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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 2
| Issue : 1 | Page : 33-38 |
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The effectiveness of multimedia education on patients' knowledge and behavior on fall prevention: An interventional study
Shamsi Nasiri1, Samira Daneshvar2, Habib Emami1, Fatemeh Nasiri1, Dina Batebi1, Fatemeh Bahrambeygi1
1 Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| Date of Submission | 02-Dec-2022 |
| Date of Decision | 20-Jan-2023 |
| Date of Acceptance | 17-Feb-2023 |
| Date of Web Publication | 13-Mar-2023 |
Correspondence Address:
Fatemeh Bahrambeygi
Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran
Iran
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jpdtsm.jpdtsm_104_22
BACKGROUND: Falls are considered a serious problem among hospital events. Patients in hospitals are at risk for falls due to unfamiliar and potentially high-risk environments, weak physical conditions, and medicines that may increase fall risk.
AIM AND OBJECTIVE: There is some evidence that patient education is an important component of multifactorial interventions for falls prevention. Given that patient education has an effective role in falls preventions at hospitals, the purpose of this study was to evaluate multimedia education for preventing falls.
MATERIALS AND METHODS: A quasi-experimental design was used to investigate the effectiveness of educational materials in fall prevention program at Masih Daneshvari hospital. The study was conducted in four models of a patient education program. Patients' knowledge and skill of fall prevention in the hospital were tested on admission (pretest) and day 7 (posttest). The intervention was delivered after admission in all groups.
RESULTS: There were 204 patients in four intervention groups and 50 patients in the control group. The comparison of the intervention groups with the control group showed that the changes in knowledge and behavior in the group that used multimedia education were significantly higher compared to traditional education.
CONCLUSION: The findings of the present study suggest that patient education can be considered one of the main strategies to prevent falls, especially in a hospital setting. Further, the use of multimedia education simultaneously with face-to-face training has a synergistic effect and increases the effectiveness of fall prevention education programs.
Keywords: Behavior, education, fall prevention, knowledge, multimedia
How to cite this article:
Nasiri S, Daneshvar S, Emami H, Nasiri F, Batebi D, Bahrambeygi F. The effectiveness of multimedia education on patients' knowledge and behavior on fall prevention: An interventional study. J Prev Diagn Treat Strategies Med 2023;2:33-8 |
How to cite this URL:
Nasiri S, Daneshvar S, Emami H, Nasiri F, Batebi D, Bahrambeygi F. The effectiveness of multimedia education on patients' knowledge and behavior on fall prevention: An interventional study. J Prev Diagn Treat Strategies Med [serial online] 2023 [cited 2023 Mar 31];2:33-8. Available from: http://www.jpdtsm.com/text.asp?2023/2/1/33/371632 |
| Introduction | |  |
A fall is defined as an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.[1] Falls are considered a serious problem among hospital events.[2] Patients in hospitals are at risk for falls due to unfamiliar and potentially high-risk environments, weak physical conditions, and medicines that may increase fall risk.[3],[4],[5] The Centers for Disease Control and Prevention (CDC) was reported that fall death rates among adults aged 65 years and older increased about 30% from 2009 to 2018 in the United States and the age-adjusted fall death rate is 64 deaths per 100,000 older adults.[6] Each year about $50 billion is spent on medical costs related to nonfatal fall injuries and $754 million is spent related to fatal falls in the United States.[7] Falls are the second leading cause of unintentional injury deaths worldwide. The World Health Organization (WHO) an estimated 684,000 individuals die from falls globally of which over 80% are in low- and middle-income countries each year. Furthermore, 37.3 million falls that are severe enough to require medical attention occur each year.[1] Accordingly, the key to success is the prevention of falls which promotes patient safety and reduction costs related to falls.[3],[8]
There is some evidence that patient education is an important component of multifactorial interventions for falls prevention.[9],[10],[11] Effectiveness of educational interventions in falls prevention is confirmed that individualized patient education programs combined with training in basic prevention care are able to decrease falls rates.[12],[13] Patient education is an interactive process which enable patients to understand their illness conditions and health-promoting behaviors.[14],[15] As well as the result of different researchers confirm that patient education assisted to reduced disagreeable patient experiences in hospitals.[16],[17],[18] Different types and sources of educational materials are used for patient education. Before technological advances, written instructions have been used for patient education, but by increasing access to electronic media, the variety of patient education materials were expanded.[19],[20],[21],[22]
Given that patient education has an effective role in falls preventions at hospitals. The purpose of this study was to evaluate multimedia education for preventing falls.
| Methods | | |
A quasi-experimental design was used to investigate the effectiveness of educational materials in fall prevention program at Masih Daneshvari Hospital. The study was conducted in four models of a patient education program. Patients' knowledge and skill of fall prevention in the hospital were tested on admission (pretest) and day 7 (posttest). The intervention was delivered after admission in all groups.
Educational materials
Video intervention development
In the first instance, the research team reviewed videos for fall prevention which produced by other health-care organizations worldwide. Then, a script was prepared based on the values and policies of Iranian health-care organizations. The data which used for video script content included the fall prevention protocols made available by the Ministry of Health of the Islamic Republic of Iran, the WHO and the CDC. The initial version was assessed by nursing managers, professionals of health education and promotion, and the clinical director, and necessary corrections were made. The finalized video script was sent to the system videographer for video production. After production, the video was sent to nursing managers, professionals of health education and promotion, and the clinical director for additional feedback. The corrections were proposed to produce the final product. The final video product was also duplicated to an external memory for using the TV. The film was shown in the patient's room within the first 24 h of patients' arrival.
Booklet intervention development
The data which used for booklet content included the fall prevention protocols made available by the Ministry of Health of the Islamic Republic of Iran, the WHO and the CDC. After preparing, the relevant content for the booklet, texts were made appropriate to the public. Then, the material was delivered to a designer to construct the illustrations. The initial version of booklet was assessed by professionals of health education and promotion who are experts in educational technologies and media and nurses with expertise in patient safety. All suggestions presented by experts were analyzed. The proposed changes were made to improve the text and illustrations. The final booklet was printed and delivered to patients within the first 24 h of their arrival.
Poster intervention development
The data which used for booklet were used for designing the poster. The material was delivered to a designer to prepare the poster. The initial version of poster was evaluated by professionals of health education and promotion and nurses with expertise in patient safety. Finally, changes were made to improve the text and photo and the final version was prepared.
Content for face-to-face patient education
The same content which was used for video, booklet, and poster was delivered to nurses for face-to-face intervention as a text file.
Participants and setting
In this study, the effectiveness of educational media is compared in education programs for fall prevention. Potential participants were adults admitted to the two infectious disease wards, two respiratory diseases wards, and a chest surgery ward of Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Patients were excluded if they were loss of consciousness and too ill to provide informed consent.
Interventions
Four models of a patient education program were tested. The content in all models contained causes of falls and the development of preventive strategies and behaviors and the design of each material was explained. The first involved providing video material was shown in the patients' room and face-to-face education by a health professional at the patient's bedside. The second model involved providing the written material in the format of poster which was mounted to the wall of the patient's room and the trained health professional follow-up at the patient's bedside. The third model involved providing the written material in the format of booklet which was delivered to the patient and face-to-face education by a health professional at the patient's bedside. The fourth model was complete program involved providing both written materials (poster and booklet), video-based material, and face-to-face education by a health professional at the patient's bedside [Figure 1].
Control
As the education of patients for preventing falls is essential in hospitals, control group received only face-to-face education by a health professional at the patient's bedside without any educational materials.
Instrument
The instruments used to assess fall prevention knowledge and skill were developed from a synthesized literature review. The instrument included a questioner which was assessed fall risk factor and fall prevention knowledge, and a checklist was assessed fall risk prevention skills. The total possible score of the questionnaire was 10 points. Patients with total scores <5 were considered at a high risk of falling. Higher scores indicated better fall prevention knowledge. The total possible score of the checklist was 10 points and the total score >5 points indicated better fall prevention skills.
Data collection and analysis
This study was approved by the National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Science (IR.SBMU.NRITLD.REC.1395.243). Patients admitted who met the inclusion criteria were invited to participate in the study, and informed consent was obtained. The knowledge and skill of all participants were evaluated on admission, and after applying the intervention, the posttest questionnaire and checklist were conducted on day 7 of hospitalization. The data were analyzed using descriptive and inferential statistics.
| Results | | |
Characteristics of participants
The general characteristics of the participants are represented in [Table 1]. Participants in each group were mainly similar. There were 204 patients in the intervention group and 50 patients in the control group. | Table 1: Characteristics of participants' intervention groups (n=204) and control group (n=50)
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Intervention groups
Of the 204 total participants, 106 (51%) were older than 55. One hundred and ten participants (55%) were female and 90 (44%) were male. Nearly half of them had underlying disease 98 (48%). With regard to their academic background, a large proportion of them was high school graduates or less than 150 (73%). None of them had any experience of falling.
Control group
The control group included 50 participants. Twenty-six (52%) of them were older than 55. Of the 50 total participants, 27 (54%) were female and 23 (46%) were male. Only 20 (40%) of them had a university education and 23 (46%) participants had suffered from underlying disease.
Effect of fall prevention education program
Four groups received educational intervention with the media and were compared with the control group, which was trained in the traditional way. In the first intervention group, fall risk factors and prevention methods were shown in a 7-min training video in the patient's room at the time of admission. Furthermore, face-to-face education was offered by a health professional at the patient's bedside. The mean rank of knowledge (Z = −6.374, P = 0.0001) and behavior (Z = −4.524, P = 0.0001) score before in after the intervention was more than the control group. Furthermore, the intervention had a significantly higher score in comprise with intervention group with poster.
A total of 49 patients were in the educational intervention group with booklet. The mean rank of knowledge after the intervention was significantly higher than the mean rank of knowledge before the intervention (Z = −5, P = 0.0001). Comparison of behavior before and after the intervention was also significant (Z = −2, P = 0.046).
Fifty-four people received falling training based on multimedia. Testing of knowledge and performance scores in the intervention group that received multimedia training compared to other groups showed that the changes in knowledge and behavior scores in this group are more than in other intervention groups and control groups. In this section, according to the first type of error less than P < 0.0001 and Z = −6.5388, it can be concluded that the average knowledge rank after the educational intervention was higher than the average knowledge rank before the intervention. Moreover, according to the first type of error <0.01 and Z = 6.763, it can be concluded that the average performance rank after the intervention is significantly different from the average performance rank before the intervention.
Overall, the comparison of the intervention groups with the control group showed that the changes in knowledge and behavior in the groups that used one media education and the group that used multimedia education were significant compared to traditional education (face to face) [Table 2] and [Table 3]. | Table 2: Comparison of the mean±standard deviation score of knowledge and behavior before and after in the intervention and control groups
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 | Table 3: Comparison of the mean±standard deviation of differences in knowledge and behavior scores
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The aim of this study was to investigate the effect of multimedia education on patients' knowledge and behavior regarding falls in Masih Daneshvari Hospital. The study was conducted in four models of a patient education program. Patients' knowledge and skill of fall prevention in the hospital were tested on admission (pretest) and day 7 (posttest).
The results of this study showed the effectiveness of media-based education in increasing knowledge and improving patients' behavior, to fall prevention. Furthermore, our result confirmed that the use of multimedia education simultaneously with face-to-face training has a synergistic effect and increases the effectiveness of training. The use of more interactive media such as educational videos and booklets was more effective than posters. The results are in line with the results of a study by Wang et al. They reported that the use of multimedia education was significantly more effective than the use of one media and that it altered patients' knowledge, attitudes, and behaviors about falling.[23]
The results obtained in the present intervention regarding the relationship between age and the level of knowledge and behavior were similar to the research conducted by Francis-Coad et al. they taught patients how to prevent falls by providing an educational video. They followed patients over 3 months and assessed the barriers to fall prevention programs. The results showed that older people downplayed the link between training programs and falling. Older people were unaware of the consequences of the fall and had lower health. They did not know the meaning of the fall and repeatedly fell.[24]
A study by Jhaveri et al. also showed that a patient education program through video conferencing after hospital discharge could improve patient behavior and prevent falls.[25] A point to consider in the forthcoming research is the emphasis on the use of educational media as a tool to increase the effectiveness of traditional educational methods (face-to-face training). In this study, unlike the study of Jhaveri et al., we emphasize on maintaining interaction with patients and traditional education and consider the use of educational media as a complementary method to increase the effectiveness of traditional education.
Further, Jang and Lee studied the effect of using educational media along with traditional education. In a three-session training program, they taught the elderly the causes of falls and prevention by face-to-face method and provided them with training booklets and files. The education materials were developed in a cartoon form with culturally familiar characters for Koreans. The results demonstrated that the provision of appropriate education can be considered a crucial intervention for fall prevention and increase the confidence of the elderly in adopting preventive behaviors.[26]
In a similar intervention to the present study, Kang and Song compared the effectiveness of the media. One group (49 people) received only video training and the second intervention group (45 people) received video training and a brochure. Findings showed that both intervention groups had higher scores in fall prevention behaviors, and participants trained with video and brochures had higher scores than those trained with video alone.[27] The results of this study are consistent with the results obtained in the present study. With the difference that in the present study, four intervention groups were considered and the effect of the booklet and educational poster methods were evaluated alone.
The evidence obtained from this study as a whole suggests that patient education can be considered one of the main strategies to prevent falls, especially in a hospital setting. Due to the fact that the level of knowledge and behavior in falling prevention decreases with age, so educational programs for the elderly as the target group should be planned to increase the effectiveness of education.
Limitations
The main limitation of our study was the lack of measurement of fall incidence. This means that it was not possible for us to follow-up with patients for a long time and assess the rate of falls in the intervention groups. Another limitation of this study was the evaluation of the intervention over a short period. Due to the fact that patients are hospitalized for a short period and training fall prevention programs in the hospital environment should begin immediately after hospitalization, inevitably the effectiveness of the intervention was evaluated in a short period.
| Conclusion | | |
The findings of the present study suggest that patient education can be considered one of the main strategies to prevent falls, especially in a hospital setting. Further, the use of multimedia education simultaneously with face-to-face training has a synergistic effect and increases the effectiveness of fall prevention education programs.
Consent to participate
All participants were fully informed about the study aims prior to any participation in research activities and they had the opportunity to ask questions throughout the study. Then, the participants signed a letter of informed consent which it was clearly mentioned they are allowed to exit the study whenever they wish and for any reason. All data remained confidential and anonymized. Permission to take notes or record audio was obtained and audio files deleted after research.
Authors' contributions
BF and NS designed the method and prepared educational materials, NF and BD collected the data, DS and EH analyzed the data.
Availability of data and materials
The datasets used and analyzed in the current study are available from the corresponding author at reasonable request.
Financial support and sponsorship
This study has financially supported by the National Research Institute of Tuberculosis and Lung Diseases.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3]
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