title: Comparison of effectiveness and time-efficiency between multimedia and conventional counselling on metered-dose inhaler technique education.
abstract: BACKGROUND
  This study aimed to evaluate whether multimedia counselling (MC) using a touchscreen computer is as effective and time-efficient as conventional counselling (CC) in promoting correct metered-dose inhaler (MDI) technique, with or without the valved holding chamber (VHC).
  
  
  METHODS
  Participants in the MDI-only and MDI-with-VHC groups were randomly assigned to the MC group or CC group. No blinding was imposed. Inhalation technique was assessed using checklists before and after counselling. Time spent on counselling was determined for all participants, while time taken to perfect the technique was determined only for participants who achieved perfect technique within one hour.
  
  
  RESULTS
  The CC group had more elderly participants than the MC group, but the difference was not significant. MDI-only and MDI-with-VHC users showed significant improvement in their inhaler technique after multimedia (44.5 ± 28.0% and 44.1 ± 14.4%, respectively) and conventional counselling (36.8 ± 20.5% and 37.0 ± 14.6%, respectively). No significant difference in MDI technique enhancement was found between the two groups. Although no significant difference was found between the MC and CC groups with regard to the time spent on counselling and the time taken to perfect the technique, the average time spent on counselling was longer for MDI-only users. MDI-only users had 13.5 times the odds of failing to achieve perfect technique compared to MDI-with-VHC users (95% confidence interval 1.50-121.32, p = 0.020).
  
  
  CONCLUSIONS
  MC and CC significantly improved MDI technique. Both methods showed comparable short-term effectiveness and time-efficiency in MDI technique education. VHC was beneficial, especially for MDI-users with hand-lung coordination problems.
authors.affiliation: Clinical Research Centre, Sibu Hospital, 5½ Mile, Jalan Ulu Oya, 96000 Sibu, Sarawak, Malaysia. kingtl@crc.gov.my.
authors.forename: Teck Long
authors.initials: TL
authors.lastname: King
authors.forename: Evelyn Kui Yee
authors.initials: EK
authors.lastname: Kho
authors.forename: Yiek Hung
authors.initials: YH
authors.lastname: Tiong
authors.forename: Siti Norhajariah Binti
authors.initials: SN
authors.lastname: Julaihi
mesh_terms: D000368:Aged; D017028:Caregivers; D003142:Communication; D003376:Counseling; D005260:Female; D006801:Humans; D001239:Inhalation; D008297:Male; D036501:Metered Dose Inhalers; D008875:Middle Aged; D019212:Multimedia; D015999:Multivariate Analysis; D010353:Patient Education as Topic; D010604:Pharmacy; D011369:Professional-Patient Relations; D011446:Prospective Studies; D013997:Time Factors