Background: In the US, 60% of adults have at least one chronic disease (such as diabetes, hypertension, and heart disease) and 42% have more than one. Chronic disease is the leading cause of death and disability and significantly contributes to annual healthcare spending (1). Studies have shown that patient education interventions can improve outcomes in patients with congestive heart failure (CHF) (2). Additional studies have demonstrated that educational videos are effective at improving patient-reported confidence levels (3). A prospective interventional study was conducted at an urban safety net hospital to evaluate the effect of a mobile educational tool delivered to hospitalized patients with CHF and Type 2 Diabetes (T2DM) on patient experience, health literacy, and clinical outcomes. Our hypothesis is that patients who complete the mobile educational experience will have higher quiz scores and patient satisfaction scores compared to patients who do not.
Methods: 124 patients admitted to the medicine inpatient service from September 2021 to October 2022 with a complication related to CHF or T2DM were screened for eligibility and randomized to the intervention group or the control group. The intervention group (n=60) watched a video about their chronic disease (CHF or T2DM) on a tablet computer and then completed a comprehension quiz and a survey. The control group (n=64) completed the same comprehension quiz and survey but did not watch the educational video. Health confidence levels were assessed using two validated tools. Quiz scores, patient satisfaction, and education level were also collected at that time. Additional information about demographics and medical history were collected via retrospective chart review of the electronic health record.
Results: The average quiz score was significantly higher in the intervention group (71.70%) compared to the control group (56.32%) (p< 0.001). The average satisfaction score was not statistically significantly different between the intervention group and the control group. For patients with heart failure, the odds of hospital readmission were lower for those in the intervention group versus the control group at 60 days (OR=0.91) and 120 days (OR=0.42), but not at 30 days or 1 year. After controlling for education level, the association between the intervention and the average quiz score was statistically significant for patients with a high school level of education (p=0.007), but not for patients with middle school or lower level or college or greater level.
Conclusions: Based on our results, we conclude that the mobile educational experience was associated with increasing patients’ knowledge about their chronic disease. The results after controlling for confounding suggest that further efforts can be made to optimize the mobile education experience for patients at lower education levels – a target population our urban safety net hospital and other institutions that care for medically underserved groups. Furthermore, the inconsistent results for the association between the intervention and hospital readmission rates are as expected, given the complex social determinants of health that contribute to patients re-presenting to the hospital. Future patient education interventions can draw upon these insights to improve health literacy through technology integration and mitigate underlying disparities in chronic disease management.