1. Bianca A. Simonsmeier Maja Flaig Michael Schneider
The effects of patient education on health: A second order meta-analysis
Bianca A. Simonsmeier Maja Flaig
Michael Schneider

2. Risks and Side Effects of Surgery and Medication
Complications
Side effects
Over dose
Drug addiction
Resistant bacteria problems
Relevance of medical treatments other than surgery or drug prescription

3. Patient Education
Patient education is an instructional intervention with the goal to inform patients and change attitudes and behavior patterns which in turn helps to recover from their disease
For example pamphlets, conversation, trainings
Mainly conducted by nurses, doctors, pharmacists, psychologists, or social workers
Most commonly for patients with chronic diseases

4. Advantages of Patient Education
Quick and easy
Cheap as compared to surgery or drug prescription
Key variable of informed consent
Strengthens the patients self efficacy and autonomy
No known side effects
No harm of overtreatment

5. But is Patient Education Effective?
“It is commonly believed that psychoeducation interventions are ineffective“ (Donket et al., 2009)
Many studies and meta-analyses
Goal of the current study: Integration of results from previous meta-analyses
Research questions
Causal effect of patient education on health?
For what health outcomes?
For what diseases?
For what instructional methods?

6. 2. Order Meta-Analysis 2. order meta-analysis Meta-analyses … Patients
Our study
Meta-analyses …
Patients
Single studies … …

7. Inclusion Criteria
Comparison between treatment (with patient education) and control group (no patient education)
Effect sizes related to patients (not significant others or healthy population)
Effect for objective or subjective health outcome or health behavior reported
Standardized effect size reported

8. Standardized Literature Search
Databases: PsycINFO, PubMed, Cochrane Library, Eric, explorative search
Search string: meta-analysis AND (patient education OR health education OR psychoeducation)
469 hits
Screening of titles and abstracts  220 articles excluded
Screening of full-texts  202 articles excluded
When studies were included in more than one meta-analytic integration, effect size was excluded from analysis
47 meta-analyses were independently coded by two raters

9. Included Studies 173 effect sizes from 47 meta-analyses
Meta-analyses were from 1980 – 2015
ICD-10-categories: A, B, C, E, F, I, J, K, M, O, Z (Surgery, diabetes, cancer, heart attack, stroke, arthritis, etc.)
Outcomes: blood sugar, medication use, anxiety, death, hospital admission, etc.)

10. Mainly experiments (RCT)
Overall Effect
Meta- analyses
Effect sizes
Cohens d
95% CI
Overall 47
173
0.32
[0.26, 0.39]
Mainly experiments (RCT)

11. 2. Health Outcomes Meta- analyses Effect sizes Cohens d 95% CI
Meta- analyses
Effect sizes
Cohens d
95% CI
Relapse and visits of medical facilities 15 23
0.28
[0.16, 0.39]
Medication 5 7
0.34
[0.11, 0.57]
Pain 8 10
0.23
[0.12, 0.34]
Physiological functioning 27
0.25
[0.07, 0.44]
Physical functioning 11
0.20
[0.02, 0.37]
Psychological functioning 14 35
[0.08, 0.37]
General functioning
0.39
[-0.09, 0.86]
Beispiele für physisch/physiologisch/psychologisch nennen

12. 2. ICD-10 Categories Meta- analyses Effect sizes Cohens d 95% CI
Meta- analyses
Effect sizes
Cohens d
95% CI
C (Neoplasms) 5 10
0.32
[-0.13, 0.77]
E (Endocrine, nutritional and metabolic diseases) 6 45
0.40
[0.20, 0.59]
F (Mental and behavioural disorders) 7 12
0.48
[0.29, 0.68]
J (Diseases of the respiratory system) 20
0.19
[0.07, 0.30]
Z (Factors influencing health status and contact with health services) 16
0.20
[-0.02, 0.42]
Various 18
0.29
[0.19, 0.39]

13. 4. Instructional Methods
Employed
Not employed
Effect sizes
Cohens d
Fact knowledge
125
0.32 13 -
Conceptual understanding 15
0.30 27
0.23
Attitudes 9
0.26 68
0.29
Self-management 82 25
Social skills 19 56
Other skills 38 54
Other content 33
0.22 60
0.33
Keiner der Unterschiede ist bisher statistisch signifikant

14. Discussion Patient education seems to be effective
For various health outcomes
For many diseases
Not exclusively for chronic illnesses (but here more effective?)

15. Discussion Analyses are still running
Statistical analyses for second order meta-analysis in some cases unclear (e.g. how to deal with first and second order sampling error)
Some meta-analyses don't report number of participants or SD/variance of effect size – need to be excluded
Many small meta-analyses

16. Conclusion
Patient education has positive effects on a variety of health outcomes and disease patterns
Results are especially promising as education is cheap and has less risks and side effects as compared to medication use or surgery
Patient education might even be more effective when instructional design principles are considered

17. Thank you! 