theories

7. Health Belief Model
(Rosenstock & Becker)
http://www.onlineconsultation.org.uk/

8. Theory of Planned Behaviour
(Ajzen & Feishbein)
http://www.onlineconsultation.org.uk/

9. Transtheoretical Model
Stages of Change
(Prochaska & DiClemente)
www.wipp.nhs.uk/tools_scfp/participants_hbook.

10. Social Cognitive Theory/Self-efficacy
(Bandura)

11. Evidence

12. Health Belief Model
• The beliefs about the seriousness of
osteoarthritis and the amount of symptoms
experienced were strongly associated with more
utilization of medical services, poorer quality of
life, and engagement in more self-management
activities.
(Hampson et al. 1994)
• Patient education for patients with RA showed
positive correlation between the self-efficacy
construct and the adherence to medication.
(Brus et al.1999)

13. Health Belief Model
• Patients’ beliefs about the causes and outcomes
of their condition can predict and influence
patients’ health behaviour. These beliefs can
also act as barriers to interventions, for example,
the belief that painful, stiff joints are a normal
part of aging may mean that patients do not
seek medical help and treatment for their
osteoarthritis
(Carr 2001)

14. Theory of Planned Behaviour
• Beliefs and social norms predicted intentions relevant to
exercises in a group of university students.
(Lowe et al. 2003)
• A booklet was developed targeting older adults to
promote healthy eating and physical activity, contained
persuasive messages targeting perceived behavioural
control and intention and also encourages goal-setting
and planning. The study showed statistically significant
increase in perceived behavioural control and intentions
in the intervention group compared to the control group
on follow up in relation to healthy eating but not physical
activity.
(Kelly & Abraham 2004)

15. Transtheoretical Model
• The Pain Stages of Change Questionnaire was used
with 109 subjects who were undergoing a psychological
self-management treatment for chronic pain. This study
compared the stages of change profile between patients
who completed and those who did not complete the
treatment. Overall, the completers of the self-
management treatment had beliefs consistent with
contemplating stage. The non-completers had beliefs
consistent with precontemplation stage. None of the
demographic variables, the nature or intensity of pain
and disability could predict treatment completion
(Kern & Rosenberg 2000)

16. Self-efficacy
• The Arthritis Self-Management Programme
based on the self-efficacy theory and included
strategies of skill mastery, modelling process,
reinterpretation of symptoms and persuasion
(Lorig et al.1984)
• Stronger self-efficacy beliefs were associated
with self-reports of better functional performance
(Gaines et al. 2002)

17. Needs Assessment
Definition
Process

18. Maslow’s Hierarchy of Needs
cit.dixie.edu/vt/reading/maslow.asp

19. Why need’s assessment?
• It is the first step required to ensure high
quality programmes that are consistent
with the patient-centred approach to
medical care, when treatments are tailored
to fit the needs, beliefs, and preferences of
individual patients.
(Adab et al. 2004)

20. Why need’s assessment?
• Differences existed between patients’ and health
professionals in their preferences related to
quality of care.
(Van der Waal et al. 1996)
• Differences in preferences related to health care
existed between patients from different ethnic
background.
(Byrne et al. 2004)
• Other factors include severity of the symptoms,
age, and income
(Ratcliffe et al. 2004)

21. Definitions
• Health need  ‘what patients – and the
population as a whole desire to receive from
health care services to improve overall health
(Twigg & Atkin 1994)
• These desires may be physical, emotional, or
social and may have a direct effect on patients’
satisfaction and quality of life
(Asadi-Lari et al. 2004)

22. Patient education standards
Joint Commission on Accreditation of
Healthcare Organizations emphasized the
need for:
‘systemic assessment of client’s learning
needs, readiness, barriers, motivation,
limitations, and cultural values and beliefs’
(Cravener 1996)

23. • This process usually preceded the
development of an educational
programme in order to capture individual’s
beliefs, preferences, or requirements.

24. Procedure
• Subjects: Involving key informants: patients,
family members or carers, and health
professionals
– Random sampling
– Purposeful sample
• Methods:
– Survey
– Interviews
– Focus groups

25. Procedure
• Tools: need to be valid and reliable for the
purpose of need’s assessment
• Process: continuous to consider the
changes of disease process and people’s
perceptions

26. Educational Needs
• Patients with chronic disease regardless
of the diagnosis may have similar needs;
e.g. knowledge about the condition, self-
care, or emotional support
(Widerman 2003)

27. Table: Semi-structured questionnaire used to examine the needs of people with
knee OA
1. What are your complaints related to your knee?
2. Which of these complaints are more important to you?
3. Did you have any information about this condition before the diagnosis?
4. What do you know about your condition?
5. Is there someone else in your family that is affected by the same condition?
6. Was this person having the same complaints that you have?
7. If different, why do you think?
8. How does it affect your activities of daily living?
9. How does it affect your state of mind?
10. How does it affect your social life?

28. Putting it all together!

29. Setting priorities
• Listing all behaviours affecting the condition
• Determining which behaviours are most
important in affecting health status
http://www.ahrq.gov/research/
• Determining which behaviours are the easiest to
change, given a limited amount of educational
time

30. Setting objectives
• Process objectives
– Determine the process of patient education
e.g. Fifty people will receive arthritis education
this year
• Outcome objectives
– Changes in health behaviours or health status
e.g. After 6 sessions 70% of people with
arthritis will be able to self-stretch

31. How to write objectives
– Who will perform the behaviour
– What is the specific behaviour
– Under what condition the behaviour will be
performed
– How the outcome will be measured
e.g. “80% of the patients will increase their
score by 10 or more points on an arthritis self-
efficacy scale”

32. Programme planning
• Tips:
– Write few objectives (less than 10)
– Objectives are basis of outcome evaluation
– Write objectives for each session or patient encounter
e.g. “Instructor will make sure that all participants say
something at each session, ensure that 80% of the
participants make commitment to some activity at the
end of the sessions, and use problem-solving
technique”

33. Educational Approaches
• Provision of information
– Booklets/Brochures
– Lectures
– Internet
– Multimedia
• Counseling
– Biopsychosocial model
– Group/individual
– Cognitive-behavioural

34. Educational Approaches
• Multi-disciplinary/Inter-disciplinary
• Multi-dimensional
– Self-management
– Group
– Individual

35. Putting it all together
• Set objectives
• Evaluate resources: time, personnel, money,
space
• Vary the activities
• Use the same instructor or facilitator for every
session
• Tailor teaching patient needs and beliefs
• Patients always have choices
• Evaluate the efficacy of the programme in
changing behaviour or health status

36. References
• Lorig K. (2001). Patient education: a
practical approach. Sage publications,
Thousand Oaks
• http://
www.ahcpr.gov/research/elderdis.htm