Objective: Consumers are becoming increasingly aware of the need to evaluate the quality of care they are receiving. They may have limited knowledge, however, about what constitutes quality of health care and what actions they can take to improve the quality of their own care. Information about quality care is available to consumers from many sources on the Internet. Nurses can teach consumers how to access information about health care quality and apply it to their own lives. The purposes of this study were to (1) examine the effectiveness of using the Internet to teach consumers about quality care, (2) compare consumer definitions of quality health care prior to and following completion of the Internet experience, and (3) compare ratings of learning, satisfaction and value of the experience with the Internet instruction between consumers who complete the Internet intervention alone and consumers who complete the Internet intervention and interact with a nurse. Design: This comparative study used a randomized two-group, pretest-posttest design. Population and sample: The setting for the study was a public library in a suburban community. A convenience sample was used. The total sample size was 34 with 17 participants in each group. Concepts: Quality care, Consumer Information Processing Model, consumer education, Internet instruction, and nursing interaction. Methods: All participants read five Internet documents on quality of care that were evaluated by consumers in previous studies. The documents were: “Improving Health Care Quality: A Guide for Patients and Families” (AHRQ web site), “In Search of Quality Health Care” (Consumer Reports Online web site), “Now You Have a Diagnosis: What’s Next?” (AHRQ web site), “20 Tips to Help Prevent Medical Errors” (AHRQ web site) and choice between “Making Medicare Choices: Medicare Options” (AARP web site) or “Top 10 Ways to Make Your Health Benefits Work for You” (DOL web site). Participants were randomly assigned to two groups by appointment sequence. Group I received Internet instruction only and Group II received Internet instruction plus interaction with the nurse. All instruments were contained in a packet given to each participant. Pretest instruments included a demographic data sheet, Likert scale questions rating experience using the Internet and access to the Internet, an open-ended question asking, “What does quality health care mean to you?” and a test that assessed knowledge of the content presented in the five documents. During the Internet instruction, participants in Group I read the documents without interruption from the nurse. Participants in Group II were instructed to let the nurse know when they were finished reading each document. At that time the nurse asked two questions: “Do you have any questions about the material that you read in the document?” and “How might you use this information in making decisions about your own health care or that of your family? The nurse entered into a discussion with the participants after each question according to the participants’ responses. Posttest instruments included a knowledge test consisting of the same items as the pretest, the question “What does quality health care mean to you?” and seven Likert scale items for consumers to rate their learning, satisfaction, and value from the Internet instruction session. Findings: The intervention was effective in increasing consumer knowledge of quality care from pre- to posttest (t=5.75, df=32, p=<.001). Although there were no significant differences between the two groups in knowledge gain, consumers in the interaction group had significantly higher scores on the usefulness of the information in assessing the quality of care they are receiving from their physicians, nurses, and other providers (t=2.95, df=32, p=<.006) and the extent to which their questions about quality care were answered (t=2.06, df=30, p=.050). Definitions of quality health care changed from pre- to posttest, chi-square (5, N=52)=19.17, p < .05. At posttest more definitions represented health outcomes and self-care. Conclusions: The Internet can be an effective medium for teaching consumers about quality of health care. By interacting with consumers while they read information on the Internet, a nurse can help them to apply abstract concepts about quality care to their own lives. Implications: The Internet can be used to inform consumers about quality care particularly when supplemented by interaction with a professional nurse.
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