title: Enhancing patient understanding of medical procedures: evaluation of an interactive multimedia program with in-line exercises.
abstract: BACKGROUND
  Standard print and verbal information provided to patients undergoing treatments are often difficult to understand and may impair their ability to be truly informed. This study examined the effect of an interactive multimedia informational program with in-line exercises and corrected feedback on patients' real-time understanding of their cardiac catheterization procedure.
  
  
  METHODS
  151 adult patients scheduled for diagnostic cardiac catheterization were randomized to receive information about their procedure using either the standard institutional verbal and written information (SI) or an interactive iPad-based informational program (IPI). Subject understanding was evaluated using semi-structured interviews at baseline, immediately following catheterization, and 2 weeks after the procedure. In addition, for those randomized to the IPI, the ability to respond correctly to several in-line exercises was recorded. Subjects' perceptions of, and preferences for the information delivery were also elicited.
  
  
  RESULTS
  Subjects randomized to the IPI program had significantly better understanding following the intervention compared with those randomized to the SI group (8.3±2.4 vs 7.4±2.5, respectively, 0-12 scale where 12=complete understanding, P<0.05). First-time correct responses to the in-line exercises ranged from 24.3% to 100%. Subjects reported that the in-line exercises were very helpful (9.1±1.7, 0-10 scale, where 10=extremely helpful) and the iPad program very easy to use (9.0±1.6, 0-10 scale, where 10=extremely easy) suggesting good clinical utility.
  
  
  CONCLUSIONS
  Results demonstrated the ability of an interactive multimedia program to enhance patients' understanding of their medical procedure. Importantly, the incorporation of in-line exercises permitted identification of knowledge deficits, provided corrected feedback, and confirmed the patients' understanding of treatment information in real-time when consent was sought.
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, United States; Center for Bioethics and Social Sciences in Medicine, University of Michigan, United States. Electronic address: atait@umich.edu.
authors.forename: Alan R
authors.initials: AR
authors.lastname: Tait
authors.affiliation: Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, United States.
authors.forename: Terri
authors.initials: T
authors.lastname: Voepel-Lewis
authors.affiliation: Department of Cardiology, University of Michigan Health System, Ann Arbor, MI, United States.
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Chetcuti
authors.affiliation: Department of Cardiology, University of Michigan Health System, Ann Arbor, MI, United States.
authors.forename: Colleen
authors.initials: C
authors.lastname: Brennan-Martinez
authors.affiliation: Emergency Care Center, Jackson Memorial Hospital, Miami, FL, United States; ArchieMD, Inc., Boca Raton, FL, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Levine
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods*; D032882:Comprehension; D003194:Computer-Assisted Instruction / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008491:Medical Informatics Applications; D008875:Middle Aged; D019212:Multimedia / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000458:organization & administration*; D015397:Program Evaluation; D014584:User-Computer Interface
keywords: Health information technology; Multimedia; Patient comprehension