This research proposal will explore the uses and benefits of carrying out research on how written information benefits service user prior to treatment. Before being hospitalised many service users know very little about the disease in which they are suffering from, it impacts on their lives and kind of adaptation needed during and after the treatment. This lack of knowledge can cause unnecessary anxiety and stress on top of the physical suffering to a patient. Therefore, this signifies the need for information prior to treatment towards patients extremely important and significant. Limitations of verbal communication especially lack of recording capability and its easiness to be forgotten after the conversation, make written information vital when informing the patients. A hospital where the researcher attended the placement offer verbal and written information prior to treatment which helps service users to familiarise with the new situation but very little has been investigated on how written information benefits patients. The researcher intends to concentrate on the patients' side or receiving side of the written information. Even though the hospital side which tend to stress on diseases and making sure information reaches the patients will also be investigated. Researcher will not investigate information regarding treatment about any specific disease or written information in particular. The findings from the research helps the policy makers decide on what is needed for the patients. Also this will help hospitals acknowledge how to best present and convey information. Furthermore, the findings will benefit patients and members of the public, if the improvement is done regarding the information that has been obtained from hospital prior treatment.
Written information is a form of communicating using written text, graphs, bars, pictures and letters. It is used when hospitals want permanence of information. Currently, the written information in terms of leaflets and posters are mainly used to convey information about the disease in general. The information is not tailored to individuals; leaflets and posters supplied by both hospitals contain hospital health care workers' experience and observation. Normally any patients of particular diseases, for example; Chronic kidney diseases get the same leaflet or booklet and see the same posters used when it comes to written information prior to treatment.
This information is intended to prepare and inform the patients, so that they know what to expect once they make a decision on whether or not to gone ahead with the treatment. But instead of putting importance to individuals, its emphasis is on the group of patients. The concentration is on a particular disease and on how to tackle it. Definitely, a newer and more positive approach is needed to be promoted; by investigating how written information benefits patients prior to treatment, the best ways to prepare and present that information to patients will be found. Patient based strategies that start from information users, patients, which target only a certain area that assist patients can be developed out of this study. This type of strategy coupled with other types of information activities that already exist such as raising awareness, involvement and persuasion of patient's much better care for patient will be obtained. This way written information will not only inform but specifically help patients eliminate their, doubts, insecurities and uncertainties and urge them to take action towards improve their health and by supporting their decisions.
The research objectives will be to determine:
- the benefits of written information
- satisfaction, reaction, motivation, and feelings of the patients towards written information
- effectiveness of the written information in informing the patients
- determine whether the quality of written information prior treatment can be improved
The research study will be in steps. First, the researcher will check existing books and journals to find any related materials and any useful information. The next step will be to carry out a qualitative research in order to find more information on the benefits of written information prior treatment.
The study is significant because it may result into improvement of the patient health care. It may also help the policy makers and hospital health care workers in recognizing important areas that matter the most to patients. This in return will help them provide patients with better service in relation to the information they present and the way they present it. Another thing that this study may contribute is adding additional knowledge as not much research has been done relating to this topic.
When contracted a disease, one has to adapt to life as a patient, which brings its own emotional, physical and psychological disturbances, as well as the experience of concerns, misunderstandings and fears of the unknown.
Information provides an understanding and expiation that problems are normal, make patients think that because other patients have gone through it, then they will. It gives patients confidence if they know others are experiencing the same problems. Information gives the knowledge of the cause and duration of problems patients understood the problems. Information provides an opportunity and permission for patients to ask questions about diseases if explained before treatment starts that some condition will be affected, patient can think about questions to ask about the treatment. Information helps to reduce anxiety caused by problems when discussed at the beginning. Information helps to improve relationship with patients by informing them about what would happen. Written information can be stored for future reference and referred back to when the need arise. Documents such as policies, terms and conditions, confidential information, and instructions are stored and send to patient in written form. Written information can be sent to patient even if patient live far away. Written information can be used when the message is long and is expected to reach a lot of patients. Written information provides more time to patient in order to make decisions about the information. Written information is more organized and ordered, and can serve as a binding contract. Written information can be passed around between various hands and entities while preserving its integrity. Information give patients' clear views of diseases, hence, make them being able to organise their lifestyle according to the new situation. It also prepare them psychological long before the treatment. There are also disadvantages which if not looked on properly may render the whole information useless. Written information misses the advantages of the face to face meeting such as gestures, facial expressions, personality, and instant feedback. Other disadvantages of written information can be in the form of lack of confidentiality and privacy. It is also very rigid to change as it requires time for reviews or additional explanation to be prepared and posted. It lacks feeling and convictions. It requires skills, effort, time and money to present. It requires knowledge, skills and effort on recipient side to be able to absorb the information.
There were other researchers who worked on written information related to patients even though not really dealing with the benefits of it prior treatment. One of the studies was carried out by Zissiadis et al, 2010, to determine the impact of more intensive written information on patients' anxiety and satisfaction levels. The study found no significant change in patients' anxiety and satisfaction levels but patients were satisfied with the information received and not satisfied with information on lifestyle.
In another study Kraemer et al, 2010, conducted a study on patients' awareness of postoperative adhesions, and found out that there was a lack of information among patients and hospital care workers. Kraemer et al concluded that written information before surgery would help to increase awareness.
The benefits of written information in increasing patients knowledge has long been considered for long time (Sandler et al, 1989). Sandler et al investigated on the usefulness and helpfulness of information booklet for patients leaving hospital also found that when patients are given clear instructions about what to do they will take correct action. Written information helped patients to answer questions, enhancing the recall of important information, reducing error and misunderstanding.
All written patient information must be written from the patient's point of view and use plain everyday language to make information easier to understand (NHS general guidelines).
The use of patient friendly text, appropriate, relevant, consistent and explanatory information together with health care workers being helpful by giving patients facts on benefits, side effects and risks of treatment options have been recommended (Moser 1999). Moser also recommended things such as not giving patient too much different information, giving patient support, up to date, evidence based and other sources of information. Other recommendations include the use of short sentences, question and answer format, small blocks of text, bulleted points, active and present tense and lower case letters.
Giving patients proper information, a chance to ask questions and solving doubts increase patients' satisfaction (Perez et al, 2010)
Johnson et al, 2004, mentioned a number of benefits of providing written information at discharge such as decreasing recovery time, reducing read missions, improving confidence, satisfaction and adherence. Written information together with verbal information enables provision of patient care information, improve satisfaction and knowledge (Johnson et al, 2004).
Keating et al suggest that patient trust can be improved if efforts are placed in improving patient to physician interactions. Keating et al also added that patients showed to be more trusting if they receive as much information as they wanted (Keating et al, 2004). However, Raynor et al, 2007, who carried out quantitative and qualitative review, explored best practices in information design and gather inputs from stakeholders workshops that review written information and found out that most patients do not value written information due to the poor quality of leaflets, contents, and layout. They also found out that the information included do not increase knowledge neither does information affect satisfaction or compliance. This finding that information does not affect satisfaction or compliance contradict with other health care workers perspective that the main function of patient information leaflets is to improve compliance.
Raynor et al found that the way risk information was portrayed influenced side effect knowledge. The accurate estimation of the likelihood of a side effect and risk to health could be ensured if risk information was delivered numerically rather than verbally. In their study patients showed concerns about complex language, readability and poor visual presentation of medical information. Patients were critical about the credibility of the information provided. Patients would appreciate information tailored to individual patient with context of specific disease that includes benefit and side effects that could occur. Patients needed and valued written information that helped them in making decision about treatment. Patients needed information for continuous decisions about the interpretation of symptoms, disease and medicines management. Patients did not want written information as a substitute for verbal information. All patients who wanted written information also wanted sufficient detail to meet their needs.
Raynor et al also mentioned that some health care workers wanted the information to be brief and simple while others did not recommend leaflets and in other instances were reluctant to give certain information such as side effect information. Raynor et al observed a gap between leaflets provided and useful information that patient's value, and the need to develop flexible approach that allow for different aspects of varying information depending on the needs.
Data will be collected by talking to the patient directly through interviews, by carrying out related paper reviews and by conducting a survey that will involve distributing thirty questionnaires to patients. The main method will be to distribute questionnaires.
A number of journals and text books will be searched to find materials related to the research topic in order to gain understanding on the written information and gather materials that will be used to construct questionnaires. Then questionnaires will be distributed to patients admitted or attend clinics in hospitals. Researcher will try to get participants who are about to be treated to answer questionnaire. Patients will be asked questions on information effectiveness, its ability to increase patient knowledge, to motivate, to increase confidence and its usefulness.
The research will use exploratory research design this is due to the fact that research intends to gain understanding. This design will also be appropriate because sample size used is small.
Both types of data primary and secondary data will be used. The primary data mainly will be collected through questionnaire given to patients. These will be complemented by researcher's observation and interviews. The interviews will be one to one unstructured but less extensive interviews. This form of interview will help to get information without inconveniencing patients. Researcher's observation, interview result and literature review information will provide the bases for designing and constructing questionnaires.
The questionnaire will include ordinal scale of measurement to assist participants to rank the questions according to participants' agreement. The questions will be scaled from strongly disagree as number one up to strongly agree as number five. The interval scale of measurement will also be used to remove too many options for the participants. For example, a question will ask the participant to select their age in the range ten years such as 50 – 59 years.
Interviews will be conducted to check several things on the hospitals workers to ensure whether they give adequate information and of the good quality:
Train personnel who compile, analyse and write information.
Continuous patient assessment is in place to follow up progress to make sure patient has understood the information.
Information target vulnerable group and address their concerns
Successful ways of informing patients about the diseases are used similar to the commercial ways of marketing the information
Design patient information is tailored according to individual needs not that of one size fit all.
Support and create learning environment for patients by giving them more information in case they want to know more about the disease, reputation of the hospital and doctor who is going to treat them. If patients can also be referred to library and other institutions for further reading.
The subjects covered in the questionnaire will include the areas of research objectives. The questionnaires' questions will seek to find out how the written information prior treatment benefits patients on the patient side for things such as:
Information is friendly and easy enough to motivate patient to complete reading the whole information.
Knowledge obtained has tackled one's concerns and increase patient's confidence in taking action.
Information helpfulness in feeling better patient on making decisions concerning treatment
Satisfaction to the information obtained
Effectiveness of information in informing and making the patient understand the medical procedures
The judgemental sampling technique will be used in selecting the sample. The questionnaire will be distributed to randomised sample of thirty patients in three different hospitals in Milton Keynes. The researcher will distribute the questionnaire in person and take advantage of getting quick response from the participants. This method is also cheap as there will be no transport or postage costs. It is also easy to conduct and get high rate of response. However, due to the nature of the hospital and state of the participants, sick people, it might not be possible to get many participants to participate in answering the questionnaires. The participants will not get any form of payment but will be asked to participate on the voluntary basis.
The research will be harmless to researcher and participants as there will be no experiments conducted. Also there will be no potential risks of any kind as the answering of questionnaires and interviews will be conducted with the permission of the hospital concerned and under the supervision of the health care worker. Furthermore, all participants will fill informed consent form as the evidence of their acceptance.
The researcher will comply with equal opportunities policy by making sure patients from all back ground, race, gender, age and class participate in the survey and interviews. Permission and consultation will be sort from University in case of any major change away from the research proposal.
Confidentiality and anonymity of the data in this research will be ensured by not mentioned names of the participants and hospital departments in which research will be carried out.
The research will start on 15th October, 2010 and finish 15th May, 2011. The research stages and deadlines will include: Data collection from 15th October 2010 to 15th November 2010; Literature review from 16th to 30th November 2010; Research Methodology from 1st to 30th December 2010;
Questionnaire preparation and distribution from 1st January 2011 to 30th February 2011; Questionnaire collection and data analysis from 1st March 2011 to 30th April 2011; Research draft form 1st May 2011 to 15th May 2011; Final research writing and submission from 16th May 2011 to 30th May 2011.
This time table can be changed depending on the completeness of the task at that particular time. However, the submission date, 30th May 2011 will not be compromised because the deadline has been set by the University.
The availability of patients who will be willing and able to carry out interviews and answer questionnaires will be one of constraints when conducting this research. To address this problem enough time has been allocated for this task and number of participants picked, thirty, will be appropriate and easy to get. Regular updates and research progress report will be given to research supervisor after completion of every stage.
Data Collection and analysis
Data will be collected directly by the researcher soon after patient has finished filling questionnaire. When all thirty questionnaires have been filled data will be analysed using SPSS method to find the level of agreement for each question.
Information will be collected from reputable secondary sources mainly books and journals. Primary data will be collected by researcher directly from patients and hospital care workers. The combination of data methods and sources also will help in reinforcing data validity. Higher percentage of similar findings will confirm the validity of the data.
Lack of reliability in measuring process and possibility of change of opinion that can result in data collected from people. In order to remove possibility of error and biasness, it will be essential to investigate one issue using a number of different patients and sources.
Research will be conducted in one town, Milton Keynes, due to time and financial constraints. When it would have wider coverage if it would have been conducted in different towns, Milton Keynes is a multi cultural town with people from different background, race, gender, age group and countries. So three hospitals in chosen for carrying out this research will still provide almost the same coverage.
when conducting a literature review researcher read books, journals, leaflets, booklets, course notes and magazines but none of these sources provide the evidence that topic similar to the research topic has been researched. However, researcher noted a number of written information benefits on these sources that may relate to the benefits of written information prior treatment. These findings will help researcher in construction of questionnaires which will be distributed to the patients. The benefits found in literature review include range from providing permanent record, easy to store and reuse in case of doubt, maintain accuracy, exactness, effectiveness, helpfulness, friendliness and ability of distributing to the patients easily. Written information also pointed out for its ability to reduce anxiety and stress. One of researcher noted that written and oral communication must be used to complement each other. In most cases written information cannot be used and will not serve the purpose alone.
The written information in terms of leaflets and posters are mainly used to convey information about a particular disease in both hospitals researcher intends to carry out her study. The information is not tailored to individuals but rather is of what the hospital health care workers' experienced and observed over a period of time. One size fit all is normally used when it comes to written information prior treatment. It is important to see how this type of information is going to benefits all the patients of the particular disease from different spheres of life.
Despite searching for a long time researcher found no similar study as research topic. Researches on written information about patients were either during the treatment, after treatment, about diseases or about effects of medicine. Even though there are a lot of written information given to patients' prior to treatment, but there has been little research on the benefits of these information. This makes continuing with this research worth doing.
On the other hand, researchers who investigated related topics other ways of improving the way of preparing, delivering and getting feedback information have been recommended by other. Patient led information strategy similar to the strategies in the commercial sector was one of the recommendation, because these strategies have proved be successful. In this type of strategy patient specific information is compiled after obtaining patient symptoms, location and detailed lifestyle information then properly analysed written information given to the patient. Then, other types of information activities such as raising awareness, involvement and persuading patient to participate in treatment follow.
With the written information that relate to patient in hand, the patient can relate to it and this can motivate patient to take action such as show it to family members or help him or her to make decisions. In this way written information does not only inform but also used as a tool to improve health care and support decision making process.
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