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which did not have clear/specifi c goals and objectives [ 28 ]. Educational programs
with more specifi c goals, such as those with a behavioral component or counseling,
have shown superior effects compared to the information-only programs [ 29 – 31 ].
These fi ndings were endorsed by a recent systematic review [ 5 ], which revealed that
objectives of educational programs were not always clear. Generic measures such as
disease activity score (DAS-28), which is unlikely to be directly affected by educa-
tion, were used to evaluate the effects of patient education. While several biomedi-
cal measures are valid for assessing some aspects of disease activity, they are
insensitive to most non-pharmacological interventions. Even measuring disease
activity relies on composite measures, which take into account biomedical, clinical,
as well as patient-reported outcome measures (PROMs). EULAR recommendations
for patient education program have therefore specifi ed that outcomes must refl ect
the objectives [ 5 ].
Outcomes of Patient Education
Outcomes of patient education can be categorized as increase in knowledge,
improvement in psychosocial status, and change in behavior. Change in one or all
of these aspects may translate into improvement of clinical symptoms. However,
there is str ong evidence to suggest that interventions that focus on change in knowl-
edge only do not necessarily translate into improvement of health status. However,
psycho- educational and behavioral interventions are more effective in improving
health status [ 29 – 31 ]. While behavioral outcomes (such as adherence to therapy and
exercise) can easily be measured using self-report or observation, validated PROMs
are required to assess knowledge outcomes (e.g., patient knowledge, educational
needs, and health literacy) as well as psycho-educational outcomes (e.g., as self-
effi cacy, coping, and patient activation). PROMs are more relevant than biomedical
measures in evaluating outcomes of non-pharmacological interventions such as
patient education. Therefore, it is important that specifi c PROMs validated for par-
ticular outcomes are used for assessment and evaluation in order to ensure that they
accurately estimate the effects of patient education in a given domain.
Health professionals have used PROMs innovatively as part of intervention in
the patients’ care. A recent study revealed that sharing previous PROMs scores
and goal setting had a signifi cant impact on improving infl ammatory arthritis
patients’ self-perceived health as well as their adherence to therapy [ 32 ]. These
fi ndings were endorsed by another work carried out using the Educational Needs
Assessment Tool (ENAT) to derive needs-based education in the clinic. Results
revealed improvement of patient’s self-effi cacy as well as other aspects of their
health status [ 33 ]. However, whilst clinicians can easily deliver knowledge-
related patient education [ 34 – 36 ], delivering p sychosocial and behavioral-related
education, such as cognitive behavior therapy, may require referral to other spe-
cialized professionals.
D. Palmer and M. Ndosi