Producing content for delivering Information Therapy in India – opportunities and challenges

2nd Annual ConferenceUsing Information Therapy to Put Patients FirstFree Registrations: www.patientpower.in

Mr Parag Vora, CEO, PEAS. www.peasonline.com

Ram Khare, a security guard in a Mumbai suburban society, visits a doctor for his chronic cough, which is diagnosed as ‘bronchitis’. His doctor gives him medicines along with printed material on how bronchitis can be managed effectively. This handout is in three languages – English, Hindi, and Marathi. However, that doesn’t solve the issue. Ram Khare can’t read or write. How does Information Therapy come to the rescue here?
“Effective patient education ensures that patients have sufficient information and understanding to make informed decisions regarding their care.”American Academy of Family Physicians’ Guidelines for Patient Education

In order for Information Therapy to be effective, the patient education materials used must be both accessible and understandable. Whenever I pose a simple question to doctors about their approach towards patient education and what tools they use for this purpose, their knee-jerk response is – ‘We use print material’. Printed material indeed is one of the most commonly used forms of patient education worldwide. They are either in the form of typical handouts given to patients by healthcare professionals or can be accessed via various health websites. These materials are and always will continue to be one of the most cost-effective methods of patient education for the masses. I am not contesting the efficacy of printed material but I am sure that this not always the best solution in poor countries where health illiteracy is so widespread, and where many health education materials are difficult to understand. This is especially true in India which is many countries within a country! As a result, we miss out on harnessing the power of patient education. Hence it is important to apply a patient-centered approach to developing patient educational material.
As a company involved in developing effective patient education material, we have come across various challenges and situations which have helped us create some simple yet effective ways of delivering patient education material using various media. High-quality patient education material respects the principles of adult learning and should be able to:
· Adapt teaching to the patient's level of readiness, past experience, cultural beliefs and understanding· Create an environment conducive to learning with trust, respect and acceptance· Involve patients throughout the learning process by encouraging them to establish their own goals and evaluate their own progress· Provide motivation by presenting material relevant to the patient's needs· Provide opportunities for patients to demonstrate their understanding of information and to practice skills Barriers in creating patient education material
To overcome the communication barriers created by poor health literacy, it is important to put the patient first when developing educational materials. In India, patient education is still a comparatively new field. While designing engaging patient education material, we come across various issues, practical problems and challenges. The most important of these problems are:· Financial considerations· · Misconceptions about disease and treatment · Low literacy and comprehension skills· Fear of doctors· Language barriers· Negative past experiences with doctors· Denial of personal responsibility and a sense of fatalism

Over time, we have been able to build a team of doctors, artists and digital graphic specialists. We can tap into our experience and expertise in this niche area, to produce a wide variety of materials which are adapted to Indian conditions. We have made a conscious decision to use the animated format. This is universally understood; so that we do not have to reinvent the wheel every time we create new content.
We now have a library for over 150 hours of unique content; and given the fact that skilled computer professionals charge much lesser for their time in India, we can produce high-quality graphic digital patient educational materials for Information Therapy at a fraction of what it would cost in the western countries. Since we are addressing a neglected market, but are using high-tech tools to do so inexpensively, we feel the future is very bright.
Elements of successful patient education
- Interactivity§ Educational materials should be engaging and leave an impact on the patient’s mind, thus increasing patient confidence and fostering fast recovery§ Ease of access and navigation also forms a key feature of patient education programs, thus facilitating easy understanding of the health care plan§ It should help the patient to develop a positive approach towards his/her health-related problems and not scare him§ It should help to dispel common myths and misconceptions

- LanguageVerbal communication between patient and doctor should ideally be in the same language. But in a country like India, it is impossible for a doctor to know all the regional languages and dialects. A knowledge-rich patient education material dubbed in multiple regional languages can solve this problem for doctors.
- Cultural beliefsCulture affects how people communicate, understand, and respond to health information. To produce positive health outcomes, it is important for health organizations and doctors to recognize the local cultural beliefs, values, attitudes, traditions, language preferences, and health practices. This means that it’s often necessary to customise patient education materials for local needs. The use of modern digital media allows us to do this easily!
- Infrastructure requirementMultimedia patient education materials can be used with a wide variety of devices. The good news is that many doctors own smartphones which can be easily used to facilitate one-on-one dialogue with the patient. Print materials should be placed where they can be accessed easily and the visuals are not distorted.
Types and tools to deliver patient education material
- Oral CommunicationCommunicating one-to-one with the patient is and always will be the cornerstone of effective patient education. In today’s scenario, it is very important the doctor spends enough time answering all of the patients’ queries. Quality is more important than quantity.
- PrintAs I mentioned earlier, print material is the most economical and effective way of teaching patients. It is always good to give patients written explanations of their conditions and treatments. One should always look out for materials containing trusted content but at the same time make sure the materials are suitable for everyone. When choosing printed materials, one should remember that the layout and graphics play an important role. We have used a wide variety of printed materials, including: § Handouts§ Leaflets§ Posters§ Flashcards§ Pop-up books§ Comic books§ Illustrated books

- Multimedia materialVideo and other multimedia presentations are more effective than traditional printed patient education methods in increasing short-term retention of information. However, they should be used as a supplemental part of the patient education process. Even the most well-produced multimedia patient education material will not be effective if there is no window to discuss the content with the doctor.
§ Since multimedia uses visuals and graphics, it helps overcome language barriers. The new clever touch screens are very user friendly, and allow even illiterate patients to assimilate information efficiently !§ A doctor may sometimes forget to provide some information about a condition/procedure during a consultation, but multimedia content is always consistent§ Multimedia material is a better choice than print when patients have low literacy levels. § One major advantage of video is that it’s possible for the doctor to document that the patient was adequately educated and the consent which the patient gave for the treatment was truly informed consent. This can help in risk management!
A major advantage of modern audiovisual media is that it is all produced in a digital format. This means that it can be delivered through a wide variety of channels and platforms, to a large number of devices, including TVs, PCs, and smartphones. This means that it’s possible to deliver the content inexpensively, no matter where the patient is – whether he is in a hospital bed or in a small village.

How I prescribe Information Therapy in my practice

2nd Annual Conference on
Using Information Therapy to Put Patients First
To Register visit: www.patientpower.in

Dr.Aniruddha Malpani, MD, Founder, HELP

My patients, Mr and Mrs Gupta, are sitting in the waiting lounge of my clinic, awaiting their turn. The usual gamut of magazines is in front of them. But do these serve any purpose? Instead, my receptionist gives them a comic book about IVF, so they can learn more about their treatment options. This puts them in a better frame of mind, and many of their doubts get resolved even before they come in. The beauty of Information Therapy is that it can be used in many innovative ways !

I am an IVF doctor and I put my heart and soul into treating my patients. IVF is often the last resort for infertile couples, and, understandably, these couples will have countless questions about IVF. This is an expensive treatment, and they are investing immense time, hope and energy in building their family. Since the outcome of IVF is always uncertain, they have a lot of doubts and misgivings. These are still many myths and misconceptions surrounding IVF, and many women are worried that IVF babies are ‘weak’; or that all IVF pregnancies are multiples; or that the hormonal injections taken for IVF will make them fat or cause them to develop ovarian cancer in the future. Moreover, infertility often impacts the entire family (and not just the couple), and many decisions about medical treatment are made in consultation with many family members.

I proactively use Information Therapy to clear doubts and answer questions. This helps ensure that everyone is on the same page. Since I provide this information, patients are reassured that I am open and transparent. They know they are in safe hands, because they can see that I am well informed and knowledgeable. The fact that I am an expert in my field makes them put their faith in me.

Information Therapy needs to be embedded in clinical workflow, and we start providing Information Therapy well before the patients come to us for a consultation. We do this online, using many channels, including our website (www.drmalpani.com) ;
videos on youtube (http://www.youtube.com/user/aniruddhamalpani);
and social media, including twitter (http://twitter.com/#!/drmalpani) and facebook
( www.facebook.com/Dr.Malpani) .

Web-based information prescriptions have major advantages:

(1) I can update the information quickly and easily.
(2) The information is accessible to all my patients around the world. Using Google translate, patients can read it many different languages!
(3) The information can be presented in an interactive and engaging manner through the use of animation and videos ( www.ivfindia.com) .
(4) Delivering the information does not cost me anything.
(5) Patients can absorb and review the information at their own pace – and for free!

Isn’t all this expensive? Who has the time to do all this? Yes, it is expensive and time-consuming, but the beauty is that once you have done it, you can use it many times, for many patients, and over many years! ‘Create once, use multiple times’ is a very cost effective proposition. Updating and maintaining content is much easier once you are familiar with the process.
Even better, you can get your patients to contribute to your online resources. For example, we have a section called Success Stories (http://www.drmalpani.com/ivfsuccessstories.htm). We request our patients to write about their infertility story and their experiences at Malpani Infertility Clinic and then upload this to our website. This first person account helps other infertile couples when they are making decisions regarding their treatment, as they are getting information from someone who has been there, done that! We also encourage our patients to act as email buddies, to help other infertile couples in distress. I always remind my patients that helping others is a great way of helping yourself.
The Internet has become an important source of health and medical information. However, a significant amount of health-related information on the Web is inaccurate, unreliable or untrustworthy. By creating our own content, we can direct patients to information that is of high quality, appropriate to their condition, and consistent with our approach to treatment. This helps them to save time and stops them from getting confused or misled. Patients still depend on doctors to provide the most credible answers to their health questions!

In addition to providing Information Therapy online, we also provide it in the real world. When patients come to the clinic for a consultation, we give them with an IVF comic book while they are waiting for an appointment. Thanks to such Information Therapy, my consultations have become much easier. I do not have to waste time going over the basics and can focus quickly on the patient’s key concerns. The fact that I am an author reinforces their confidence in my professional competence and helps to reassure them that they are in safe hands. Doctor shopping is a fact of life in today’s world, and since we provide this information proactively, our patients prefer coming to us, because they can see that we are open and transparent.
All our educational materials help to ensure that patients have realistic expectations of their treatment. While it is true that our success rates are excellent, it is also a fact that the outcome of any IVF cycle is always uncertain, and patients need to be prepared for failure. Reading about this in black and white helps them to understand the limitations of our technology.

Patients often forget a great deal of what is told to them. This is why we give them a DVD to take home, which they can review at leisure – often with other family members. This helps to reinforce my message, and it also ensures that we stand out amongst the other IVF doctors that they have visited. During and after the IVF treatment, we encourage patients to remain in touch by email. I find this a very efficient way of answering questions. This way we don’t have to play telephone tag – and since everything is in writing, patients don’t get confused or forget things! We also have a FAQs page on our website, while helps us to proactively reassure patients and put their doubts to rest.
We know that different patients have different learning styles, which is why we use myriad tools to deliver Information Therapy. On our site at www.ivfindia.com, we have developed a wide variety of educational tools, including e-learning courses, animated cartoon films, games, and you tube movies. Providing this kind of Information Therapy has helped me to become a better doctor. It ensures that I look at the world through my patient’s eyes, so it is easier for me to be empathetic. Also, because we help patients to have realistic expectations, they don’t get emotionally shattered if the cycle fails and they are able to cope better with the IVF emotional roller coaster !

Docs use comic books, DVDs to help patients

Malathy Iyer, TNN, Jan 16, 2011, 06.41am IST

MUMBAI: If infertility treatment sounds like jargon, dial the newest helpline in town and let the recorded voice educate you. Information about health is as accessible and easy as phone-banking nowadays. If the interactive voice recording system on the phone is too distant for your liking, try a comic book for an update on infertility management. Colourful boxes and narration make the most complex medical topics come alive. In fact, comics on HIV\AIDS, infertility and malaria are already available at some doctors' clinics and hospitals in the city.

Welcome to the desi world of patient education; it is no longer an alien concept found only in the West. In the city's clinics and hospitals, doctors and patients themselves are working out innovative ways to disburse health-related information. Dr Aniruddha Malpani launched an infertility helpline two weeks ago because he wanted to offer his patients a bouquet of information hubs. "Our clinic in Colaba has comic books that we specially developed for our patients. But a helpline helps the patient prepare for a session with an infertility specialist," he said.

Health information for patients can now be more than just about Googling on the net. Nutritionist Rujuta Diwekar wrote books on weight-loss and her celebrity size-zero client Kareena Kapoor and made it to the national best-sellers' list. Ghatkopar youngster Parag Vora has created a niche market by making CDs and DVDs on 83 health topics such as angioplasty, Caesarean section or stroke. "Five years ago, I started with eight topics and a handful of doctors in the central suburbs. My CDs are now bought by over 1,700 doctors across the country," said Parag.

Eye surgeon Dr S Natarajan begins his interaction with most patients with a virtual tour of the 3D Eye programme on his iMac. "Patients should understand their problems so that they have realistic expectations from their doctor," he said.

And herein lays the importance of patient education. Research done in leading hospitals in the US has shown that patient education improves communication between health care providers and patients. Studies done for management of chronic diseases such as cancer, diabetes and hypertension have shown that patients who were counseled and given educational material brought their disease in control faster than others who were not.

The evolution of patient education in India has been slow mainly because it doesn't have a sponsor. It is left to the doctors and patient support groups to educate patients. Said Dr Ankit Khambati of Cheeny Kum, a website that provides diabetes management for patients, "Most doctors in India don't spend time educating patients. They are hard-pressed for time. We have tried to plug this gap with our website that provides information and support on management of diabetes."

The Web as a large role to play here. "Technology in India is available at less than one-fifth the cost in the US. We can thus use technology to educate patients," said Dr Malpani, who also offers a web-based SMS service to patients who want to track their fertile days of the month.

Most important, this kind of education provides a reality check for patients, said doctors. "The patient-doctor relationship has suffered in the past because of a breakdown in communication lines. By educating the patients about what to expect from a treatment bridges this gap," said Malpani. Natrajan feels patients don't expect miracles after they are explained the facts of a surgery in a manner that they understand.