Computer-assisted instruction offers the potential to overcome knowledge barriers and improve screening rates

Even patients with minimal education and no computer skills can be successfully educated about health topics using computers, according to new research at Wake Forest University Baptist Medical Center.

Reported in the November issue of the Journal of General Internal Medicine, the study found that patients who used a computer to learn about a screening test for colon cancer were just as knowledgeable about the topic as patients who were educated by a nurse. In addition, the two groups had equal success rates completing the screening test.

"With physicians frequently reporting inadequate time with patients, computer-assisted instruction is a potentially time-saving and cost-effective patient education solution," said David Miller Jr., M.D., lead author and an internal medicine specialist.

In addition, Miller said, the research suggests the potential for computer-assisted instruction to help increase screening rates for colon cancer, which is the second leading cause of cancer-related deaths in the United States. Reported barriers to screening are patient confusion about the screening process and physicians' lack of time to educate their patients.

"This study shows us that even patients with no computer experience can learn just as well from a computer program," said Miller. "The opportunities are boundless to use computers to educate patients. It can save time for a busy medical practice and allow patients to learn at their own pace."

The research involved 194 patients over age 50 whose doctors recommended a fecal occult blood test, which is completed at home. Participants were randomly assigned to learn about the test from a nurse or from an educational computer program. The two groups were similar: half of the patients had not graduated from high school and few had ever used a computer. Most of the patients (65 percent) had never received any screening tests for colon cancer.

Patients in the computer group used a desktop computer to view a multi-media presentation that included graphics and video and audio clips. They used a mouse to advance the program. Patients in the other group met privately with a nurse, who taught them how to complete the screening test.

The following day, all participants were telephoned and asked seven questions to test their knowledge about how to prepare for the screening period, including dietary and medication adjustments, and how to collect samples.

The two groups' knowledge scores were similar, with a trend toward increased knowledge in the computer group: 56 percent versus 41 percent. However, the groups were not large enough to verify that the trend was statistically significant, or was a "true" finding, rather than occurring by chance. Rates for successfully completing the kits were 62 percent in the computer group and 63 percent in the nurse-education group.

Several prior studies have demonstrated that computer-assisted instruction can increase knowledge – this was one of the first to examine whether it can affect screening rates.

"Computer-assisted instruction offers the potential to overcome knowledge barriers and improve screening rates," wrote the authors.

Miller said computer-based learning can potentially be used for a wide variety of patient education topics, including diabetes education, smoking cessation, weight loss, and chronic disease management.