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Cited by 249Health Sciences Research and EducationClinical practice guidelines implementationHealth Policy Implementation Science

Printed educational materials: effects on professional practice and health care outcomes

Farmer, Anna P, Légaré, France, Turcot, Lucile, Grimshaw, Jeremy, Harvey, Emma, McGowan, Jessie, Wolf, Fredric M·2008·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd004398.pub2
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Abstract

BACKGROUND: Printed educational materials (PEMs) are widely used passive dissemination strategies to improve knowledge, awareness, attitudes, skills, professional practice and patient outcomes. Traditionally they are presented in paper formats such as monographs, publication in peer-reviewed journals and clinical guidelines and appear to be the most frequently adopted method for disseminating information. OBJECTIVES: To determine the effectiveness of PEMs in improving process outcomes (including the behaviour of healthcare professionals) and patient outcomes. To explore whether the effect of characteristics of PEMs (e.g., source, content, format, mode of delivery, timing/frequency, complexity of targeted behaviour change) can influence process outcomes (including the behaviour of healthcare professionals and patient outcomes). SEARCH STRATEGY: The following electronic databases were searched up to July 2006: (a) The EPOC Group Specialised Register (including the database of studies awaiting assessment (see 'Specialised Register'under 'Group Details'); (b) The Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effectiveness; (c) MEDLINE, EMBASE, CINAHL and CAB Health. An updated search of MEDLINE was done in March 2007. SELECTION CRITERIA: We included randomised controlled trials (RCTs) , controlled clinical trials (CCT), controlled before and after studies (CBAs) and interrupted time series analyses (ITS) that evaluated the impact of printed educational materials on healthcare professionals' practice and/or patient outcomes. There was no language restriction. Any objective measure of professional performance (sch as number of tests ordered, prescriptions for a particular drug), or patient health outcomes (e.g., blood pressure, number of caesarean sections) were included. DATA COLLECTION AND ANALYSIS: Four reviewers undertook data abstraction independently using a modified version of the EPOC data collection checklist. Any disagreement was resolved by discussion among the reviewers and arbitrators. Statistical analysis was based upon consideration of dichotomous process outcomes, continuous process outcomes, patient outcome dichotomous measures and patient outcome continuous measures. We presented the results for all comparisons using a standard method of presentation where possible. We reported separately for each study the median effect size for each type of outcome, and the median of these effect sizes across studies. MAIN RESULTS: Twenty-three studies were included for this review. Evidence from this review showed that PEMs appear to have small beneficial effects on professional practice. RCTs comparing PEMs to no intervention observed an absolute risk difference median: +4.3% on categorical process outcomes (e.g., x-ray requests, prescribing and smoking cessation activities) (range -8.0% to +9.6%, 6 studies), and a relative risk difference +13.6% on continuous process outcomes (e.g., medication change, x-rays requests per practice) (range -5.0% to +26.6%, 4 studies). These findings are similar to those reported for the ITS studies, although significantly larger effect sizes were observed (relative risk difference range from 0.07% to 31%). In contrast, the median effect size was -4.3% for patient outcome categorical measures (e.g., screening, return to work, quit smoking) (range -0.4% to -4.6%, 3 studies)). Two studies reported deteriorations in continuous patient outcome data (e.g., depression score, smoking cessation attempts) of -10.0% and -20.5%. One study comparing PEMs with educational workshops observed minimal differences. Two studies comparing PEMs and education outreach did not have statistically significant differences between the groups. It was not possible to explore potential effect modifiers across studies. AUTHORS' CONCLUSIONS: The results of this review suggest that when compared to no intervention, PEMs when used alone may have a beneficial effect on process outcomes but not on patient outcomes. Despite this wide of range of effects reported for PEMs, clinical significance of the observed effect sizes is not known. There is insufficient information about how to optimise educational materials. The effectiveness of educational materials compared to other interventions is uncertain.

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Authors
Farmer, A. P., Légaré, F., Turcot, L., Grimshaw, J., Harvey, E., McGowan, J., & Wolf, F. M.
Affiliations
  • University of Alberta (CA)
  • Hôpital Saint-François d'Assise (CA)
  • Centre hospitalier universitaire de Québec (CA)
  • University of Ottawa (CA)
  • University of Washington (US)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2008-07-16
Issue
3
Pages
CD004398-CD004398
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd004398.pub2
OpenAlex
W2595809667
Cited by
249
References
63
Citations by year
2026: 3 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 7 · 2021: 10 · 2020: 7 · 2019: 16 · 2018: 17 · 2017: 8 · 2016: 10 · 2015: 9 · 2014: 14 · 2013: 34 · 2012: 28
Type
reference entry
Language
en
Update notices
new_version (2012-10-17)
Open access
closed
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
printed educational materials, professional practice change, healthcare workers, patient outcomes, clinical guidelines, prescribing behaviour, smoking cessation, health professions education, behavior change, process outcomes, patient satisfaction, patient safety, quality of care, patient-centered care, patient information leaflets, patient information brochure
MeSH terms
Manuals as Topic, Outcome and Process Assessment, Health Care, Periodicals as Topic, Practice Patterns, Physicians', Professional Practice, Practice Guidelines as Topic, Information Dissemination

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