What do patients want?

If you have been involved in healthcare advertising, promotion or education in the last five years, you won't have been able to avoid hearing about a 'patient-centred approach'. The phrase now litters both communications from pharmaceutical companies and initiatives launched within the NHS. The approach is clearly well regarded by patients, since it acknowledges that they are the focus of initiatives and that they can take control of their own healthcare. There is also a realisation developing within the industry itself that focusing on the needs of patients is a successful strategy for driving overall sales, regardless of whether the short-term goal is adherence, brand recognition, or switching.

In this case study, I will provide some simple tips on how patients can truly be placed at the centre of healthcare education, producing optimum results for all concerned.

Involve patients at the start
HealthEd was approached to develop a patient follow-up pack to educate patients receiving their second dose of a therapy for an inflammatory condition. The idea for the follow-up pack came from the patients who had received an initial education pack during their first treatment dose. Although the first pack had been well received and had addressed the patients' educational needs, they were still keen to learn more.

Before starting to develop content for the follow-up pack, a panel of patients was chosen. These patients were asked what issues were facing them and how they could be addressed. Their feedback gave us a useful insight into the educational needs of the patients. It also generated some great ideas in terms of formats and how to present the information.

What matters to patients?
The number one rule is: don't assume you know what patients want. It would be easy to make hard-and-fast rules about the types of things that matter to a patient, however, patient groups can often surprise us in terms of what they would like to know.

One of the recurrent sentiments expressed in the feedback from patients was that they really liked the explanation of the drug's mode of action in the first pack, and that they would appreciate a similar explanation of what had happened in their body since the first treatment dose. This was not what we had expected, but demonstrates that the educational materials patients have received previously have a bearing on the level and focus of what they will require at later treatment stages. Without the benefit of these patient insights, we may have excluded this content.

Continue the consultation
The finished pack contained an information booklet, a 'lifestyle' magazine and standalone cards relating to various aspects of treatment and living with the condition. The advantage of involving patients at the outset is that they can provide insights and influence the development of the project, helping to maintain the relevance of the finished item.

The usefulness of this level of patient input is easy to underestimate. In the case of the patient follow-up pack, the value of this input was clear. Not only did the patients help to maintain the correct level of detail throughout the pack, but they also provided stories of how the condition and its treatment had affected their lives.

Including patient stories is not always possible, given the space constraints of some educational items. It is also something that pharmaceutical companies may be reluctant to include, in case the patient does not respond to treatment, or says something contrary to the accepted educational messages of the product. Although these are valid concerns, the advantages gained from including real-life patient stories can far outweigh the potential pitfalls.

It is a consistent theme that patients like to know where they fall within the spectrum of a condition. Hearing first-hand accounts of other sufferers' experiences allows patients to make comparisons with their own situation and can help them to put their own concerns into perspective. The personal stories can also inform patients of how others cope with the condition on a day-to-day basis.

Apply health literacy
Many patient education materials use technical and scientific language, possibly because they are written by writers or healthcare professionals who are accustomed to writing for a scientific audience. There is also a concern that if you 'dumb down' the materials too much, you risk offending some readers. When preparing healthcare information, these fears are largely unfounded.

The average reading age of adults in the UK is approximately 13 years. This means that if you pitch an educational material at a 16-year-old reading age or higher, you may be excluding a large proportion of your target audience. Additionally, many factors can reduce a person's ability to understand and act upon healthcare information. It is essential to consider the situation in which a patient will find himself reading this information: he may be able to understand relatively complicated information under normal circumstances (that is, in the comfort of his own home and in a non-anxious state of mind), but the real-world situation in which the patient will be reading the materials will be in a consultation with a healthcare professional. The stress and time pressure of the situation can reduce the ability of a patient to understand fully the information presented. Poor doctor–patient interactions can hinder this further. The reality is that patients will often simply skim through healthcare information that appears too complicated and are likely to gloss over any sections they don't immediately understand.

For the specific patient follow-up pack mentioned above, we applied principles of health literacy to content, layout and design to maximise the reach and audience of the materials. The ability to 'road test' the content with the patient panel provided us with the reassurance that both the level and the tone of the materials were right.

Give patients the right tools
Educational messages are often seen as the single most important aspect of healthcare education. But in building a lasting relationship with your patient group, you don't just want patients to learn about your product. To build trust, you also need to give patients information that allows them to take control of their own health. A broadly educated patient can understand how your product fits in as part of an overall health package, and so is more likely to be adherent to your product.

Giving your patients tools such as lifestyle action plans, adherence reminders or symptom trackers can empower patients to manage their condition more effectively and make any behavioural changes needed. For example, on the patient follow-up pack, we included a set of reference cards focused on exercise, sleep and recipe ideas. While these did not focus directly on the condition or on the medication, they helped patients to make small and manageable lifestyle changes that would have a noticeable impact on their condition and general wellbeing. By including this type of education, you are demonstrating that you are considering the whole patient experience. This approach helps to build trust among patients and assures them that you are working in their best interests, rather than simply promoting a product.

Providing patient support and tools that are not directly product-related is also in the interest of the healthcare professionals who prescribe the products and are well aware of the problems of non-adherence to medication. Since adherence influences product effectiveness in the clinical setting, healthcare professionals are more likely to prescribe a medication if there are support materials available for patients.

Include interactive elements
People are more likely to pay attention to and recall an educational message if they can interact with it. Interactivity is a well-established approach employed by education specialists, but interactive elements are not always used because they can be difficult to incorporate into printed patient education materials.

The increase in the availability of healthcare education on the internet has opened the door for a range of interactive programmes. Patients can now chat with other patients, get personalised health advice and check their risk of developing certain conditions online. This has resulted in a greater thirst for healthcare information in a variety of formats.

Despite the increased reliance on electronic media, there are plenty of situations in which printed materials still represent a cost–effective method of educating patients. There are also many patient populations for whom the internet and electronic media are not yet preferred sources of information. There are many ways to build interactive elements into these materials that are both useful to patients and encourage them to retain and re-visit the educational item.

The patient follow-up pack we produced utilised interactive elements, both as educational aids and to personalise the information for the patient. For example, a section on healthy living included a body mass index (BMI) graph on which patients could record their BMI versus recommended guidelines. It also reminded patients to use their interactive medication tracker diary, which was contained in the first patient pack. A puzzle section, to keep patients amused while they were having their treatment, was also included. Interactive aspects such as this are easy to employ and have value beyond the patient gaining information: they also give the patient a reason to retain the education materials.

Conclusion
Healthcare education is not simply about educational messages; it is about empowering patients to make improvements in their health. The advantages of patient-centred healthcare education far outweigh the drawbacks. Involving patients throughout the initiation and development of patient materials helps to ensure that programmes are relevant and engaging.

A patient-centred approach can have a significant impact on the sales of your product; it can build brand and company loyalty among patients and healthcare professionals and it can also increase long-term adherence and decrease switching to other products.

The Author
Noel Curtis is head of editorial services at HealthEd

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