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This is to certify that the
thesis entitled
Efficacy of Video Tape Production

In Post-Operative Instruction

presented by

Dwight Brady

has been accepted towards fulfillment
of the requirements for

Masters Telecommunication Mgt.

degree in

 

 

 

Major professor

M Ma

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MSU Ie An Affirmative Action/Equal Opportunity Institution
cMmflf

 

Efficacy of Video Tape Production

In Post-Operative Instruction

BY
Dwight John Brady

A THESIS

Submitted to

Michigan State University

in partial fulfillment of the requirements

for the degree of

MASTER OF ARTS

Department of Telecommunication

1990

ABSTRACT

EFFICACY OF VIDEO TAPE PRODUCTION
IN POST-OPERATIVE INSTRUCTION

BY
Dwight John Brady

This thesis studied the efficacy of using the video tape
medium in post-operative instruction of patients recovering from
open heart surgery. Efficacy was measured in two primary
dimensions: (a) perceived involvement of physician with recovery,
and (b) actual understanding of information.

It was found that patients who were given a half hour video
tape containing advice and instruction from health care
professionals showed significantly higher levels of perceived
physician involvement, than patients who were not given a tape.

Though not a significant factor individually, exposure to
video tape combined.with level of education, proved significant in

increasing the level of actual understanding of information

presented.

Copyright by
Dwight John Brady

1990

DEDICATION

This thesis is dedicated in memory of Robert Curtis.
During the final stages of preparing this writing, Uncle Bob
was overcome .by a lengthy' bout with lung cancer (July

28,1990). His wealth of knowledge and his many stories will

be sorely missed, but not forgotten.

ii

ACKNOWLEDGEMENTS

I would like to express my gratitude to Dr. Thomas Muth,
for providing the impetus for this project and offering
helpful guidance all along the way; It would also like to
thank Dr. Gina Garramone, who not only devoted her time to
analyzing the data, but her computer as well. A special
thanks is due to Gary Reid and Stana Martin, who greatly
contributed to the production phase of this work. Finally, I
would like to thank Dr. Alonso Collar and the staff at Ingham
Medical Center for their participation in making this

undertaking possible.

iii

TABLE OF CONTENTS

Page
LIST OF TABLES O O O ........ O O ...... O O O O O O O O O O O O O O O O ...... v
LIST OF FIGURES... ................ . .................... Vi

Chapter
I. INTRODUCTION.0.0.0...O...OOOOOOOOOOOOOOOOOOOOOO 1

II. LITERATURE REVIEW AND CONCEPTUALIZATION........ 5

III. HYPOTHESES, RESEARCH QUESTIONS AND
METHODOLOGY.OOOOOOOOOOOOCO0.0... OOOOOOOOOOOOO O. 28

IV. RESULTS ....... 00.0.0.0...OOOOOOOOOOOOOOOOOOOOO. 38

V. DISCUSSION AND RECOMMENDATIONS................. 49

APPENDIXAOOO... ..... O ......... 0...... ........... O ..... 57

BIBLIOGRAPHY ..... . .......... . .......................... 63

iv

LIST OF TABLES

BEES
Breakdown of Time Spent By Segment.... ..... .........16
Frequencies of Media Choice By Group .............. ..40
Frequencies of Media Choice By Age...... ......... ...42
Frequencies of Media Choice By Education............43
Frequencies of Media Choice By Sex ....... .. ......... 44

Presence of Family Members While Watching Video.....48

LIST OF FIGURES

1 Rating of Instructional Segments By Perceived
HelprIneSSeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee46

vi

INTRODUCTION

The need for extending health communication beyond the
protective environment of the hospital is becoming
increasingly important. Ten years ago, the normal stay for a
patient following open heart surgery was ten to twelve days.1
During this period, the patient was given extra time to
assimilate new information required to best facilitate their
recovery. Now, patient stays have been reduced to less than
a week for many heart operations. This reduction is due
in part to financial cut backs from Medicare and insurance
companies, and advances in‘technologyu Currently the trend is
to eliminate the overnight stay in the hospital prior to
certain heart operations. In addition to reductions in the
length of stay, other factors may contribute to surgeons
spending less time with their patients.

According to a panel of nurses and patient care managers,
much of the contact with a patient following surgery has been
delegated from the surgeon to physician assistants. This is
attributed to greater work loads undertaken by heart surgeons.
Ten years ago, a doctor would do no more than one surgery per
day, now they perform as many as three.2 This reduced
opportunity for physician-patient interaction calls for
alternate methods which provide health care information to

recovering patients.

2

The purpose of the present study is to explore the
efficacy of using the video tape medium as a means of
extending home health care information to patients recovering
from open heart surgery.

The study will attempt to assess the medium's ability to
convey certain interpersonal qualities and instruction, often
associated with positive health communication.

Efficacy will be examined in several different
dimensions:

1. Perceived involvement of physician (Index of
interpersonal involvement; i.e. demonstrated.concern,
attention sympathy, friendliness etc.)

2. Actual understanding cf information presented

3. Perceived wellness of patient

4. Perceived helpfulness of information

5. Perceived effectiveness of media (print and/or video)

6. Usage of media (print and/or video)

Scope of the Study

Although this field experiment is comprised of a
nonrandom sample of relatively small size, it may provide
useful information in several capacities. First of all, this
study hopes to offer greater understanding of video tapes role
in extending health communication into the home. Secondly,
findings will aid in conducting more extensive research in
this area. In an effort to improve the educational design and

quality of future tapes, data regarding content and

3
helpfulness of the presentation will also be provided by this
experiment.

This study will examine the efficacy of the video tape
medium by using a four group design. The first group will be
comprised of patients who view their own physician on the
video tape. The second group will view the same video tape
but will not be under the care of the physician shown on the
tape. The third group will serve as the control for group
one. These patients will be under the care of the same
physician as those in group one, but will receive no video
tape treatment. Group four will serve as the control for
group two. Patients in group four will not be under the care
of the same physician as group one and will receive no video
tape treatmentw .All four groups will receive the same printed
information to take home.

By employing a fbur group design, comparisons between
users and nonusers of the medium will not only be possible,
but comparisons regarding the personalization of the video
tape medium will also provide meaningful information for

future studies.

CHAPTER I

Reference Notes

Interview with Marilyn Ballantine and Renee Shannon, Patient
Care Manager and R.N. Ingham Medical Center, Lansing Michigan,
28 June 1990. (Information based on their personal experience
and recollection of procedure at Ingham Medical)

Ibid.

CHAPTER II
LITERATURE REVIEW AND CONCEPTUALIZATION

Research indicates that patients are satisfied with the
medical care they receive from doctors, but are dissatisfied
with the communication accompanying that care. (Decastro,
1972; Fuller & Quesada, 1973; Skipper, 1965a). This may be
due in part to a tendency by physicians to see concern with
"bedside manner" as a concession to "selling medicine" (Korsch
& Negrete, 1972) . Despite what preconceived ideas exist,
numerous studies indicate significant relationships between
patient satisfaction and the degree of the physician's
perceived interpersonal involvement (Street and Wiemann, 1987:
Kreps et al., 1987; Korsch et al., 1971). Perception of
physician involvement has been studied by focusing on concepts
such as amount of concern shown by physician, interest shown
by physician, and time spent (Ben-Sira, 1976, 1980; Carter et
al., 1982; Korsch & Negrette, 1972). These studies all found
positive relationships between patient satisfaction and
perceived involvement.

While the literature supports the need for positive
interpersonal involvement by the physician, this may not be
expedient due to the on going reduction of time spent by
patients in the hospital. To help in extending the surgeon's
role in the patient's recovery, use of the video tape medium

is being explored. Production techniques used to foster

6
concerned and caring appearances by the health care profes-
sionals will be discussed in greater detail later in this
chapter. At this point however, it is sufficient to say that
findings from related research was utilized in the selecting
content and style of the presentation.

Research also indicates that over use of medical jargon
cannot only deter a patient's understanding of communication,
but diminish their satisfaction with their physician (Cousins,
1985; Daly & Hulka, 1975). For this reason highly technical
medical language was used only when absolutely necessary.
Even in these circumstances, the technical term was often
followed with a layman's term or description. Also, verbal
instruction offered by the health professionals was at times
supplemented by visual graphics displaying printed
information.

A common problem for doctors, is getting patients to
comply and adhere to medical treatment instructions (Hendin,
1977). Many studies have found that compliance is enhanced
when doctors offer education about important aspects of the
patient's illness and treatment regimen (Boyd, et al. 1974;
Leistyna & Macaulay, 1966). Information of this nature was
thoroughly presented during the first several minutes of the
video tape in a segment titled, "Understanding Heart Disease. "
By using a plastic heart model accompanied with graphics and
operative video, the physician explained the cause, treatment,

and potential outcomes for patients.

7

Researchers also suggest that explaining the importance
of adherence can increase patient compliance (Cole & Emmanuel
1971). Explanations regarding adherence were scattered
throughout the presentation and were particularly frequent
during the portion on exercise. These explanations by health
care ‘professionals were (accompanied. by’ an exhorting' and
encouraging testimonial from a recovering patient.

While an effort was made to limit the amount of
authoritarian language, it was used in certain portions of the
script. Research has shown that use of threatening
communication has been found to be an effective method of
enhancing adherence (Schmidt, 1977). Although communicating
in an authoritarian manner may be hazardous, it can facilitate
compliance when used sparingly and when the patient's

vieWpoint is considered (Svarstad, 1976).

W

Patient needs were determined through consultation with
health care professionals and existing literature regarding
health communication.

An initial meeting consisting of medical professionals
and media specialists met several months prior to the shooting
of the video. This meeting was to help establish a goal for
the production.and the study as a whole. From this meeting it
was determined that a video presentation comprised of
distinct, clearly defined segments, would be most helpful. By

producing the video in this manner, it was reasoned that the

8
patient would be allowed to select particular portions of the
information most endemic to their individual needs. The
segments outlined from this meeting were: Emotional aspects of
recovery; Practical considerations (guidelines for daily
activities): Medical considerations (taking medication, care
of incisions, etc.): Warning signs: and Exercise.

These elements proved similar to information already
being disseminated in print. It was important that the
information included in the video also be covered in the
accompanying take home literature in order to draw direct
comparisons between the efficacy of the two media in terms of
actual understanding.

Once having selected the overall topics, a more detailed
needs assessment was undertaken.

Based on post-discharge research of cardiac patients, the
most notable concerns of patients are: chest pain, arm
numbness, and shortness of breath (Nicklin, 1986). In a study
conducted at the University of Ottawa Heart Institute,
patients were encouraged to telephone nursing coordinators
anytime of the day or night if a concern or question arose.
Fifty-three of the 217 patients called regarding chest pain,
arm numbness, and shortness of breath. These leading concerns
were addressed in the video during the portion on flaming
Sings. The second most common concern or question pertained
to medication. This issue was also addressed in the
formulation of the script, and placed under the heading of

o s' e a 'o . Also covered under medical

9
considerations was the third most cited concern dealing with
pain and swelling of the leg.

Research has shown that the emotional and psychological
status of'a patient can effect their recovery’process, even to
the point of life or death in certain cases of coronary
surgery.

Low morale was a significant predictor of death in the
study conducted by Garrity and Klein that assessed 48 patients
for anxiety, hostility, and. depression. as compared. with
calmness and cheerfulness five days following admission to
intensive coronary care. Of the 12 patients who died within
six months of discharge, 10 had been characterized as
suffering from unresolved emotional distress, and previous
physical status did not explain the excess death rate among
the depressed patients (Garrity & Klein, 1975) . Another study
found that 17 patients with myocardial infarctions (heart
attacks) who subsequently died had significantly higher
depression scores than did survivors (Bruhn et al. 1969).

Due to the importance of emotional and psychological
factors in a patient's recovery from heart surgery, a separate
category of the video was devoted to addressing these
problems. By devoting an entire segment to the psychological
aspects of recovery, more detail was included on ways the
patient and their family could combat feelings of depression
and anxiety. Also, by keeping this portion separate from the
others, it could be referred to as needed then easily skipped

once the patient had made sufficient emotional adjustments.

10

i eo

Currently, the most common way to extend health care
information into the home is through literature given to the
patient following their discharge. In the case of patients
recovering from open heart surgery, these materials address
primary areas of concern such as diet, physical limitations,
emotional aspects, and exercise.

Research has shown however, that patients given only
pamphlets and other printed literature have been found to
demonstrate less adherence and comprehension than those
patients exposed to mediated devices such a audio or video
tapes (Assaf et al., 1985: Pinto et al. 1989).

Baskerville et al.(1985) found that audio tapes were
perceived by 98% of the respondents as being helpful. Support
for the use of video tape productions has also been found in
pre-operative studies (Pinto et al. 1989) , but little is known
about the medium's efficacy in post-operative settings.

To maximize the potential effectiveness of the
production, literature concerning the visual medium as an
educational tool was also solicited along with articles
pertaining to production parameters and quality considera-
tions.

Television is a powerful medium. According to Drew
Tiene, Assistant Professor in the Educational Technology
Department of Kent State University, sequencing of shots and

events can be controlled to portray a subject in a positive or

11
negative light. Music can be used to manipulate emotions and
the proper delivery of a script can be very convincing.
However the primary strength of the television medium is its
ability to combine these stimuli with dynamic visuals. It is
the visual that makes the narrative material more interesting
(Tiene 1986).

By properly utilizing the television medium, it is hoped
that the perceived involvement of the physician can be
enhanced along with increased comprehension.

Jaako‘Ukkonen, an audio/visual specialist from.Helsinki,
Finland has published some extremely interesting statistics.
Of all the things we hear, we recall about 70 percent after
three hours and only 10% after three days; of things we see,
we remember about 75% after three hours and about 20% after
three days; of the things we both hear and see, we remember
about 85% after three hours and about 65% still after three
days (Ukkonen, 1988). This information seems to suggest that
by combining audio and visual stimuli, a patient would.tend to
have greater comprehension of the information presented.

Equally as encouraging, is that learning through the
visual medium has been elevated to a new dimension due to the
rapid proliferation of the home VCR. With the popularity of
the VCR, a barrage of exercise videos, home fix—it tapes, and
others have emerged as instructional videos. While the
integrity and quality of some of this fare is questionable,
the potential for quality video instruction does exist in many

different applications.

12

The use of a take home video tape for post-operative
instruction may be especially helpful in eliminating
miscommunication problems endemic to the medical profession
(Kreps & Thornton, 1984). Cardiac patients in particular, are
often in a state which seriously limits their comprehension,
even several days following surgery (Atman, 1972: Sethee,
1967). By allowing the patient to take home a video tape
containing carefully encoded messages, proper decoding of the
intended information may be increased.

The ability to replay portions of the video that are of
extreme importance or more complex is also made available by
a made for VCR presentation. This is especially true with the
addition of remote control units which would be invaluable to
a recovering patient.

The environment in which the information is displayed may
also be beneficial to both the patient and their families.
According to previous post-operative studies using mediated
devices, 75% of the patients listened to the audio tape with
their spouses and 32% listened with other household members
present (Baskerville et al. 1985). While the visual medium
may produce differing levels of family participation it is
logical to assume it will occur to some degree. Shared
viewing would seem to be important in light of the serious
consequences coronary surgery can mean for a family (Segev &
Schlesinger, 1981). By placing a video tape in the home, it

may help to foster family participation in the patient's

13
recovery and dispel certain misconceptions held by family
members.

While the potential of the video tape medium is certainly
promising, it is not to suggest that this medium is in any way
a substitute for personal contact by a physician with a
patient. The literature and recent trends in telecommunica-
tion do however, lend support for this medium as a viable

supplement to personal communication.

Production Parameters

The production under study was written and produced
during a six month period from October, 1989 to April, 1990.
All of the visual components, except for graphics were shot on
location at Ingham Medical Center in Lansing, Michigan or in
the surrounding area. Nearly seven hours of raw footage was
required to produce the twenty-eight and a half minute video.

During the planning stages of the production many
different details had to be considered. The length, content,
pacing, and types of camera shots all had to be estimated and
planned around the development of the script.

The length of the program was determined by several
factors. The first consideration*was:made with respect to the
amount of content. In order to parallel the written material,
a great deal of information had to be included. This
presented a problem of including enough information to be

effective, without violating the parameters of the visual

14
medium which should not be used simply to transfer written
information to a television screen.

Previous studies utilizing audio tapes ranged in length
from 12.5 minutes to 20 (Young, et al. 1986; Baskerville,
1983). It was determined.that the length of the participatory
part of the video would be sufficient at roughly fifteen
minutes in length while the semi-interactive exercise portion
would proceed for approximately ten minutes. The completed
length of the presentation, including introductory segments
and close, totaled twenty-eight and a half minutes. Though
several minutes longer than originally planned, the completed
length was determined well within the typical television
viewing time of half hour time blocks.

In order to maximize the patient's attentiveness during
the nonparticipatory segments, the doctor's role of
instruction was divided into four separate parts. Another
section covering emotional aspects of recovery was placed in
the middle of the doctor's instruction. This portion was
hosted and narrated by a nurse. Her scripted instruction was
also interspersed with comments from patients and their
spouses regarding emotional and familial adjustments to the
post—operative stage. By placing this portion between the
doctor's instruction it allowed for a change in setting,
personality and tone of voice. It was felt that changing the
pace of delivery'would.help reduce the tendency for viewers to

lose concentration.

15

The ordering of the topics was determined through the
review of literature and through consultation with the
participating physician.

As previously stated, compliance is enhanced when
physicians educate their patients about important aspects of
their illness and treatment regimen (Boyd. et al. 1974;
Leistyna & Macaulay, 1966). These findings plus a desire to
present such background information in the early part of the
video, made the topic WW first in the
order of individual segments. The only disadvantage of making
this topic the first instructional portion was the length
required to fully explain the necessary information. Due to
the length and detail of this segment, it was fellowed by
Engnignn1_1nnggn, which featured a new host. This was done
for pacing considerations mentioned earlier. In addition to
changing the talent and setting, the placing of this topic in
the second position permitted the discussion of emotional
aspects before getting into medical and practical
considerations. This ordering' scheme was ‘used tottmake
transitions more natural while creating a build up to the
exercise portion (see Table 1). For instance, the three
topics of: Mgdignl__§gn§1ggnnnign§, Warning Signs, and
Pnagnical Considerations were all related and allowed for
logical transition statements made by the talent. Because
information regarding practical considerations contained
guidelines to activity it was easy to make the transition from

this topic to the portion on exercise. In addition to

16

Table l
Breakdown of time

spent by segment

 

 

Item
Musical Introduction
Talent Introduction
Understanding Heart Disease
Path To Recovery
Psychological Impact
Medical Considerations
Practical Considerations
Exercise Portion
Closing Comments
Credit Roll

Totals

1:00

11:30

28:30

 

l7
creating a building process, the exercise portion was placed
near the end of the tape to facilitate easy location of this
portion. It was felt that after one or two viewings of the
entire tape, the patient would refer primarily to the exercise

portion due to the repetition of exercises on a daily basis.

Pngdnction Technignes

As stated earlier, a television producer has the ability
to portray someone or something in a positive or negative
light. For the goals of this project the former option was
obviously selected in order to make the health care
professionals as warm and caring as possible, without over
dramatizing their appearance.

To give an example of how such abstract objectives were
accomplished, a breakdown of the production techniques for the
opening shot of the talent may be helpful.

The first consideration for this shot was the setting.
This sequence was very important, because it would offer the
health care jprofessionals their first chance 'to 'make. a
positive visual impression on the viewer.

The second concern centered around the type of apparel
the talent would be wearing. The third and perhaps most
important consideration was the type of lighting that would be
used to create the desired visual feeling.

After considering different options, a conference room
which also served as a library for a group of physicians was

chosen as the proper setting for the opening shot. This

18
decision was made for several reasons. First of all, the
room's decor was virtually all wood which gave it a warm
visual feeling; Secondly, the books on the shelves behind the
subjects would also help to symbolize knowledge and medical
competence.

The second issue of clothing was addressed by having only
the exercise physiologist wearing the typical white clinicians
coat, while the surgeon and nurse would appear well dressed
but casual. The surgeon wearing a suit and tie, was placed
between the exercise physiologist and the nurse who wore a
dark colored dress. The rational for having the doctor and
nurse appear without medical attire was to allow them to blend
with the warm color and atmosphere of the setting. By having
the exercise physiologist present in her white coat, it gave
this shot an identifiable medical look while permitting the
physician and nurse to retain a personable yet professional
appearance.

The reason so much attention was paid to creating a warm
and friendly atmosphere is due in part to research which found
that the amount of warmth and friendliness shown by a doctor
is positively related to satisfaction (Daly & Hulka, 1975:
Korsch et al., 1968). To add warmth to this scene a golden
gel was placed into to the back lights This helped accent the
wood work while giving the talent more natural flesh tones

than typical lighting techniques.

19

Other' scenes ‘were shot. based. on similar' production
techniques and research to determine the look and feel of the
video in which health care professionals were portrayed.

The scene following the introduction was shot in a new
location to simulate the physician making rounds. This was
done by having him enter the picture coming out of an
examining room. This time he was wearing a white coat which
coincided with the clinical setting and the technical
information.about to be presented” .Another reason for wearing
a white coat is to allow the physician to establish medical
authority following his role in the open which was purposely
more informal. A study done in 1976, offers support for the
manner in which these scenes were produced. Patients expect
a certain degree of reassurance along with technical
competence (Ben-Sira, 1976).

In an effort to add impact and a more personable feel to
the entrance of the nurse, specific production techniques were
utilized. A moving shot known as truck was used to give the
feel of her talking with the patient while walking down the
hall. By using this trucking technique, there was no need to
verbally cue her entrance. 'This was due to an adequate change
in time and space created through the use of the camera
movement and transition music.

In striking contrast, a direct verbal cue was used to
establish the entrance of the exercise physiologist. This
verbal cue was accompanied by visuals effects. These obvious

indications were purposely employed to cue the viewer as to

20
the events about to follow, and to clearly separate the
exercise portion from the rest of the presentation.

A production technique which is normally associated with
broadcast journalism was incorporated in this project. This
was done iby conducting' on camera interviews with fomer
patients and their spouses regarding their post-operative
experiences. Their responses offered indirect sources of
information. While they never directly addressed the camera,
such as in the case of the health care professionals, their
responses offered very candid and accurate information.

Research shows that family dynamics are affected when the
head of the household has had an acute myocardial infarction
or other serious complicatiOn regarding heart surgery.
Significant. changes in familial relationships. can follow
causing spouses to have difficulty in adjusting to this new
situation (Segev & Schlesinger, 1982).

Because of the important role family members play in a
patient's recovery, it was determined that comments from
spouses and recovering patients themselves would offer
encouragement and allow the viewer to compare their
experiences with the persons interviewed in the video.

In. addition. to offering' encouragement, some of the
questions that were asked of the patients in the video were
designed to solicit replies that would challenge the viewer.
This technique was used especially in the portion on exercise.
The purpose for such strong motivational appeals in this

segment, is due to research which shows patients who are in

21
good physical condition may better tolerate further heart
damage than those who are not (Segev & Schlesenger, 1981).
While the use of established field production techniques were
utilized to insure proper encoding of intended messages, many
post-production techniques were employed to further enhance
the quality of the overall production.

Dr. Larry R. Whiting, head of Information and Applied
Communications at Ohio State University, states that a high
quality video must be produced. Viewers have seen so much
television that they easily recognize the difference between
good and bad video production. Poor quality productions
create boredom and loss of credibility. A program must
provide more visuals than the typical "talking head"
(McCallum, 1990).

Being mindful of society's demand for quality video
production, extensive work was done in preparing a well
conceived well edited and fast paced musical introduction.
This was done to immediately sell the viewer on the quality of
the presentation.

In step with proper visual theory, the opening shot
consisted of a wide angle areal view of Ingham Medical Center.
The second shot moves the viewer closer with a ground level
view. A third shot offers still more detail, by showing a
familiar portion of the facilities exterior. Next, a medium
close up of a man looking towards the hospital establishes the
arrival of a patient. Following these shots the viewer sees

the man and his wife climbing stairs and entering the Thoracic

22

and Cardiovascular Institute. Their location is made known by
a tight shot of the lettering on the door. From this point
the viewer sees the patient going through preparation for
surgery, and the doctors preparing for what appears to be the
patients actual surgeryu In.reality, the surgical video used,
was from another surgery that was video taped. As the music
builds, a rapid sequence of shots showing the patient being
wheeled out of surgery dissolves into a shot of the patient
being wheeled out of the hospital in a wheel chair. In all,
the entire admitting, preparation, surgical, and discharge
sequence was shown in less than sixty seconds.

The introduction not only is used to sell the viewer on
production quality, it is also used as means of setting the
stage for information about to be presented. By visually
reviewing the admitting, operative, and discharge sequence,
discussion regarding post-operative care is now in order.

As the music begins to descend from its crescendo, the
introduction video dissolves into the opening shot of the
talent. .At this point the pace is quickly diminished.in order
to establish a calm and reassuring introduction of the health
care professionals. While the verbal pace continues at a very
calm and steady rate, the use of visual effects help to
provide eye catching movement in order’ to maintain. the
viewer's concentration. Use of colorful graphics and printed
information also helped to reinforce the verbal instruction.

Each topical section was given a different color

background to allow for easy location when scanning through

23
the video tape. For example, the segment on practical
considerations was given a pleasant blue background while the
portion on warning signs was given a red (alarming color) for
its background.

The use of music was not only important in creating a
dynamic introduction for the program, it was used to aid
participation of the exercise portion. A certain musical
selection was also used to provide a happy and somewhat
triumphal close to the program.

In both the intro and the close, the title of the
program, flgnztcare appears. The title was constructed by

using a Chyron character generator. The word Heart was typed

 

in red with the word ggne typed in blue. A matching blue
horizontal stripe was placed under the lettering to add
continuity to the title when it was superimposed over other
video sources. The color scheme of the title was even held
constant in the packaging of the video cassettes. The color
of the cases selected was very similar to the blue used on the
title.

The reason for such extreme detail in the production and
packaging, was.due in part to industry and personal standards,
and from a desire to simulate a commercially produced video
presentation.

Research also indicates the need for quality
considerations. John Phillipo of the Merimeck Educational
Center in Salsbury, Massachusetts says that people of today

are visual learners. Media producers who know about video

24
need to supply learning materials of high quality, equal to
commercial quality.
In practical terms, the video being tested had to have
all the components of a commercially viable production in
order for this research.to offer any clear meaning to those in

the medical, and video production fields.

10.

11.

25

CHAPTER II

Reference Notes

Decastro, F. J. "Doctor-Patient Communication: Exploring
the Effectiveness of Care in a Primary Care Clinic."

gliniggl Pediagrics 11 (1972):86-87.

Fuller, D. S., & Quesada, G. M. "Communication in Medical

Therapeutics." Journal_2f_§2mmunieetien 23 (1973)=361-
37o.

Skipper, J. K. "Communication and the Hospitalized
Patients. In J. K. Skipper 8 R. C. Leonard (Eds.),

Sggigl Intenacnion and Patient Care (pp. 61-81).
Philadelphia: J. B. Lippincott, 1965.

Korsch, B.M. & Negret, V.F. "Doctor-patient Communica-

tion." Scientifis_5merigen 227 (1972:)=66-70-

Street, R. L. & Wiemann, J. M. "Patient Satisfaction With
Physicians' Interpersonal Involvement, Expressiveness and

Dominance." ggnnnnignnign_3gnnng_k 10 (1987): 591- 613.

Kreps, G.L., Ruben, B.D., Baker, M. & Rosenthal, S. "A
National Survey of Public Knowledge About Digestive
Health and Disease: Implications for Health Education."

Publie_flealth_fieeerts 102 (1987)=270-277-

Korsch, B.M., Freemon, B. & Negrete, V.F. "Practical
Implications of Doctor Patient Interaction: Analysis
for Pediatric Practice." eri an r a o D'so s

Chilgzgn 121 (1971):110-114.

Cousins, N. "How Patients Appraise Physicians." Tng New

Enslend_£eurnal_2f_nedieine (Nov. 28. 1985) p- 1422.
Daly, M.B., & Hulka, B.S. "Talking With the Doctor."
Jonnnnl 9f Cgmnnniggnion 25 (l975):l48-152.

Hendin, 0. W. New

York: North American Library, 1977.

Boyd, J. R., Covington, T. R., Stanaszek, W. F., & Coussons,
T. "Drug Defaulting Part II. Analysis of Noncompliance

patterns." Anenigan Jgnnn nl gf Hgsninnl Phannac cy 1974,
485- -491.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

26

Leistyna, J.A., & Macaulay, J.C. "Therapy of
Sterptococcal Infections." er' J u na 'seases

2£_Lh§_flhilé 11 (1956)=22-25-

Cole, P., & Emmanuel, S. "Drug Consultation: Its
Significance to the Discharged Hospital Patient and its
Relevance As a Role for the Pharmacist. " American Journal

2f_n2§pital_£harmaex 28 (1971)=954-960-

Schmidt, D.D. "Patient Compliance: The effect of the
Doctor As a Therapeutic Agent." Jou na 0 il

Enngnige 35 (1977):60-81.

Svarstad, B.P. Conformity In Medical Advice. In D.
Mechanic (Ed.), e Growt o ure r ic 'c'ne,
New York: John Wiley, 1976.

Nicklin, W .M. "Postdischarge Concerns of Cardiac Patients
As Presented Via a Telephone Callback System."

fleant & Lung 15 (1986):268-272.

Garrity T.F., & Klein, R.F. "Emotional Response and
Clinical Severity As Early Determinants of Six Month
Mortality After Myocardial Infarction." Heant & Lnng

4 (1975):?30-737.

Bruhn, J.C., Chandler, 8., Wolf, S. "A psychological
Study of Survivors and Nonsurvivors of Myocardial

Infarction." nggngggn_ngg 31 (l969):8-19.

Baskerville, P.A., Heddle, R.M., Jarrett, P.E.
"Preparation for Surgery: Information Tapes for the

Patient." The Pnggnigner 229 (1985):677-678.

Tiene, D. "Using Video to Facilitate Educational Change."
Educational_leshnelegx (April 1986)-

Ukkonen, J., "Audio-Visuality Squeezed Into the
Classroom."
15 (l988):3

Kreps, G L-. & Thornton. B C- Health_92mn_nisatien:
Th_erx_and_2reetice New York: Longman. 1984-

Atman, N. "Understanding Your Patient's Emotional

Response." Jounnnl gt Enagniggl Nursing 22 (1972):22-25.

Sethee, U. "Verbal Responses of Nurses to Patients in
Emotional-Laden Situations in Public Health Nursing."

Nureins_Ee§areh 16 (1967)=365-368-

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

27

Segev, U. & Schlesinger, Z. "Rehab of Patients After
Acute Myocardial Infarction: An Interdisciplinary Family
Oriented Program." fignn§_§_Lnng 10 (1981):841-846.

Young, R. S. , J ourgenson, R. J. , & Shapiro, S . D.
"Efficacy of and Patient Preference for Three Counseling
Formats." our en 3

De_eleementel_n_elegx 6 (1986): 3-14-

Baskerville, et al. "Preparation for Surgery Information

Tapes for the Patient." The Pnggtipignez 229 (1985):667-
678.

Boyd, et al. "Drug Defaulting Part II: Analysis of

Noncompliance Patterns." Anerican qurnal of Hospital
Bhgznngy (1974):485-49l.

Leistyna, et al. "Therapy of Streptococcal Infections."
AmericanmI2urnalmefJEEHEEESEJuLJTELthld

111 (1966): 22-
26.

Daly, et al. "Talking With the Doctor." Jou a of
gommunication 25 (1975):148-152.

Korsh, B. M., Gozzi, E. K., & Francis, V. "Gaps in

Doctor-Patient Communication." Eggignnigg 42 (1968):
855-871.
Ben-Sira, Z. "The Function of the Professional's

affective Behavior in Client Satisfaction: A Revised

Approach to Social Interaction Theory'. gpnnnnl_gj_ngnlpn
gng Sgc ial Behnvipz 17 (1976): 3-11.

Segev, et al. "Rehab of Patients." neant g Lung 10
(1981):844.

Ibid., p. 843.

McCallum, C. L. "Paint Blitz 89." M.A. Thesis, Michigan
State University, 1990.

CHAPTER III
HYPOTHESES, RESEARCH QUESTIONS
AND METHODOLOGY

Based on the preceding literature review we hypothesized
that when a patient views his or her own physician on the
video tape, they will demonstrate higher levels of satisfac-
tion with their physician's involvement than patients
under the care of another physician who view the tape. We
also predicted that both groups exposed to the video will
demonstrate higher satisfaction levels than those not

exposed.

Hla: Patients exposed to video tape treatment will perceive
greater physician involvement than those not exposed to

the video.

Hlb: The difference of perceived involvement between treatment
groups and control groups, will be greater when patients
view their own surgeon, than when patients do not view

their own surgeon on the tape.
Due to ‘the exploratory' nature of this study, many

research questions were asked to examine relationships and to

inquire as to the preference of media type.

28

RQI:

RQ2:

RQ3:

RQ4:

RQ5:

RQ6:

H2:

29

Does the relationship between video tape exposure and
satisfaction vary according to a patient's sex, education

level, and age?

Do patients exposed to the video tape demonstrate
significantly greater satisfaction with their recovery

process?

Will patients consider the video tape production more

helpful than written materials?

Does media preference hold true regardless of whether a

patient's own physician is featured in the video

presentation?

What are the reasons given for choice of media?

Do age, gender, or education significantly interact with

media preference?

Patient exposure to media, significantly interacts with

their actual understanding of messages:

R Q7: Which components of the video tape were most helpful?

30

MQLDQQQIQQY

Participants in this study were solicited from the
Thoracic and Cardiovascular Institute in Lansing, Michigan.
The non random sample contained 75 patients recovering from
open heart surgery. Patients were assigned to one of four
treatment conditions: Group 1, video exposure with own
physician on tape (n=17) 9 male and 8 female: Group 2, video
tape exposure without own.physician on tape (n=30) 22 male and
8 female: Group 3, same doctor as Group 1 but no video tape
exposure (n=11) 8 male and 3 female: Group 4, different
physician than Group 1 with no video tape treatment (n=17) 8
male and 9 female. While only two groups received the video
tape to take home, all four groups were given identical
printed material.

The first and second conditions were compared to the
third and fourth to test the efficacy of the video tape medium
in altering levels of perceived physician involvement. Groups
one and three and two and four were also compared for
significant differences of perceived involvement.

Other comparisons were made regarding actual understand-
ing, perceived. wellness of patient, variables measuring

effectiveness and patient preference of media.

mus

Patients were given several weeks to utilize their

instructional materials as they chose. Along with their

31
printed materials, patients in the two video groups were given
an identical 28 and a half minute video featuring instruction
by medical professionals from Ingham Medical Center. The
physician appearing on the tape was the surgeon who had
operated on the patients in Group 1. Patients in Group 2,
were under the care of other physicians. All patients in the
study were under the care of the nurse and exercise

physiologist appearing in the video.

Qnespionnaire

Due to the absence of the video in.the control group, two
questionnaires were employed in this study. Both
questionnaires were identical except that seven questions
pertaining only to the video tape, were not present on the
questionnaire administered to the control group.

The questionnaire given to the control group was made up
of six parts, while the survey given to the two treatment
groups divided into seven parts: perceived general health and
understanding of material: actual understanding of material:
specific information pertaining to the doctors role in the
patient's recovery: information on the use and effectiveness
of written materials: information on the use and effectiveness
of the video tape presentation: information regarding the
exercise portion: and demographic data.

Perceived general health, and understanding of
information were determined by asking the patient to rate the

overall progress of their recovery. The rating scale used in

32
this portion was a five-point summated rating scale. Patients
were also asked. to rate the ease of understanding and
helpfulness of verbal information given to them by their
doctor prior to discharge.

The perceived. role of’ the doctor in the jpatient's
recovery was compiled through an index of certain
characteristics. The index included: concern for patient's
well being: personal attention or interest shown: degree of
sympathy: friendliness: encouragement: and amount of time
spent with patient. Being consistent with the first three
items, a five-point summated rating scale was used to measure
the patient's perceived satisfaction with their physician's
role in their recovery. Use of a five-point Likert scale is
in keeping' ‘with. previous studies examining' patient
satisfaction (Street and Wiemann, 1987: Zyanski et al. 1974).
The Likert method of scoring with a range of five response
alternatives was used in these studies in order to place
greater emphasis on the strength.or intensity of the patient's
belief, which is important in understanding attitudes
(Zyzanski, et al. 1974).

The eight items evaluating perceived satisfaction with
involvement, were designed based on Zyzansky's satisfaction
questionnaire which offered the patient an equal number of
positive and negative statements. For instance, "My physician
showed genuine concern for my well-being." This was followed

by, "My physician did little to keep me from worrying."

33
Combining positive and negative statements was used as a means
of reducing response set.

Statements regarding patient satisfaction with their
physician were deliberately positioned before asking questions
pertaining to use of instructional materials. This was done
to insure that patient responses about their physician were
not influenced by their answers to other questions.

Information concerning use and effectiveness of written
materials include a forced choice. question tot determine
frequency of use. Again a five-point scale was used to
measure ease of understanding and level of helpfulness.

Identical questions were asked in reference to the use of
the video tape. One other question regarding the presence of
family members was added to the questionnaire containing the
video tape portion.

A direct forced answer question asked the respondents
which medium they found to be most helpful, the video tape or
written materials? This question was followed by an open
ended question leaving room for the patient to explain their
choice of media.

To shed further light on the usefulness of the video
tape, patients were given a list of the segments contained in
the video and asked to rate them in order of helpfulness.

Information pertaining to a patient's perceived
participation and actual recall was obtained by using both the
five-point Likert and forced choice and open ended questions.

For example, in evaluating the exercise portion, the patient

34

was asked: "How would you rate the effectiveness of your
exercise program in helping you return to your normal daily
activities?" The five choices ranged from, "very effective,"
to "not at all effective." The forced choice question
determined perceived frequency of participation in home
exercise work outs. This was done by asking patients to
choose from listed frequencies such as "once per day," "once
per week," etc.. This item was followed by an open ended
question which probed for actual participation and under-
standing by asking respondents to list the names of the
exercises contained in both the video and written materials.

Questions pertaining to gender, education level, and age
were asked at the close of the survey.

Response to the questionnaire was nearly 100%, with no

refusals and only several incomplete surveys.

oce

The administration of the questionnaire took place during
May through July of 1990. After spending three weeks at home
following surgery, patients returned to TIC for a routine
check up. Before seeing their doctor, patients were asked to
fill out a brief questionnaire. Patients were told that all
responses were to remain confidential.

The reason patients were given the questionnaire prior to
their examination by their physician was to guard against any
contamination of the key variables under study. The primary

interest of this research was to obtain knowledge concerning

35
the manipulation of the personalization and media type
variables. In sum the goal was to measure the effect of media
manipulation on a patient's perceptions, rather than to
measure the effectiveness of a physician's interpersonal
skills on these perceptions.

It should be noted that patients who received the video
tape were selected on the basis of access to a VCR. Patients
who did not have access to a video player were either left out
or placed in the control group. Ramifications of this
procedure will be covered more fully in the discussion
portion.

All instructional materials were distributed to the
patients by the same nurse under similar conditions. 'This was
done to eliminate any bias that may have occurred if some
patients received the materials directly from.their physician

and others did not.

W

To generate perceived physician involvement, a factor
analysis was performed on the Perceived Involvement Index
The eight items loaded together, forming a relatively strong
index, alpha = .82.

Actual understanding was also generated by forming two
separate indexes. The two items pertaining to comprehension
of practical instruction shared a weak relationship r = .17,
while the two items regarding exercise recall and warning

signs shared a stronger relationship r = .28. An effort was

36
made to incorporate a four item index, but the items loaded
independent of one another alpha = .39.

Perceived progress was developed.by correlating measures
of perceived progress with recovery and the perceived
helpfulness of exercise in returning the patient to good
health. r = .49. Perceived progress was also used at times as
a single item index.

Determination of elements in the video that were most
helpful, was done by simply tabulating frequencies and means
for each item according to the rank assigned to them by the
patients.

To test Hla, ANOVA.procedures were utilized to determine
the significance of the tape treatment along with the
interaction of the individual physicians.

To determine significant differences between the two
groups exposed to the video and their respective control
groups, a t-test was employed.

Except for RQB which required Chi-square, ANOVA
procedures were utilized for the remaining hypotheses and

research questions.

37

CHAPTER III

Reference Notes

Street, R. L., & Weimann, J. M. "Patient Satisfaction
With Physicians' Interpersonal Involvement, Expressive-

ness, and Dominance." Qommnnignpion Xepnbggk 10 (1987):
591-613.

Zyzanski, S. J., Hulka, B. S. & Cassel, J. C. "Scale
for the Measurement of Satisfaction with Medical Care:
Modification in Content, Format and Scoring." gigging;
ngg 12 (1974):6ll-620.

Ibid 0

 

CHAPTER IV

RESULTS

Hypothesis 1a proposed that patients exposed to video
tape treatment would perceive greater physician involvement
than those not exposed to the video. 'The data offered support
for this prediction. Viewers of the tape demonstrated a
significantly higher evaluation of their physicians perceived
involvement (M=36.87) than did patients who did not view the
tape (M=34.48), F = 5.23, p < .05.

According to Hypothesis 1b, it was also expected that
patients who viewed their own.physician.on the tape would.have
a greater difference between their control group's mean than
would patients who viewed a physician other than their own.
The data did not offer support for this hypothesis.
Utilization of a t-test actually revealed contrary findings.
Viewers of their own physician (M=36.80) showed no significant
difference with their control group under the care of the same
physician (35.86). Patients exposed to the tape featuring a
physician other than their own showed a significantly higher
level of perceived physician involvement (M=36.92) than their
control group (33.59), t = 2.49, p < .05.

Research question 1 asked if the relationship between
video tape exposure and satisfaction with physician
involvement varies according to a patient's sex, education

level, and age. This question was important because these

38

39

level, and age. This question was important because these
three variables were not evenly distributed among the four
groups. In this test, both treatment groups were analyzed
along with a third group which combined both control groups.
In all three of the ANOVA tests which included the perceived
satisfaction index with the tape variable and sex, education
and age, the video tape variable emerged as the only
significant difference between the groups” F== 5.16, p < .05,
F = 7.16, p < .001, F = 5.74, p < .05 respectively.

Research question 2 asked if patients exposed to the
video tape demonstrate significantly higher levels of
satisfaction with the progress of their recovery regardless of
age, sex and education. Once again the tape variable proved
highly significant in all three ANOVA tests F = 8.67, p <
.05, F = 7.82, p < .001, F = 5.33, p < .05 respectively.

The education variable, did however prove significantly
different between groups as well F = 3.53, p < .05.

Research question 3 asked whether or not patients would
perceive the video tape production more helpful than the
printed materials. Research question 4 extended RQ3 by asking
whether media preference or perceived helpfulness of media,
holds true regardless of whether a patient's own physician is
featured in the video presentation.

A Chi-square of the data showed a significant
relationship between perceived media helpfulness and

personalization of the visual message (see Table 2).

40
When the patients viewed their own physician on the tape,
7 out of the 17 said they felt the video tape was the most
helpful media while 5 said the printed materials were the most

helpful and 5 said both were helpful.

Table 2

Frequencies of Media Choice By Group

 

 

Group: 1 = Own surgeon on tape
2 = Other than own surgeon on tape

 

 

Group
1 2
Media gnoicg Row Tonal
video tape 7 3 10 or 21.7%
printed material 5 17 22 or 47.8%
both 5 9 14 or 30.4%
Column Total 17 29 45 or 100%
37.0% 63.0%

Chi-Square = 6.60, Significance = .036

 

When patients viewed a physician other than their own,
the perceived helpfulness of the video tape dropped signifi-
cantly. Only three of the 29 patients rated the video as the
most helpful of the two media, while 17 felt the printed

materials were the most helpful and 9 said both were helpful.

41

To help determine why certain respondents preferred one
form.of media over the other, research question.5.asked, "what
are the reasons given for choice of media?" This question is
worded.virtually in the same manner as the open ended question
which appeared on the actual survey form.

Responses of those who felt the printed material was the
most helpful seemed to center around two main factors. Many
felt the printed material was easier to refer to, and that it
contained more specific information. Other respondents who
said they preferred the printed material felt the video was
more of a reinforcement to information already presented in
the hospital.

Those who preferred the video tape seemed to appreciate
being able to actually see the exercises being done to insure
they did them correctly. Others felt the video was easier to
understand and that it was very helpful to the spouse and
family members who had not been exposed to the information
presented in the hospital.

To help in determining what types of patients tend to
show certain preferences regarding choice of media, research
question 6 asked, "Do age, gender, or education significantly
interact with media preference?" A significant relationship
was found to exist between a patient's age and their choice of

media (see Table 3).

42

Table 3

Frequencies of Media Choice By Age

 

 

 

 

Age: 1 < = 60 years

2 > = 61 years

A92
1 2
Med1____e' a Choic Beam
video tape 3 . 7 10 or 22.2%
printed material 13 9 22 or 48.9%
both 2 11 13 or 28.9%
Column Total 18 27 45 or 100%
40.0% 60.0%

Chi-Square = 7.03, Significance = .029

 

The variable of education approached significance when
comparing frequencies with the variable "Media Choice" (see
Table 4). No significant findings emerged as a result of
introducing a patients gender, which suggests an even
distribution of media preference between males and females

(see Table 5).

43

Table 4

Frequencies of Media Choice By Education

 

 

Education: 1

= Some High School
2 = High School Graduate

 

 

3 Some College or Grad School
Museum:
1 2 3
Medium Rm
video tape 8 2 0 10 or 21.7%
printed material 8 6 8 22 or 47.8%
both 7 5 2 14 or 30.4%
Column Total 23 13 10 46 or 100%
50.0% 28.3% 21.7%

Chi-Square = 7.83, Significance = .097

44

Table 5

Frequencies of Media Choice By Sex

 

 

 

 

Sex: 1 = Male
2 = Female
£93
1 2
mm Row__'1‘_95_al_
video tape 7 3 10 or 21.7%
printed material 15 7 22 or 47.8%
both 8 6 14 or 30.4%
Column Total 30 16 46 or 100%
65.2% 34.8%

Chi-Square = .588, Significance = .745

45

Hypothesis 2 expected that exposure to media, would
significantly interact with a patient's actual understanding
of information. To control once again for age, sex and
education, these variables were figured in to the analysis.
An ANOVA test was run for both indexes representing actual
understandingu The index: combining exercise recall and
warning sign recall showed no significant differences between
groups, but a significant two-way interaction of media
exposure and education was discovered F = 3.39, p < .05.
When analyzing the comprehension index of the driving and
lifting variables no significant differences were apparent,
although media exposure approached significance when analyzed
with the variable age, and education approached significance
when analyzed with media exposure.

In order to help obtain information for future
productions, research question 7 asked, "which components of
the video tape were most helpful?" The segment entitled
"Understanding Heart Disease" was rated as the most helpful

portion of the video tape (see Figure 1).

We
In ‘terms of’ media. usage, a significant. difference
emerged between the print media (M=2.87) and video tape
(M=1.55). A t-test of the means representing frequency of use

revealed a highly significant difference p < .0001.

 

46

Rating of Instructional Segments
By Perceived Helpfulness

Segment Titles

 

Understanding H.D.

Exercise Portion .

 

Med. Considerations

1 .
I l l l
0 1 2 3

 

 

   

Emotional Aspects

l
4 5

 

 

1 - Highest Rating

- Mean Scores

Flgure 1

47

While frequency of use was higher for the print media,
there were no differences between the levels of perceived
helpfulness of print (M=4.72) and video (M=4.70) . Even though
the means were virtually identical, the percentage of
respondents who marked the highest possible rank on the five-
point scale for helpfulness of the video was greater (83.0%)
than the seventy-four percent representing the helpfulness of
print. It was also found that a significant relationship
exists between a patient's perceived helpfulness of the video
and their age Chi-Square = 27.0, sig = .007 and their
education Chi-Square = 23.1, sig. = .026.

A correlation between video helpfulness and the level of
perceived physician involvement was conducted for both groups
exposed to the video. A moderately strong but not significant
correlation was found to exist when comparing these variables
for only the one group who viewed their own physician r =
.34, p = .181. When running the same comparison for the
patients who viewed the tape but without their own physician
featured, showed a significant correlation r = .51, p = .003.

Other interesting comparisons included video helpfulness
with education. A significant negative relationship emerged
when these two variables were correlated for the group not
viewing their own physician r = -.36, p = .047. For the
group viewing their own physician, a similar but not
significant relationship was also found r = -.42, p = .089.

As one would expect the variable of education correlated well

48
with the two indexes measuring actual understanding. A
significant relationship emerged with the index measuring
recall of exercise and warning signs r = .25, p < .05. The
education variable approached significance when correlated
with the index measuring recall of practical considerations
r = .20, p = .075.

A multiple regression of six predictor variables with the
dependent variable of perceived involvement was also examined.
The results showed that the variable "vidhelp" or video
helpfulness emerged as the best predictor of perceived
involvement T = 3.28, sig. = .002.

Information regarding the presence of family members

while viewing the videO‘was also made available (see Table 6).

Table 6
WW Percent
All of the time 42.6%
Most of the time 27.7%
Once in a while 14.9%
Very few times 6.4%

Never 5.3%

CHAPTER V

DISCUSSION AND RECOMMENDATIONS

Egggiple Lininntipns

The present study sought to explore the effectiveness of
the video tape medium in altering the perceived involvement of
the patient's physician. It also attempted to determine the
medium's effectiveness in contributing to improved understand-
ing of medical information. Before discussing the results
and their implications, it is important to mention possible
limitations to the generalizability of these findings.

As mentioned in the Methods section, the sampling
technique was not randomized. This was due to two main
factors limiting this exploratory research. First, before a
patient could be given a video tape, it had to be determined
whether they possessed or had easy access to a video tape
player. Patients who met this criteria were given a video to
watch, while those without access to a‘VCR, were placed in the
control group. Secondly, due to time constraints resulting
from academic deadlines, the size of the sample had to be
somewhat limited.

Despite the limitations of the sampling procedure and the
relatively small sample size, there ‘were no significant
influences from the education, sex, and age variables upon the

index measuring perceived involvement of physician. The

49

50
imbalance of these variables in certain cells however is of
concern due to the significance of a patients education on
their perceived helpfulness of the video tape medium.

It should also be remembered, that this attempt to
measure effectiveness of the video tape medium in altering a
patient's perception of their physician's involvement, is very
new and pioneering. There is a need for alterations and
replication before results can be viewed as a basis for any
substantial decision making.

While a substantial reliability coefficient was found for
the index measuring perceived involvement. A lack of a strong
index for actual understanding should be cause for caution
when interpreting any findings related to patient comprehen-
sion of information. Despite the overall weaknesses of the
two indexes measuring actual understanding, there is evidence
that they possess at least some accuracy. This is stated
because the variable of education approached significance when
analyzed with media exposure in an ANOVA with the
comprehension index. Education and media exposure also
combined for a significant interaction effect in a one-way
ANOVA.of the index made upiof exercise recall and warning sign
recall.

Education also approached significance when correlated

with the index measuring recall of practical considerations.

51

W

The results supported the prediction that patients
exposed to the video tape treatment would perceive greater
involvement by their physician than those not exposed. The
apparent reason for this difference would certainly seem to be
the introduction of the video tape, because other factors such
as age, sex, and education have no significant effect.

Confounding results surfaced however when testing the
hypothesis that patients who are exposed to their own
physician will demonstrate more significantly different levels
of perceived physician involvement between treatment group and
control group than. the group‘ not exposed to their own
physician and their control group. The results actually
showed. a larger' and. statistically’ significant. difference
between treatment and control groups for the treatment group
not exposed to their own physician. A possible reason for
this occurrence was suspected due to an outlying case which
was present in the treatment group of those patients exposed
to their own physician. The patient in this case was very
negative in virtually all of their responses concerning their
perceived state of health and perceived involvement of the
physician. This particular case was so different from the
other 16 in this group, that the mean score with the case
included was 36.79, with the case thrown out, the mean score
increased almost a full point to 37.72. ‘While this alteration

made the differences between groups approach significance at

 

 

52
the .05 level, the overall difference was still less than the
significant finding between the treatment and control groups
for those patients not exposed to their own physician.
Despite failing to reject the null hypothesis for Hlb, it
would still be worth testing under different circumstances,
especially with a larger random sample of patients.

As mentioned earlier, there appeared to be no significant
interaction between a patient's age, sex, or education level
when rating the level of perceived involvement of their
physician. This finding of research question 1, helped offer
reliability to this study by ruling out the effect of these
demographic variables while showing consistently significant
results concerning the role of the video tape.

One of the more interesting findings of this study
centered around media preference. While the majority of
patients exposed to the video still felt printed materials
were of more help, this certainly did not lessen the
credibility of the video tape medium. The majority of
patients exposed to their own physician found the video to be
more helpful than print. Coming as somewhat of a surprise,
those who said they preferred video over print were for the
most part over 61 years of age, they were also less educated
than those who preferred print. These findings lead one to
hypothesize reasons why older and less educated patients seem
to feel the video is more help than print. This may be due to
the likelihood that older patients do not see as well to read

as their younger counterparts and because they have less

 

53
formal education, they come from a more oral tradition than
those who have been educated through written material.

Ratings of the different segments of the video production
showed "Understanding Heart Disease," followed by "The
Exercise Portion" to be the two most helpful parts of the
video. These findings are interesting in that these two
portions are by far the longest segments. The portion
regarding understanding heart disease contained highly
technical and detailed information. These two factors
indicate that patients seem to prefer longer more detailed
segments than faster moving overviews.

Because of a need for detail and easy reference, patients
were found to use the print materials significantly more than
the video tape. It is not clear however, exactly what this
finding means. Because the measuring instrument did not ask
for specific information concerning length of media use, any
number of combinations could. have brought about such a
significant difference.

For instance, a patient may have considered referring to
the printed material for one or two minutes at a time, three
times a day, three different uses. At the same time they may
have considered watching the video for fifteen minutes one
use. Even though the total time spent watching the video
would be far greater than the time spent with the printed
material, this cannot be determined when only asking for the

number of media uses.

 

54

ngpmmendapions

Regarding 'the prospect. of future studies there are
several options and alterations that should be discussed.
One suggestion is that a study be attempted which utilizes a
video similar to the one deployed in this study, but in the
hospital to offer an overview to the patient and preparing
them to go home. Also by offering the video in the hospital,
patients who do not own a‘VCR could at least gain some benefit
from the video. More elaborate studies designed to
accommodate those not having access to a VCR could also
benefit by this design. By having a patient view the tape in
the hospital and become familiar with using a remote control
device to play the tape, they would be more likely to use the
video players provided to them for the experimental period.

In any case, the patient could be given upon discharge,
a series of tapes that offer greater detail regarding various
aspects of their recovery. For instance, a separate tape
could.be provided which.dealt with.diet, smoking and.drinking.
Another could focus solely on exercise. This would offer the
type of detail that many patients seemed to indicate would be
of help in video productions for the patient recovering form
Open heart surgery.

Because this study revealed that older and less educated
patients seemed to prefer the video production as it stands,
testing should also attempt to determine if too much detail

will start diminishing the tapes effectiveness for'this group.

55

In cases where there are no resources available to
accommodate patients without access to VCRs, a sampling
technique should be employed to assure randomization. This
can be accomplished simply by permitting only those patients
who own or have easy access to a VCR to be included in the
overall population. Once establishing a population of
patients who are eligible to participate, subjects could then
be randomly assigned to either the treatment group or the
control group.

Some amendments should also be considered for the
measuring instrument used in this study. Greater information
concerning recall and understanding would help in establishing
a more reliable recall index. As stated earlier, a need to
accurately measure media usage exists and could be solved by
simply asking for length of use rather than just frequency.

One particular item on the perceived involvement index
also should be reworded. The statement "My physician did
little to keep me from worrying," seemed to confuse many
patients. It appears that this subtle negative statement may
be better worded in a positive manner.

While the questionnaire asked whether any family members
were present, it did not ask which family members or how many
were usually present when viewing the tape. This information
could be helpful in designing a brief questionnaire for the
patient's closest family members.

Despite some deficiencies in sampling procedure and

questionnaire design, this study provided valuable

56
information” 'The findings do indeed indicate that.presence of
the video tape medium had a certain degree of impact upon the
patient's perceived involvement of their physician. The
results also suggest that patients perceived progress with
recovery is also effected by the video tape treatment. Based
on these results, the efficacy of video tape in post-operative

care, is certainly a topic worthy of continued study.

APPENDIX A

APPENDIX A

SAMPLE QUESTIONNAIRE

Upon your discharge from Ingham.Medical Center, you were
provided with information to aid in your rehabilitation
process. To help us provide the best post-operative
information possible, we would appreciate your participation
in filling out this brief questionnaire. All responses will
remain confidential.

FOR EACH QUESTION BELOW, MARK THE SPACE THAT BEST INDICATES
YOUR FEELINGS.

1. How would you rate the progress of your recovery at this
time?
excellent poor

2. When discharging you from the hospital, your physician

verbally explained your rehabilitation process. How
difficult was this explanation to understand?

very very
difficult easy

3. How helpful did you find this explanation?
very not helpful
helpful at all

THE FOLLOWING SET OF ITEMS ADDRESSES THE ROLE OF YOUR
PHYSICIAN. FOR EACH STATEMENT, MARK THE SPACE THAT BEST
INDICATES YOUR FEELINGS.

4. My physician showed genuine concern for my well-being.

Strongly agree Strongly disagree

57

10.

11.

12.

58

Appendix A
My physician did little to keep me from worrying.

Strongly agree Strongly disagree

 

 

My physician gave me adequate personal attention.

Strongly agree Strongly disagree

 

 

My physician made me feel like everything would be
all right.

Strongly agree Strongly disagree

 

My physician showed little sympathy for my experiences
while I was recovering from surgery.

Strongly agree Strongly disagree

 

My physician needs to be more friendly.

Strongly agree Strongly disagree

 

My physician seemed personally interested in me.

Strongly agree Strongly disagree

My physician spent too little time with me.

Strongly agree Strongly disagree

 

In addition to verbal explanations, your physician also
provided you with some printed information to take home
and review. How often did you refer to this printed
information?

less than once per week

once or twice per week

three to four times per week
once per day

more than once per day

13.

14.

15.

16.

17.

18.

59

Appendix A
How difficult was this printed information to understand?

very very
difficult easy

How helpful did you find this printed information?

very not helpful
helpful at all

which addressed the different aspects of your surgery
and rehabilitation process. How often did you refer to
this video tape?

less than once per week

once or twice per week

three to four times per week
once per day

more than once per day

When viewing the video tape, were other family members
present...

all of the time
most of the time
once in a while
very few times
never

How helpful did you find this video tape?

very not helpful
helpful at all

60

 

 

 

 

Appendix A
19. Which did you find most helpful, the video tape or the
printed material?
video tape printed material
20. In the spaces below, please explain your choice for
question number 19.
21. What portions of the video tape were the most helpful to

you? (Please rank the following with 1 being the most
helpful and 6 being the least helpful.)

Practical considerations
Emotional aspects
Understanding heart disease
The exercise portion
Medical considerations
Warning signs

NOW WE WOULD LIKE TO ASK YOU SOME QUESTIONS REGARDING YOUR
EXERCISE PROGRAM.

22.

How would you rate the effectiveness of your exercise

program in helping you return to your normal daily
activities?

very not at all
effective effective

 

 

 

23.

24.

25.

26.

61

Appendix A

About how many times per week did you follow the exercise
regimen given to you?

0

1 to 2

3 to 4

5 or more

What were the names of the exercises you were assigned?
List as many as you can recall...

 

 

 

 

 

 

 

 

 

 

THE INSTRUCTIONAL MATERIALS YOU RECEIVED CONTAINED
INFORMATION REGARDING VARIOUS ASPECTS OF YOUR RECOVERY.
THE FOLLOWING QUESTIONS PERTAIN TO SPECIFIC INSTRUCTIONS
YOU WERE GIVEN.

How many weeks following surgery should you wait before
attempting to drive an automobile?

two weeks
four weeks
six weeks
eight weeks

During the early period of your recovery, you were
instructed not to lift more than...

five pounds
ten pounds
fifteen pounds
twenty pounds

62

Appendix A

27. There are certain warning signs that you were instructed
to look out for. Please list as many as you can recall.

 

 

 

 

 

 

THE FOLLOWING INFORMATION WILL BE USED TO MAKE STATISTICAL
COMPARISONS BETWEEN PARTICULAR GROUPS OF PATIENTS.

28. Your
29. Your
30. Your

age is between...

30 to 40
41 to 50
51 to 60
61 to 70
over 70

sex... male female

level of education...

some high school
high school diploma
some college
college diploma
graduate degree

Thank you very much for your time and participation.

FOR OFFICE ONLY

Patient #

Tape # Physician #

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