Six-Month Effects of a Multimedia Patient Education Tool in Patients with Rheumatoid Arthritis. a Randomized Controlled Trial

BACKGROUND/PURPOSE: We conducted a multi-centered, open-label, parallel, randomized controlled trial to evaluate the efficacy of a multimedia-patient education tool (MM-PtET) for patients with rheumatoid arthritis (RA) in improving outcomes immediately after the intervention and at 3 and 6 months. METHODS: Patients were recruited from 5 centers and through advertisement. Inclusion criteria were: (i) age ≥18 years (ii) diagnosis of RA by a rheumatologist (iii) disease duration ≤10 years (iii) adequate cognitive status and, (iv) ability to communicate in English or Spanish language. The efficacy of the MM-PtET was evaluated longitudinally using questionnaires on disease knowledge, decisional conflict and role preferences, self-efficacy and disease management before and after viewing the assigned materials, at 3 and 6 months. Linear regression and generalized estimating equation were used in order to determine the effective impact of correlative factors on the efficacy of the MM-PtET, including age, sex, race, education level, language in which the questionnaire was answered, health literacy and disease duration. RESULTS: 221 participants were randomized (111=MM-PtET, 110=written booklet). Mean age was 51±13 years, mean disease duration was 5±3 years, 85% were female 24% had inadequate health literacy levels and 46% answered the questionnaire in Spanish. 116 (64=MM-PtET, 52=booklet) and 158 (76=MM-PtET, 82=booklet) participants returned their questionnaires at 3 and 6 months, respectively. Within groups most outcomes were improved from baseline to 3 and 6 months. At 6 months, participants assigned to the intervention group had statistically significantly higher disease management scores compared to the control group (mean 81.1 vs 76.6, p=0.03). Greater improvement in knowledge scores from baseline to 6 months were observed in those participants who received the intervention (p=0.03) and those with inadequate health literacy (p=0.006). Meanwhile, among Whites, the intervention was associated with greater improvements in the decisional conflict scale and uninformed subscale (p=0.004 and p=0.02, respectively); and among males, receiving the intervention group led to improvement in the clarity subscale (p=0.02). Among younger individuals, booklet was associated with improvement in self-efficacy but among older ones, it was MM-PtET (p=0.003). Shorter disease duration, on the other hand, was associated with better disease management (p=0.009). Higher level of education (High School or above) was associated with active role played in health decision-making (p<0.003) after adjusting for correlated outcome data and controlling for other variables. CONCLUSION: Our MM-PtET was more effective in improving disease management compared to reading written materials in RA patients at 6 months. The multimedia tool was associated with greater health outcomes improvement among older patients, Whites, and males. Independent factors associated with improvement include disease duration (shorter) and level of education (at least High School diploma).