Family Practice Advance Access originally published online on October 1, 2004
Family Practice 2004 21(6):651-653; doi:10.1093/fampra/cmh517
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Family Practice Vol. 21, No. 6 © Oxford University Press 2004, all rights reserved.
Does a patient-held health record give rise to lifestyle changes? A study in clinical practice
a Center for Clinical Research Dalarna, Nissers väg 3, S-791 81 Falun, b Epidemiology, Department of Public Health and Clinical Medicine, Umeå University, S-901 85 Umeå and c National Institute of Public Health-Sweden, S-103 52 Stockholm, Sweden
Email: lars.jerden{at}ltdalarna.se
Received 5 September 2003; Revised 19 March 2004; Accepted 17 May 2004.
Jerdén L and Weinehall L. Does a patient-held health record give rise to lifestyle changes? A study in clinical practice. Family Practice 2004; 21: 653–655.
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Abstract |
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Background. Patient-held records have been sparsely studied as instruments for behavioral change.
Objective. Our aim was to examine to what extent patients report lifestyle changes as a result of using a patient-held health record.
Methods. This was a descriptive cross-sectional study based on questionnaires distributed in six primary health care centres in Sweden, and comprised 418 patients aged 20–64 years. The main outcome measure was patients' self-reported valuation of having made changes in their health situation as a result of reading the booklet regarding their health.
Results. Twenty-five percent of the patients reported a change in health situation as a result of reading the booklet. Exercise, diet and habits related to stress were the most common habits to be specified. Age, educational level, health status and smoking habits did not influence the proportion of patients who reported lifestyle changes.
Conclusion. The study suggests that patient-held health records might be a useful tool for promoting lifestyle changes in primary health care.
Keywords. Medical records, patient-held records, patient participation, lifestyle, primary health care.
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Introduction |
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Patient-held health records have been advocated as a tool for health promotion among adults.1 There are few studies describing how such records affect lifestyle. Two uncontrolled pilot studies could not demonstrate significant behavioural change after an intervention.2,3 A study comparing different health records shows a reduced alcohol intake for the users of one record, but no effect on smoking, exercise or diet.4 In a randomized controlled study, patients sharing medical records with their physicians after a health examination report a significantly increased rate of smoking reduction or quitting after 6 months.5
In the county of Dalarna, Sweden, a patient-held health record was developed, with the primary aim to be a personal document for reflection and reference. Use as a tool for communication with health professionals was considered a less important, secondary objective. The main topic of the record, ‘My book about health’ (MBAH), was lifestyle, including stress, and social network. A Swedish version of the record can be found at http://www.ltdalarna.se/folkhalsa.
The main aim of this study was to examine to what extent patients report lifestyle changes as a result of using the MBAH. Another aim was to investigate if different background characteristics influence the occurrence of such changes.
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Methods |
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All primary health care centres in the county were invited to distribute the MBAH. Those centres that agreed were, in consecutive order, asked to participate in the study. Centres were recruited until six centres agreed to participate.
Doctors and community health nurses distributed the booklet to those patients that they deemed appropriate during regular visits. The centres also distributed booklets through the reception to patients who requested them. The distribution started in March 2000, and ended in June 2001.
Patients, aged 20–64 years, who obtained the booklet were asked to participate in the study. The patients received a postal questionnaire 6 months after obtaining the booklet.
In order to estimate whether the patients who received an MBAH were representative of all patients visiting the centres, data were also compared with the regular population postal survey carried out by the County Council of Dalarna in March 2000.6
A total of 418 patients agreed to participate, and 314 of them (75%) returned the questionnaires. Women (P-value 0.012) and patients 50 years and older (P-value 0.003) answered the questionnaire more frequently.
A majority (73%) received the booklet from a registered nurse, 14% from the health centre reception and 3% from a doctor. Ten percent received the booklet in other ways, or did not know.
Data were analysed by univariate logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (95% CIs).
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Results |
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Eighty percent of those who received the record had looked at/read the booklet. Thirty-three percent had written in the record. Fourteen percent valued it as ‘very good’ on their own behalf, 49% as ‘rather good’, 16% as ‘neither good or bad’ and 2% as ‘rather bad’ or ‘very bad’. Nineteen percent did not answer this question, and this percentage corresponded to those who did not read the booklet. In their free text remarks, those who were critical pointed out a personal lack of interest, criticized deficient follow-up at the health centres, and questioned the cost-effectiveness of the record.
Twenty-five percent answered ‘yes’ to the question: "Is there something in your health situation you have changed as a result of reading the booklet?" Physical exercise and diet were the most common habits mentioned (Fig. 1).
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In answer to another question, 26 patients reported that they had changed their smoking habits during the previous 6 months, i.e. the period since they had received the MBAH. All of them reported a decrease in smoking or smoking cessation. Four of them were among the six patients who stated that they had changed tobacco habits as a result of reading the booklet (in Sweden, there is a marked difference between tobacco and smoking habits, as the use of oral snuff is common). Thus, 22 out of 26 patients who had changed smoking habits did not report the change as a result of reading the booklet.
An analysis of the correlation between self-reported behavioural change and background characteristics (age, sex, ethnicity, education, occupation, smoking, chronic disease and self-reported health status) did not show significant differences. Compared with all patients visiting doctors at the health centres, age above 50 years and treatment for hypertension were significantly more common among patients who received the booklet. There were no differences in education or smoking.
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Discussion |
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A quarter of the patients related their behavioural change to the influence of the booklet. This finding could be of importance, assuming that the patients made a realistic assessment. Certainly, patients might overestimate the role of the record, and credit any changes to the booklet. The question about smoking habits makes possible an estimation of this issue. Only a few of the patients who changed their smoking habits credited this change to the record. Thus, patients in this study did not automatically attribute changes to the booklet, indicating that a substantial proportion of the patients might have made changes in lifestyle because of using the record.
Concerns have been expressed that a health record would attract mainly groups with a higher level of education, and thus increase the ‘health gap’ between different socio-economic groups. The MBAH record reached groups with a lower level of education as often as those with more education. The level of education did not affect the frequency of self-reported lifestyle changes. Although the sample size did not provide the statistical power to detect any differences other than rather large differences, the results from the study do not support concerns about an increasing ‘health gap’.
Future research includes an analysis of experiences and attitudes of health personnel concerning the MBAH. An examination of other ways of distributing such records is also planned. There was no evidence that people with chronic disease or self-reported poor health status valued the record more. This finding suggests that distribution outside the health care system might be considered.
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Declaration |
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Funding: The study received financial support from Dalarna Research Institute and The County Council of Dalarna.
Ethical approval: The study was approved by the Ga-vle-Dala Research Ethics Committee.
Conflicts of interest: None.
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Acknowledgments |
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We are grateful to the project team Ann-Christine Hansson, Kristina Krantz, Kristina Stålhandske Robertson and Rigmor Sundkvist; Mats Granvik who provided necessary material and analyses from the population survey; and the personnel at the participating health centres.
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References |
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1 Dickey LL. Promoting preventive care with patient-held minirecords: a review. Patient Educ Couns 1993; 20: 37–47.[CrossRef][ISI][Medline]
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4 Liaw T, Lawrence M, Rendell J. The effect of a computer-generated patient-held medical record summary and/or a written personal health record on patients' attitudes, knowledge and behaviour concerning health promotion. Fam Pract 1996; 13: 289–293.
5 Bronson DL, O'Meara K. The impact of shared medical records on smoking awareness and behavior in ambulatory care. J Gen Intern Med 1986; 1: 34–37.[ISI][Medline]
6 Granvik M. Hur gick det? En uppföljning av Landstinget Dalarnas hälsopolitiska målsättningar för år 2000 [The population study of 2000]. Landstinget Dalarna, Landstingsstyrelsens kansli [Epidemiological unit at the office of the County Council of Dalarna, Sweden]; 2000.
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