A toolbox for group-based patient education – development, feasibility study and evaluation

Aim and purpose
Patient education is a cornerstone in caring for people with chronic conditions. For patient education to be truly person-centred, patients must assist in identifying their problems and in formulating solutions to these. However, most patient education is based on a professional understanding of patients’ need for learning rather than a patient perspective. This generates a risk of neglecting issues of importance to patients but unrecognised by educators. Furthermore, studies show that most educational programs are not able to effectively target self-management behaviour (National Board of Health 2009).

In response to this, the aim of the project is to develop and evaluate tools for facilitating participation and dialogue in group-based patient education. More specifically, the project aims to: 

  •  Develop a health educational model for group-based patient education in chronic illness based on patient-perceived challenges
  • Study the feasibility of dialogue-based tools for patient education
  • Evaluate the effects of dialogue-based tools for patient education

We are conducting the study in three phases. In the first phase we developed the educational toolbox (2010-2011). In the second phase we tested the feasibility of the toolbox (2012-2013), and in the on-going third phase of the project we are conducting an effect evaluation of the toolbox (2013-2015).

Development of the toolbox
In order to develop tools to make patient education interactive and stimulate learning processes in patient education we used Design Thinking (Brown 2008) and qualitative methods to engage people with chronic conditions as well as healthcare professionals in the development process. Empirical data was collected in four workshops with patients and three workshops with healthcare professionals. The data was analysed using a Grounded Theory approach.

Feasibility test of the toolbox
To investigate the feasibility of the toolbox focusing on the process outcome, a feasibility study was carried out in 45 patient educations settings in the Danish Healthcare System. We looked into the ability of the toolbox to support participation and dialogue as well as mechanisms generated by the toolbox. We applied a mixed methods approach which included questionnaires, observations, and interviews with educators.

Evaluation of the toolbox
The toolbox will be evaluated using a quasi-experimental design with an intervention group and a control group. In total, 13 sites are represented in the evaluation. Realistic evaluation (Pawson & Tilley 1997) will be used as an overall framework for the evaluation. Quantitative as well as qualitative research methods will be used. This includes observations of patient education, interviews, questionnaires, clinical data, and 10 sec. interval coding measurements. The 10 second-interval coding measurements is a method to assess how much the educator talks and how much the patients participate (Skinner et al. 2008). We will also conduct a cost-effectiveness analysis of the toolbox.

Target group
The research project targets people with chronic conditions and health care professionals/educators as well as policy makers working in the patient education area.

Expected outcome
A toolbox for patient education has been developed and the feasibility test showed that the healthcare professionals considered the toolbox to be useful. Further, the results showed that the toolbox functioned as intended in the participating settings and seems to enhance participation and dialogue in the educational setting.

The quantitative evaluation will show the self-reported effects on self-management behaviours (e.g. medication adherence, physical activity, and dietary habits), and psychological effects such as quality of life and meaningfulness. The qualitative evaluation will provide insights into patient's perspectives on the mechanisms and effects of dialogue-based tools in patient education (Andersen et al. 2013). Finally, the cost-effectiveness of the patient education programmes will be evaluated.

The results will provide new insights into a wide range of short and long term effects of participatory and dialogue-based approaches to patient education. Finally, the results will guide further development of patient education including implementation and evaluation.

Four municipalities in the Region of Southern Denmark contributed to the development of the toolbox.

45 patient education settings in Denmark participated in the feasibility study.

12 municipalities and one rehabilitation hospital unit participate in the evaluation study.

Inspirational articles 
Andersen TH, Hempler NF, Willaing I. Educator challenges using participatory methods in group-based patient education. Health Education 2014;114(2);152-165.

Brown T. Design Thinking. Harvard Business Review 2008;85-92.

Craig P, Dieppe P, Macintyre S, Mitchie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:979-983.

National Board of Health. Patient Education – A Health Technology Assessment. Copenhagen 2009.

Marchal B, van Belle S, van Olmen J, Hoerée T, Kegels G. Is realist evaluation keeping its promise? A review of published empirical studies in the field of health systems research. Evaluation 2012;18(2):192-212.

Pawson R,Tilley N. Realist Evaluation. Sage 1997, London

Skinner TC, Carey ME, Cradock S, Dalosso HM, Daly H, Davies MJ, Doherty Y, Heller S, Khunti K, Oliver L. ”Educator talk” and patient change: some insights from the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) randomized controlled trial. Diabetic Medicine 2008;25:1117-1120. 

Sidst opdateret 13-12-2016

Regitze Anne Saurbrey Pals
Research assistant

Kasper Olesen

Diabetes Management Research

The 24 health educational tools in the toolbox can be used in patient education for people with chronic illness. In addition to the tools, there is a book describing the objective and background of the tools. Download tools