Table 3 Characteristics of included studies (n = 19)
1st author (Year) Country [ref] | Design | Methods/ Data sources | Sample | Barriers/ Facilitators/ Preferences/ Outcomes | Assessment of quality (MMAT) [high/medium/low] |
|---|---|---|---|---|---|
Gielen A.C. (2020) US [13] | Randomised, controlled trial | Participants were assigned randomly to receive either a personalised and stage-tailored safety report (intervention group) or a personalised but otherwise generic report on other child health topics (control group). Follow-up interviews were conducted by telephone 2 to 4 weeks and 4 months after enrolment by interviewers | 1412 parents with children who were age-eligible according to the triage sheet were approached; 239 (17%) were ineligible, 201 (14%) refused to participate, and 69 (5%) were missed by the recruiters. 901 parents were enrolled (448 in the intervention group and 453 in the control group). Follow-up rates were 86% for the intervention group (n = 384) and 83% for the control group (n = 375). Total (n = 759) | This technology is feasible for use in a busy ED with minimal intrusion into patient flow; significant improvements in safety knowledge resulted from the intervention. | low |
Koonce T.Y. (2011) US [14] | Randomised trial | Standard care discharge instructions or standard care combined with information individualised to their learning-style preference. 2 weeks post-visit knowledge survey. | ED patients aged eighteen or older, able to speak and read English, and able to provide telephone contact information were eligible for the study A total of 185 patients were initially identified inclusion. Of these, 109 patients were excluded for not meeting all inclusion criteria, refusal to participate, and other reasons. 76 patients were randomized to either the control or intervention groups. Seven patients in each arm were unable to be reached for follow up. (n = 76) | Learning style–tailored information patients perceived that the materials increased their understanding; demonstrated the feasibility of implementing a learning-style approach to patient education in the ED. Provides a framework for developing customised information prescriptions that can be broadly adapted for use across various health care conditions. | medium |
Smith S. (2008) Australia [15] | Prospective randomised controlled trial | two inner-city Australian teaching hospital EDs. Patients received either standard patient education or patient-centred education (PCE). Both groups received a six-topic curriculum. PCE patients reordered the topics according to their own priority controlling the order of education. | Adult patients presenting to two EDs with acute asthma during a 12 month period – 148, two refused participation, (n = 146) | Trend of better asthma control for the PCE group with fewer ED visits within 4 months of being educated; PCE provides potential for patients to be active participants; brief, patient-centred education processes using a basic chronic disease guideline curriculum may be of value for people who are treated, educated and discharged from the ED | low |
Chan Y-F. (2006) US [16] | Randomized before-after pre-test/post-test trial with viewing of a stroke video serving as the intervention. Follow-up telephone interview using the same questionnaire for both cohorts | Subjects were randomized into two arms: those watching a 12-min educational video on stroke (video group) and those not undergoing an intervention (control group). Both groups were administered a 13-question quiz covering different stroke-related issues, but only the video group received this same test again after completion of the educational program. Those enrolled were contacted after 1 month to determine knowledge retention via the same test. | A convenience sample of research subjects was recruited from ED waiting areas (n = 198) | Even at the 1-month follow-up, the video group had significantly higher test scores than the control group. Educational video may be a valuable and relatively low-cost tool for focused patient education in the ED. | low |
Robson S. (2020) UK [17] | Multicentre, structured survey | Staff who verbally consented received a paper questionnaire. | All doctors and nursing staff at two teaching and two district general hospitals (n = 423) | Staff felt health promotion was important in the ED; one third of staff felt their role involved providing brief interventions and to screen patients for modifiable risk factors and identify those suitable for interventions; leaflets were the most popular choice; staff believed that health promotion interventions could be delivered through a variety of methods and modes of delivery; drug and alcohol misuse were the most appropriate risk factors to discuss in ED, especially if related to ED presentation; interventions in the ED were more appropriate when risk factors were directly related to ED presentation | medium |
Bernstein J. (2017) US [18] | Survey then brief intervention delivered, followed by appropriate referral | Patients 14–21 yrs. screened for high-risk behaviour (survey), received a brief intervention with written handout and a list of community support programmes | 2149 patients screened, 834 screened positive for at least 1 health risk and received a referral, 636 received a brief intervention and 546 referred for specialist treatment | Convincing staff that prevention-based services in the ED could be helpful; educating staff; use of a Health Promotion Advocate integrated with the ED team | low |
Coombs N.M. (2016) Australia [19] | Quantitative, pre and post-test questionnaire comparison study | Data were collected before and after the implementation of a staff education session, including introducing a new education tool; ED-HOME. | Convenience sample of 14 ED nurses - (102 permanent nursing staff) | Using the structured tool led to improvement in confidence in providing education; more structured personalised education being given. If emergency nurses feel more confident with their educating practices and by using a structured format, patients may benefit from better quality patient education. | low |
Mieschke H. (2014) US [20] | Survey | EMT-delivered patient education intervention for community residents who called 911 for a non-life- threatening event on blood pressure management, blood glucose management or fall prevention | Firefighter emergency medical technicians (n = 822) | EMS providers reported they were most likely to hand out the pamphlet to patients in private residences who were treated and left at the scene; less likely if language barrier, in care centre or nursing home. | medium |
Lynagh M. (2010) Australia [21] | Self-administered questionnaire | A cross-sectional, descriptive survey | A stratified random sample of 500 ambulance officers from all four sectors across New South Wales, Australia, were selected and invited to participate in the study. 264 officers (out of 500) participated in the study, providing a response rate of 53%. (n = 264) | Need to receive training on how to deal with alcohol-affected patients, how to make referrals and to provide brief advice; not enough time to discuss issues; patient might get angry; half believed their role included health promotion Ambulance officers are ideally situated to identify and detect ‘at-risk’ drinkers because of the apparent high prevalence of alcohol-related call-outs, and are willing to screen for problem drinking. | medium |
Delgado K.M. (2010) US [22] | Survey | Four EDs surveyed interest in 28 health conditions and topics | 1321 eligible subjects – consecutive adult patients and visitors presenting to ED. 1010 (76%) completed the survey, of whom 56% were patients and 44% were visitors | Most interested in health education on stress, depression, exercise, and nutrition; preferred the traditional form of books and brochure. Learning preferences of ED population should be incorporated into future plans. | low |
Walton M. (2008) US [23] | Self-administered survey and follow up interview one month post ED visit | Adolescents were surveyed and referred to a violence prevention website. Website login data were tracked by specific logon ID one month post-ED visit. | Adolescents (ages 12–17) visiting ED (n = 115) | Twice as many participants stated they logged on as did; the Internet may provide a unique solution to busy clinicians providing health interventions. | low |
Cross R. (2005) UK [24] | Q methodology | A within-subjects design using Q methodology | Nurses working in the ED (n = 11) | Positive view of health promotion and the ED nurses’ role; lack of support from management; lack of knowledge and skills; ED is a suitable environment for health promotion. It is not possible to generalize the findings of this study due to the small number of participants. | low |
Rhodes K.V. (2001) US [25] | Self-administered computer survey | Controlled trial, with alternating assignment of patients to a computer intervention (prevention group) or usual care | 542 ED adult patients with non-urgent conditions were eligible, 89% participated (n = 470) | ED patients were very accepting of this technology and interested in using their waiting time as an opportunity to receive health information; patients receiving the computer intervention were more likely than the control group to remember being given health advice 1 week after the ED visit. Computer methodology may enable staff to use patient waiting time for health promotion and to target at-risk patients for specific interventions. | low |
Williams J.M. (2000) US [26] | Survey | Two questionnaires posted 4 weeks apart and the responses to these | Survey sent to all 165 members of the West Virginia Chapter of the American College Of Emergency Physicians (n = 56) | Physicians identified as being responsible for health education but felt ill prepared; pessimistic about success in helping patients change behaviours; smoking most commonly discussed | medium |
Hawkins E.R. (2007) US [27] | Retrospective review of injury prevention surveys | Paramedics were trained to use the injury prevention survey during home visits; homes with newborn infants identified and contacted; home visits agreed; survey served as a tool for home visit | Paramedic home visits with reports (n = 262) | Paramedics can recognize common hazards in the home and provide education and mitigation to reduce risks of paediatric injury; paramedics can distribute home safety devices in a community injury prevention program | low |
Sheahan S.L. (2000) US [28] | Retrospective review of medical records; two-group comparative study – nurse practitioners and doctors | Researchers examined random-stratified medical records of 305 non-acute ambulatory patients for selected health risk factors, including smoking, alcohol use, elevated blood pressure, obesity, and dental caries. | Emergency service medical records of a random-stratified sample of nonacute ambulatory adult patients for selected health risk factors (n = 305) | Records showed a lack of documentation of assessments of weight and tobacco and alcohol use; only 22% of adults with non-acute health problems received appropriate health promotion counselling; doctors documented more health risks than nurse practitioners | low |
Martin A. (2016) Canada [29] | Observational ethnographic approach with qualitative interviews | Qualitative data through informal discussions, semi-structured interviews and direct observation of interactions between consumers and community paramedics. | Purposive sampling of adult community members (patients, relatives and carers) (n = 14) | Acceptance of paramedics in non-traditional preventative health care roles. | low |
Shoqirat N. (2013) Jordan [30] | Qualitative semi-structured interviews | Interview transcripts | Convenience sample of 15 nurses in a Jordanian emergency department | Not our role ‘let other people do it’; nurses’ lack of competency in health promotion; fear of violence; lack of a policy and protocols; patients’ beliefs . Cultural issues and challenges may be a barrier in expanding the role of health promotion in EDs. | low |
Bensberg M. (2003) Australia [31] | Focus groups with ED staff and a workshop for health professionals who were external to EDs | Seven focus groups were held, one at each of the participating EDs; one workshop representing 5 EDs | Focus groups (n = 76) Workshop (n = 55) | Patients may not be willing to lengthen their stay at the ED to partake in health promotion activities; should be occurring further ‘upstream’; ethics of behaviour change and perceived coercion; cost; lack of staff understanding | medium |