Metered dose inhalers are not easy to use well. Every MDI  inhaler user receives information on the key steps in correct use  in the manufacturer's Patient Information Leaflet (PIL) which by law must be included in every inhaler pack. However, many people do not, or cannot, read  written information. Multimedia information systems (MIS) incorporating video clips with voice-over instruction offer an attractive alternative option. ¹ However, changing the format may change the effectiveness. ² We compared  the efficacy and acceptability of brief exposure to standard information on correct inhaler use, given by  PIL (Ventolin; Allen & Hanburys) and by a touchscreen multimedia program ( MIS; King's College London)

Method

One hundred and five English-speaking patients aged 12-87 using bronchodilator MDIs , recruited from two London practices,  were randomised to receive either MIS (57) or PIL (48). They were presented with the information and asked to look through it on their own. Acceptability and usefulness were assessed using Likert scales; verbatim comments were also recorded. Inhaler technique was demonstrated before and after viewing information, and rated blind from videotapes.

Results

There were clear differences in the extent to which subjects engaged with the information method. With the PIL, many did not look at the pictures and text describing inhaler use until prompted by the investigator. With the MIS system, user attention was engaged immediately, and many made  spontaneous comments. People viewing information on multimedia were less likely to rate the information as boring (p<0.01) than the PIL group. There was a weak association between engaging interest and global improvement in technique (p < 0.03).

Half of all patients said they had "learned something new". However, there was a difference in type of information learned .  The multimedia group were more likely to mention breathing and co-ordination (MTS 50 per cent; PIL 14 per cent) while the leaflet group were more likely to mention cleaning and checking the device (MTS 18 per cent; PIL 76 per cent). Patients in both groups showed small but statistically significant increases in inspiration time after information (p<0.01).  The multimedia group also had better hand-lung co-ordination (p<0.05) and shook  the inhaler more times  (p<0.05) after viewing information.  There were no age or gender differences.

Conclusion

Multimedia may provide key information more effectively than a PIL.  Electronic information is easy to share across healthcare settings, and takes up much less space than paper-based and videotaped methods.  Multimedia allows users to chose how information is presented (eg: language, age, gender, ethnicity).  This could increase the acceptability and personal relevance of the information, and help inhaler-users to feel more involved in their own healthcare.

References.

1. Evans JH, Collier J, Crook I et al. Using multimedia for patient information: a program about nocturnal enuresis. Br J Urol 1998;81 Suppl 3:120-2.
2. Wyatt JC. Same information, different decisions: format counts. BMJ 1999;318:1501-2