Health Education vs. Outcomes

The Pew Internet Project has found that the internet has a significant impact on some life decisions (which school to attend, for example), but it does not play a big role in other “major life moments.” Is there something similar in health care? Are there conditions and diseases which are more likely to yield to an e-patient’s ability to change the outcome? Is it enough that e-patients are more informed and feel empowered by information, or should we expect more?

I was reminded of these questions when I saw the current issue of the British Medical Journal. If only the cover story were as arresting as the cover image of a giant pregnant belly. A randomized controlled trial found, once again, that pregnant women who are given decision aids about VBAC are more likely than the control group to be informed about their choices, but no more likely to have a different outcome. Two editorials accompany the article and both are worth reading, along with the study (see: Evidence to inform and Decision aids for women with a previous caesarean section).


I post these links for a few reasons.

First, to remind everyone to check out BMJ on a regular basis since they do a good job of tracking the first generation of e-patients.

Second, to elicit people’s thoughts about the benefits of health education. Kate Lorig and her colleagues conducted a randomized controlled trial of people with chronic back pain and found that participation in a closed, moderated, email discussion group had an effect on health outcomes. But many of the other studies I’ve read are likely to report what one of the BMJ editorialists describe: Information interventions can “improve people’s knowledge of the options, create realistic expectations of their benefits and harms, improve decision making, and increase participation in the process” but not actually change the outcomes. (For example: smoking cessation and breast cancer)

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