Report on the Needs Assessment

2.3 Input on the Health Education Centres

FINDINGS
Patients said they would like to engage in the following activities in a Health Education Centre: watch health videos; read more and better-written information; use computer programs; participate in patient group discussions; and follow small classes.

Patients said the Health Education Centre should be very close to the unit and easily accessible in a clearly allocated room where they can go while awaiting their treatment. All the information/services should be available in that one place. Patients commented on the respective roles of health care professionals, volunteers and patients/families in the centre (See Appendix 7). Oncology patients in the focus group made a number of suggestions, including emphasizing the aspect of prevention and the use of videos.

A small number of interviewed patients said they would not want to use the Health Education Centre. Caregivers confirmed this. Some prefer to learn on their own while others prefer not to learn more about their illness.

Learning with computers was not a popular option among this group of patients. While it ranked as the third most popular option for an activity at the Centre, this is misleading since not all the patients answered this question. In fact, few patients (26%) actually chose computers as a preferred activity. Even when we explained that volunteers could be present in the Health Education Centre to help and guide them, the large majority of interviewed patients did not express interest. Findings from another question revealed that few interviewed patients use computers (17%), and even among those who do, few research health issues.

Caregivers said that patients would like, in descending order, videos, patient group discussions, more and better written information, small classes and computer programs. Their choices paralleled those of interviewed patients in three categories, but they ranked patient group discussions as more popular and computer programs as least. Caregivers confirmed that some patients would not use a centre. They did not comment on the location of the centre, its staffing arrangements or other aspects.

Support staff members offered concrete ideas to improve patient education and suggested activities for the Health Education Centre.

Support staff members had varied opinions regarding computer programs (some think it is a good idea, others do not), but all agreed that drama with hard-to-reach patients is not a good idea. However, one informant thought that drama would work well with Cree patients.

Health care professionals suggested the following activities and programs for the Health Education Centre: Health videos; computer programs; training for health care professionals; more and better-written information; patient group discussion; and small classes.

Computer programs are seen as more appropriate and small classes as less appropriate by interviewed health care professionals than by interviewed patients, caregivers and support staff. Nurses from the Oncology Hematology unit see the need for a Health Education Centre and appear ready to set it up on a short-term basis. They gave specific advice on how to do this. Nurses do not perceive the Health Education Centre as an add-on component, but as an essential element of the patient's care and treatment at the unit.

ANALYSIS
Results show that interviewed patients want to learn in many different ways in a Health Education Centre. There is not one preferred way of learning or one preferred educational activity. This suggests that a variety of pedagogical methods and instruments will have to be used in the Health Education Centres.

Since a larger proportion of interviewed health care professionals than interviewed patients are computer literate, it may explain why they see computers as a more appropriate tool for patient education. There appears to be a gap between the perspective of health care professionals and what hard-to-reach patients told researchers. The literature suggests that many hospitals are installing computer-based patient centres on the assumption that all patients can and wish to learn in this way; the findings from this study suggest that this assumption may be open to question. They seem to indicate that health care professionals need a better understanding of the reality faced by hard-to-reach patients and of their learning needs. Professional development training in the Health Education Centres could address this issue.

A small number of patients said they would not want to use the Health Education Centre. For some of them, it might reflect a feeling of negation about their illness, the reasoning being something like "If I do not think or learn about my illness, I will forget that I am sick". It might also reflect a refusal to become involved. One patient said he trusted the specialists and that his health is their hands. It appears that, no matter how "user-friendly" it is, we can expect that some patients will not want to come to a Health Education Centre. Hopefully, this initial reaction will change over time, after positive comments about the Centre are shared among patients and families.

While some patients might refuse to come, some others might also hesitate. Health care workers noted that those patients who already know the most would probably be the first ones to come. Hard-to-reach patients are used to facing many challenges when learning about their health, and will not be expecting activities, learning tools and strategies tailored to their needs. It will probably be a challenge to convince them that these centres have been designed for them. When promoting and planning the Health Education Centres, specific strategies should be devised to attract hard-to-reach patients.