title: Printed educational materials: effects on professional practice and health care outcomes.
abstract: BACKGROUND
  It is often assumed that merely providing information in an accessible form will influence practice. Although such a strategy is still widely used in an attempt to change behaviour, there is a growing awareness that simply providing information may not lead to appropriate changes in the practice of health care professionals.
  
  
  OBJECTIVE
  To assess the effects of printed educational materials in improving the behaviour of health care professionals and patient outcomes.
  
  
  METHODS
  We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, reference lists of articles, and contacted content area experts.
  
  
  METHODS
  Randomised trials, interrupted time series analyses and non equivalent group designs with pre-post measures of interventions comparing 1. Printed educational materials versus a non-intervention control; and 2. Printed educational materials plus additional implementation strategies versus printed educational materials alone. The participants were any health care professionals provided with printed educational materials aimed at improving their practice and/or patient outcomes.
  
  
  METHODS
  Two reviewers independently extracted data and assessed study quality.
  
  
  RESULTS
  Eleven studies were included involving more than 1848 physicians. It proved impractical to examine the impact of interventions quantitatively because of poor reporting of results and inappropriate primary analyses. Nine studies examined comparison 1. Estimates of the benefit from printed educational materials ranged from -3% to 243.4% for provider outcomes, and from -16.1% to 175.6% for patient outcomes, although the practical importance of these changes is, at best, small. Six studies (seven comparisons) examined comparison 2. Benefits attributable to additional interventions ranged from -11.8% to 92.7% for professional behaviour, and -24.4% to 74.5% for patient outcomes. Two of the 14 estimates of professional behaviour, and two of the 11 estimates of patient outcomes were statistically significant.
  
  
  CONCLUSIONS
  The effects of printed educational materials compared with no active intervention appear small and of uncertain clinical significance. These conclusions should be viewed as tentative due to the poor reporting of results and inappropriate primary analyses. The additional impact of more active interventions produced mixed results. Audit and feedback and conferences/workshops did not appear to produce substantial changes in practice; the effects in the evaluations of educational outreach visits and opinion leaders were larger and likely to be of practical importance. None of the studies included full economic analyses, and thus it is unclear to what extent the effects of any of the interventions may be worth the costs involved.
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, Yorkshire, UK, Y01 5DD. nf2@york.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Freemantle
authors.forename: E L
authors.initials: EL
authors.lastname: Harvey
authors.forename: F
authors.initials: F
authors.lastname: Wolf
authors.forename: J M
authors.initials: JM
authors.lastname: Grimshaw
authors.forename: R
authors.initials: R
authors.lastname: Grilli
authors.forename: L A
authors.initials: LA
authors.lastname: Bero
mesh_terms: D004502:Education, Medical, Continuing; D006282:Health Personnel / Q000193:education*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care; D013664:Teaching Materials / Q000592:standards*