The overall goal of this application is to develop alternative multimedia products to translate and disseminate the information provided in Comparative Effectiveness Research Summary Guides (CERSGs) for patients and consumers with low health literacy. For this proposal we have chosen four CERSGs related to three musculoskeletal disorders: osteoarthritis (OA), rheumatoid arthritis (RA) and osteoporosis (OP). They are among the most common chronic disorders and we have extensive expertise in these conditions. We will use a novel approach to translate and disseminate these guides, namely what has been defined as 'health edutainment'products. These are educational and health decision-making tools that use visual, audio, or audiovisual tools, incorporating story lines and narratives to inform consumers about alternative courses of action when facing health problems, with explicit discussion of benefits and risks. Multimedia patient decision aids may be of particular utility in populations with low levels of health literacy.
Our specific aims are: 1) to evaluate the information needs of patients with OA, RA, and OP, and clinicians who treatment them, and test the acceptability of the components of the current CERSGs for these topics;2) to develop low literacy English and Spanish language multimedia patient decision aids (MM-PtDA) following the content of current patient CERSGs for OA, RA, and OP;3) to evaluate the efficacy of the MM-PtDA, compared to current CERSG products, in randomized clinical trials (RCT) including economically disadvantaged and ethnic minority patients;and 4) to develop implementation and dissemination plans for the MM-PtDA. For the first aim we will conduct a qualitative evaluation of the CERSGs of interest and exploration of preferred content and delivery methods. Interviews will be conducted with patients who have OA, RA, and OP to determine their information needs and also acceptability of the current CERSGs. Clinicians who treat these patients will also be interviewed about a) information needs of their patients, b) how decision support technologies might be implemented in their settings, and c) what format the information materials should take. The MM-PtDA product adaptations will be guided by the Edutainment Decision Aid Model (EDAM), a framework for linking learning theory and entertainment education to design engaging and user-friendly decision aids for patients with lower health literacy (Aim 2). The multimedia materials will be distributed together with a booklet containing the key learner content. They will be developed in modules, so they can be easily updated as new information becomes available. We will initially pilot test the developed materials and evaluation tools to adjust and modify them as needed. We will then conduct three RCTs, one for each guide, to test the efficacy of the MM-PtDA, with respect to several outcomes: knowledge, self-efficacy, decisional conflict and self-reported health behaviors (Aim 3). Finally, we will gather a group of stakeholders to assist us with the development of a plan for implementation and dissemination of the MS to the population targets of interest (Aim 4).
Osteoarthritis, rheumatoid arthritis and osteoporosis are among the most common chronic health problems. Patients with these disorders face many treatment options. This project will provide tools for patients with lower health literacy educational tools to assist them in making informed treatment decisions.