August, 2009 - SUPPORT Summary of a systematic review | print this article |
Printed educational materials are widely used passive-dissemination strategies to improve knowledge, awareness, attitudes, skills, professional practice, and patient outcomes. Traditionally they are presented in paper format such as monographs, publication in peer-reviewed journals, and clinical guidelines and appear to be the most frequently adopted method for disseminating information.
Effectiveness of printed educational materials (PEMs) aimed at changing provider behaviour may be influenced by at least four factors: (1) characteristics of the intervention, (2) characteristics of the provider, (3) characteristics of the behaviour that the intervention is trying to change, and (4) characteristics of the organisation and context. Important characteristics of PEMs include: the source of the information, the content and the channel by which it is delivered. There is limited research on which characteristics of PEMs influence clinical practice. Post-dissemination compliance with clinical guidelines may be higher when recommendations are compatible with existing norms and values, are easy to follow, or are supported with evidence and do not require skills and knowledge
This summary is based on a systematic review published in 2008 by Farmer and colleagues on the effects of printed educational materials on professional practice and health care outcomes.
|Review Objectives: To determine the effectiveness of printed educational materials in improving process outcomes (including the behaviour of healthcare professionals) and patient outcomes.|
|/||What the review authors searched for||What the review authors found|
|Interventions||Randomised controlled trials (RCTs), con-trolled clinical trials (CCTs), controlled be-fore and after studies (CBAs), and inter-rupted time series analyses (ITS) assess-ing the effects of printed educational materials such as clinical practice guidelines, journals, and monographs.
||23 studies: 12 randomised controlled trials, one con-trolled before and after study, and 10 interrupted time series analyses.
|Participants||Any health care professionals.||Mostly physicians.
|Settings||Studies originating from any setting.
United States (7), United Kingdom (7), Canada (7), Nether-land (1) and Denmark (1).
|Outcomes||Any objective measure of performance (such as number of tests ordered) or patient health outcomes.
||Prescribing behaviour (12 studies), prevention and general man-agement conditions (6 studies), test ordering (3 studies), surgical rates (2 studies).
|Date of most recent search: March 2007|
|Limitations: This is a good quality systematic review with only minor limitations.|
Farmer AP, Légaré F, Turcot L, Grimshaw J, Harvey E, McGowan JL, Wolf F. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD004398.
See in Cochrane Library
The review included 23 studies conducted in high-income countries: 12 randomised controlled trials, 1 controlled before and after study, and 10 interrupted time series, were included in the review. Only randomised controlled trials are summarised in the table below.
The randomised controlled trials show that:
Printed educational materials
|Patient or population: Health care professionals
Settings: Mostly general practice settings in high-income countries
Intervention: Printed educational materials
Comparison: No intervention
Adjusted absolute risk difference
|Number of Participants
|Quality of the evidence
|Categorical process outcomes
||Median increase of +4.3%
(Range -8.0% to +9.6%)
|Continuous process outcomes
||Median increase of +13.6%
(Range -5.0% to +26.6%)
|Categorical patient outcomes||Median -4.3%
(Range -4.6% to -0.4%)
|Continuous patient outcomes||Two studies reported deteriorations in continuous patient outcome data (e.g. depression score, smoking cessation attempts) of -20.5% and -10.0%||2 studies|
|GRADE: GRADE Working Group grades of evidence (see explanations)|
|*Across the board for both professional and patient outcomes, the studies are small and there is heterogeneity of both interventions and outcome measures|
|MONITORING & EVALUATION|
*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low- and middle-income countries. For additional details about how these judgements were made see: http://www.support-collaboration.org/summaries/methods.htm
Freemantle N,Harvey EL,Wolf F, Grimshaw JM, Grilli R, Bero LA. Printed educa-tional materials: effects on professional practice and health care outcomes. Coch-rane Database of Systematic Reviews 1997, Issue 2. [DOI: 10.1002/14651858. CD000172].
Grimshaw J, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al. Changing provider behavior: an overview of systematic reviews of interventions. Medical Care 2001;39 (Suppl 8):II2–II45.
Ockene J, Zapka J. Provider education to promote implementation of clinical prac-tice guidelines. Chest 2000;118(Suppl 2):33S–39S.
de Vos M, Graafmans W, Kooistra M, Meijboom, van Der Voort P, Westert G. Us-ing quality indicators to improve hospital care: a review of the literature. Interna-tional Journal for Quality in Health Care 2009:21(2); 119-29.
This summary was prepared by
Charles I. Okwundu & Charles Shey Wiysonge, South African Medical Research Council, Cape Town, South Africa
Conflict of interest
None declared. For details, see: Conflicts of Interest
This summary has been peer reviewed by: Fernando Althabe, Argentina & Newton Opiyo, Kenya
This summary should be cited as
Okwundu CI, Wiysonge CS. Do printed educational materials have any effects on professional practice and health care outcomes? A SUPPORT Summary of a sys-tematic review. May 2009.
This summary was prepared with additional support from:
The South African Medical Research Council aims to improve health and quality of life in South Africa, through promoting and conducting relevant and responsive health research. www.mrc.ac.za/
The South African Cochrane Centre, the only centre of the inter-national Cochrane Collaboration in Africa, aims to ensure that health care decision making in Africa is informed by high quality, timely and relevant research evidence. www.mrc.ac.za/cochrane/cochrane.htm