Book Reviews
Patient Education: A Practical Approach
Kate Lorig
ISBN: 978-0-761922-90-2 2000 264 pages Sage Publications, Inc
Margaret McAllister
Lecturer, School of Nursing, Faculty of Nursing and Health, Griffith University, QLD
Patient Education: A Practical Approach by Kate Lorig (2001) is now in its third edition. Lorig writes in an accessible, practical style making frequent use of examples to illustrate ways that learning and change theories can be applied in patient education. Her approach is to describe theoretical and practical concepts thoroughly and then conclude with brief critical comments. The book has 10 chapters which are logically organized. Most chapter headings are arranged around a question -- How do I know what patients want and need? What do we know about what works? How do I get from a needs assessment to a program? This is a useful technique because the reader has a clear idea of not only what the chapter will be about, but why it is important to systematic patient education. Posing a question in this way also helps to emphasise the practical nature of good theory. Knowing what works in patient education, for example, requires knowledge of learning theories and these, for the most part, are competently and simply explained.
I found four chapters in particular to be relevant and refreshing. Chapter One discusses a variety of ways to explore and understand a specific patient group's educational needs and requirements. All too often, patient education proceeds without knowing exactly what the particular group wants and needs, and without understanding their present level of knowledge and skills. This chapter reminds of the need to know your audience and it offers a number of approaches to conduct a needs analysis. Lorig also provides helpful advice in relation to question construction to elicit truthful and complete responses from participants during focus interviews.
Chapter Two presents several learning theories including: the Health Belief Model, Social Learning Theory, Theory of Reasoned Action and Change Theory. It also contains a powerful message: understand the theory and it might help direct what you include in a patient education program, as well as when you use particular teaching strategies. Timing, facilitating change, and motivating for change are all well explained.
Chapter Three discusses planning for evaluation, and contains some basic, clear and key definitions for evaluation procedures, including process evaluation, outcome evaluation, and the difference between subjective and objective data. It also has some really helpful questions to assist in designing a meaningful, yet simple evaluation form.
For example, Lorig suggests that researchers do not ask 'What did you like best about the program' because you are likely to receive motherhood responses like 'everything!' Rather, it is better to ask 'If you could keep only three things in this program what would you keep?' or 'how well prepared was the instructor?'.
Chapter Four gets to the nuts and bolts of patient education - planning the actual program. In this chapter are many practical strategies all educators, seasoned or novice, will likely find helpful. For example, when educating around a health condition, it is useful to list all the behaviors that could be changed. Then select from this list priorities, by either selecting the behaviors that are easier to change, or letting patients choose. As the authors remind, there is always more content and skills to teach than there is time, so it is important to prioritise. Once target behaviors are identified, one must decide what patients need to know and what skills they need to accomplish the behavior. The authors advise that one ought not be distracted by including in the program loads of interesting facts when learning and practicing skills may be more important. It is also important there to base the content on the latest information. The authors list some US health research internet sites which offer current evidence based knowledge. Australian readers might also like to consult the Joanna Briggs Institute on line. Commendably, this chapter focuses very much on the process of patient education offering strategies to encourage interaction and variety so that content is memorable and motivating.
The section on how to use the internet I found particularly useful, because too often students tend to take a received view of the information contained within it and so fail to be discerning and wise. The authors consider safety, judging the credibility of information sources, currency of information, site addresses and useful references and are well worth reading. Readers may find the final chapter which lists American standards for patient education a useful framework for their own quality improvement processes, although as far as I'm aware such standards are yet to filter through to the Australian health care system.
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