Optimizing Communication Strategies for COPD Management: Effectiveness of Educational Video and Pamphlet Interventions PDF Free Download
1 / 11/11
100%
1
Optimizing Communication Strategies for COPD Management: Effectiveness of
Educational Video and Pamphlet Interventions
Jeenat Mehareen, MA1*, Sharon Zhu, BSc2*, Jim Johnson3, Mohsen Sadatsafavi, MD, PhD1,
Erica Frank, MD, MPH, FACPM3,4
1. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
2. Faculty of Sciences, University of British Columbia, Vancouver, BC, Canada
3. Patient Research Partner, Vancouver, BC, Canada
4. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
5. Faculty of Arts, University of British Columbia, Vancouver, BC, Canada
* 1 and 2 are both first authors
Corresponding Author:
Jeenat Mehareen, MA
Respiratory Evaluation Sciences Program
Faculty of Pharmaceutical Sciences
University of British Columbia
2405 Wesbrook Mall, Vancouver, BC
Email: jeenatm@student.ubc.ca| Phone: +1-604-727-2925
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
2
Abstract
Objectives: Risk prediction models are increasingly used at point of care to support personalized
treatment decisions. This study created and evaluated two Information, Education, and
Communication (IEC) resources to improve public understanding of a risk prediction tool for
Chronic Obstructive Pulmonary Disease (COPD) management.
Methods: We created a 5-minute video and a pamphlet explaining the burden of COPD and how
a prediction model generates quantitative estimates of, and benefit of certain treatments for,
exacerbations of the disease. These tools were tested among students and researchers in public
health. A patient partner was engaged throughout to ensure the materials were accessible and
patient-centered.
Results: Twenty-five individuals participated (80% female; 60% aged 25–64). After reviewing
the materials, 92% of participants agreed to the statement “I am familiar with the idea of
precision medicine approach”. Most (72%) felt they received sufficient information about the
tool, and 92% believed such materials could support patient decision. Participants stated that the
materials were clear, detailed, and written in plain language. Participants preferred the pamphlet
(68%) over the video (44%). Suggestions for improvement included expanding content on how
the tool works.
Conclusions: The findings of this study provided a better understanding of how to present
complex medical information around precision medicine that is accessible and meaningful to
diverse audiences. We will improve our materials based on these comments, and continue to
make them available at https://resp.core.ubc.ca/show/patient_committee_2025
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
3
Introduction
Risk prediction models are increasingly implemented at point of care as major enablers of
personalized treatment decisions.1,2 These models can improve medication adherence and health
outcomes as patient characteristics are objectively taken into consideration for guiding healthcare
decisions.3,4 Effective communication between patients and physicians is important when
communicating risks calculated from this model and discussing individualized treatment
decisions. However, their complexity often makes it difficult for physicians to explain risk
estimates during brief clinical encounters. This communication gap can limit the utility of risk
prediction models for shared decision-making.
In the management of Chronic Obstructive Pulmonary Disease (COPD), patients are often faced
with complex treatment decisions regarding the prevention of the occurrence of exacerbations
(also known as “lung attacks”).5 Tools that predict exacerbation risk can provide a backbone for
better understanding the risk and for shared decision-making. One such tool is the Acute COPD
Exacerbation Prediction Tool (ACCEPT)6—a risk prediction model that estimates an
individual’s risk of exacerbations in the next 12 months given selected individual and clinical
features (predictors) and provides treatment recommendations aligned with existing
pharmacotherapy guidelines. Under the IMplementing Predictive Analytics towards efficient
COPD Treatments (IMPACT) study, ACCEPT is currently being implemented and examined in
two tertiary medical hospitals.7 Physicians use the tool’s prediction to provide patients with
tailored treatment suggestions. These recommendations are typically delivered as an information
sheet, which can be further customized to include individualized advice.
Although patient education has been shown to improve quality of life and reduce
hospitalizations8, the current information sheets focus mainly on presenting patients’ risk status
and corresponding medication recommendations. They offer little insight into how predictions
are generated or why the tool should be trusted. This lack of information can undermine patient
confidence in the model's outputs and limit engagement with the recommended treatment plan.
To address the communication gap around risk prediction tools, we conducted a study to develop
and test two Information, Education, and Communication (IEC) resources. These materials
explain the concept of precision medicine and its application in managing COPD exacerbations
in lay language, using ACCEPT as an example. As the ongoing IMPACT study evaluates the
clinical and cost-effectiveness of ACCEPT, positive results may lead to broader implementation
of the tool. We therefore explored next steps by evaluating how best to communicate model-
based risk predictions to patients and the public using these IEC resources. The primary goal was
to evaluate how these materials increase understanding of risk prediction tools in COPD care.
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
4
Methods
The study received institutional ethics approval from University of British Columbia (H23-
00445). The design of the IEC materials was guided by existing evidence on effective health
communication.9 Research indicates that combining simple language with visuals improves
patient engagement and recall, especially for complex topics like pharmacogenomics and
precision medicine.10,11 Short videos have also been found to enhance comprehension of medical
concepts.12 Drawing on this evidence, two materials, a video and a pamphlet—were developed.
A patient partner with lived experience of COPD was engaged throughout the project, beginning
with feedback on the initial study design and continuing through the co-creation of materials and
review of survey questions used for evaluation. His contributions helped refine both content and
presentation, ensured that the resources were relevant, accessible, and meaningful for patients
managing COPD as well as understandable to a general audience.
The video (Please contact corresponding author to request access), approximately five minutes
in length, explained the purpose of the ACCEPT tool, how it predicts the risk of future
exacerbations, and how this information supports shared decision-making. To ensure
accessibility, the video used plain language and deliberate pacing. The script combined two
perspectives: a physician (co-author EF) who explained what COPD is, the concept of precision
medicine, and how ACCEPT works, and the patient partner (co-author JJ), who shared his
experience living with COPD and discussed how tools like ACCEPT could benefit patients.
A complementary pamphlet (Supplementary Figure A1) presented the same key information in a
brief, easy-to-read format. The content was adapted from publicly available resources, written at
an approximately Grade 8 reading level, and organized with clear sections and visuals to
improve readability. The patient partner reviewed and provided feedback on the content, layout
drafts, and design features to highlight the most relevant information and improve readability.
Finally, graduate students and researchers in Public Health at the University of British Columbia
reviewed both IEC resources and completed the survey, which captured demographics and
assessed comprehension, satisfaction, and format preference.
Descriptive statistics were used to summarize participant demographics and feedback on IEC
materials. For paired comparisons of ordinal responses (e.g., Likert-scale ratings) between the
video and pamphlet formats, the Wilcoxon signed-rank test was used to assess differences in
participant perceptions (e.g., clarity, visual engagement, and overall preference). A p-value of
<0.05 was considered statistically significant. All analyses were conducted using Microsoft
Excel and Rstudio.
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
5
Results
Twenty-five individuals participated in the study (80% female, 60% aged 25-64). 56% were
public health students (Table 1). Table 2 provides the participants’ level of agreement regarding
the IEC materials. After evaluating both the video and pamphlet, 92% of participants agreed or
strongly agreed that they became familiar with the benefits of precision medicine towards COPD
management. 72% reported receiving sufficient information about the prediction tool
(ACCEPT), while 92% believed similar materials could facilitate conversations about precision
medicine applications for disease management among patients. Regarding the clarity and
accessibility of the materials, 92% agreed or strongly agreed that the content was easy to
understand, and 96% felt that the language used was appropriate and accessible.
Table 1: Participant demographics
N %
Demography
Age Category
Adult (25-64 years) 15 60
Senior (65+ years) 1 4
Young Adult (18-24 years) 9 36
Sex at birth
Female 20 80
Male 5 20
Employment Status
Employed full time 11 44
Employed part time 9 36
Not currently employed 5 20
Currently Attending School 14 56
Racial Identity
East Asian (Examples: Chinese, Korean, Japanese, Taiwanese
descent) 9 36
Indigenous (Examples: First Nations, Inuk/Inuit, Métis), White
(Examples: European descent) 1 4
Latino (Examples: Mexican, Caribbean, Central and South
American (Ecuadorean, Bolivian, Colombian, Peruvian, Honduran,
Costa Rican) descent)
3 12
Middle Eastern (Examples: Arab, Persian, West Asian descent (e.g.,
Afghan, Egyptian, Iranian, Lebanese, Turkish, Kurdish)) 3 12
South (Examples: Indian, Pakistani, Bangladeshi, Sri Lankan, Indo-
Caribbean, Nepali, Bhutanese, and Maldivian) and Southeast Asian
(Examples: Filipino, Vietnamese, Cambodian, Thai, Indonesian,
Singaporean descent)
3 12
White (Examples: European descent) 5 20
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
6
Table 2: Participants’ feedback on IEC materials
N %
“I am familiar concept of precision medicine”
Disagree 2 8
Neither agree nor disagree 5 20
Agree 12 48
Strongly agree 6 24
“After going through the materials, I am familiar with the idea of precision medicine approach in the
management of COPD”
Neither agree nor disagree 2 8
Agree 14 56
Strongly agree 9 36
“These materials provided me with enough information about how a precision medicine tool
(ACCEPT) works”
Disagree 2 8
Neither agree nor disagree 5 20
Agree 13 52
Strongly agree 5 20
“The material was engaging and presented the message in a straightforward way.”
Agree 18 72
Strongly Agree 7 28
“The materials were sufficiently explained using plain language.”
Neither agree nor disagree 1 4
Agree 10 40
Strongly Agree 14 56
“The materials were easy to understand while providing sufficient detail.”
Neither agree nor disagree 2 8
Agree 9 36
Strongly agree 14 56
“Similar materials could assist conversations about precision medicine application in any disease
among patients and general public”
Neither agree nor disagree 2 8
Agree 13 52
Strongly agree 10 40
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
7
Table 3: Participant Ratings and Preferences for Pamphlet vs. Video IEC Materials
Pamphlet,
N (%) Video,
N (%) p-value
Length (pamphlet) vs Duration (video)
Too long 4 (16) 6 (24) 0.350
About right 20 (80) 19 (76)
Too short 1 (4) 0 (0)
Visuals: The visuals were engaging and held my attention
Disagree 3 (12) 6 (24) 0.040
Neither agree nor disagree 4 (16) 8 (32)
Agree 12 (48) 7 (28)
Strongly agree 6 (24) 4 (16)
Visuals: The visuals were simple, relevant, and easy to understand.
Disagree 2 (8) 1 (4) 0.131
Neither agree nor disagree 1 (4) 4 (16)
Agree 10 (40) 14 (56)
Strongly agree 12 (48) 6 (24)
Visuals: The style and presentation were well executed.
Disagree 0 (0) 3 (12) 0.080
Neither agree nor disagree 7 (28) 7 (28)
Agree 10 (40) 9 (36)
Strongly agree 8 (32) 6 (24)
I prefer the (either pamphlet or video)
Disagree 4 (16) 4 (16) 0.363
Neither agree nor disagree 4 (16) 10 (40)
Agree 10 (40) 7 (28)
Strongly Agree 7 (28) 4 (16)
Participant feedback on specific format of IEC materials varied (Table 3). For length, most
participants felt the length of both the pamphlet and video was appropriate, though 8% more
participants rated the video as "too long" compared to the pamphlet. In terms of visual
engagement, 72% agreed or strongly agreed that the pamphlet visuals were engaging, compared
to 44% for the video (p = 0.040). For clarity, a majority of participants found the visuals to be
simple and easy to understand (Pamphlet: 88%, Video: 80%). Similarly, 72% found the style and
presentation of the pamphlet to be well executed, compared to 60% for the video (p = 0.080).
When asked about their overall preference, 68% of participants agreed or strongly agreed that
they preferred the pamphlet, while 40% expressed a preference for the video (p = 0.363).
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
8
Responses to open-ended questions suggested that the materials were complementary and useful
when used together. However, participants recommended improving the video content to better
illustrate how ACCEPT (prediction tool) functions in clinical scenarios.
Discussion
The findings of this study offer insights into how complex medical information—particularly
prediction tools—can be presented in ways that are accessible and meaningful to diverse
audiences. Overall, participants found both the video and pamphlet clear, relevant, and easy to
understand. Most found the materials accessible and clear, with 72% indicating they received
sufficient information to understand how the tool works and how it could inform treatment
decisions. This re-establishes the fact that co-developing materials with patient partners
safeguards relevance and clarity, which allows for more patient-centered communication.
Furthermore, while both formats were well received, participants preferred the pamphlet due to
its concise language and visual clarity. Nevertheless, feedback highlighted the complementary
strengths of both formats: the pamphlet supported quick reference, while the video offered
narrative context and a patient voice—an approach known to improve emotional engagement and
retention.13
Quantitative risk prediction tools based on individual genetic, environmental, and lifestyle
factors are major enablers of precision medicine.14 Despite their promise, their adoption remains
limited due to low awareness among patients, providers, and the general public.15–17 A content
analysis of U.S. print media found that coverage of precision medicine was largely limited to
cancer, with minimal attention to its broader applications.18 This reinforces the need for
improved public education and communication, specially in the field of chronic respiratory
diseases such as COPD which is a leading cause of mortality and morbidity worldwide.19
One major challenge in communicating prediction tools is low health literacy and numeracy,
both essential for interpreting probabilistic risk.20 Public-facing materials such as ACCEPT also
require a basic understanding of disease management. Information overload and technical jargon
can overwhelm patients, impair decision-making, and erode trust in healthcare systems.21,22
Understanding this importance, our intervention research design focused on accessible, plain-
language IEC resources.
This study has limitations, including a small sample size and participation limited to individuals
in the health sciences, which is not reflective of the broader patient population or general public.
Nonetheless, it offers early insights into how precision medicine concepts—particularly risk
prediction tools—can be communicated in clearer, more accessible ways. The findings will help
guide the future development of patient and public centered IEC resources that support the tool’s
effective scale-up and integration into routine COPD care and beyond.
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
9
References
1. Moriarty AS, Castleton J, McMillan D, et al. The Value of Clinical Prediction Models in
General Practice: A Qualitative Study Exploring the Perspectives of People With Lived
Experience of Depression and General Practitioners. Health Expect Int J Public Particip
Health Care Health Policy. 2024;27(6):e70059. doi:10.1111/hex.70059
2. Steyerberg EW, Moons KGM, Van Der Windt DA, et al. Prognosis Research Strategy
(PROGRESS) 3: Prognostic Model Research. PLoS Med. 2013;10(2):e1001381.
doi:10.1371/journal.pmed.1001381
3. Ginsburg GS, Phillips KA. Precision Medicine: From Science To Value. Health Aff
(Millwood). 2018;37(5):694-701. doi:10.1377/hlthaff.2017.1624
4. Zullig LL, Blalock D, Dougherty S, et al. The new landscape of medication adherence
improvement: where population health science meets precision medicine. Patient Prefer
Adherence. 2018;Volume 12:1225-1230. doi:10.2147/ppa.s165404
5. Holverda S, Rutgers MR, Kerstjens HAM. Time to rename COPD exacerbations:
implementing the term lung attack. Lancet Respir Med. 2020;8(4):e25. doi:10.1016/S2213-
2600(20)30123-5
6. Adibi A, Sin DD, Safari A, et al. The Acute COPD Exacerbation Prediction Tool
(ACCEPT): a modelling study. Lancet Respir Med. 2020;8(10):1013-1021.
doi:10.1016/S2213-2600(19)30397-2
7. Michaux KD, Metcalfe RK, Burns P, et al. IMplementing Predictive Analytics towards
efficient COPD Treatments (IMPACT): protocol for a stepped-wedge cluster randomized
impact study. Diagn Progn Res. 2023;7(1):3. doi:10.1186/s41512-023-00140-6
8. Tan JY, Chen JX, Liu XL, et al. A Meta-Analysis on the Impact of Disease-Specific
Education Programs on Health Outcomes for Patients with Chronic Obstructive Pulmonary
Disease. Geriatr Nur (Lond). 2012;33(4):280-296. doi:10.1016/j.gerinurse.2012.03.001
9. Wynn RM, Adams KT, Kowalski RL, Shivega WG, Ratwani RM, Miller KE. The Patient in
Precision Medicine: A Systematic Review Examining Evaluations of Patient-Facing
Materials. J Healthc Eng. 2018;2018:1-10. doi:10.1155/2018/9541621
10. Martínez Silvagnoli L, Shepherd C, Pritchett J, Gardner J. Optimizing Readability and
Format of Plain Language Summaries for Medical Research Articles: Cross-sectional Survey
Study. J Med Internet Res. 2022;24(1):e22122. doi:10.2196/22122
11. O’Donnell P, Wadhwa N, Danahey K, et al. Pharmacogenomics
Based Point
of
Care
Clinical Decision Support Significantly Alters Drug Prescribing. Clin Pharmacol Ther.
2017;102(5):859-869. doi:10.1002/cpt.709
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
10
12. Cheng X, Liu J, Dale C. Understanding the Characteristics of Internet Short Video Sharing:
A YouTube-Based Measurement Study. IEEE Trans Multimed. 2013;15(5):1184-1194.
doi:10.1109/TMM.2013.2265531
13. Chatterjee A, Strong G, Meinert E, Milne-Ives M, Halkes M, Wyatt-Haines E. The use of
video for patient information and education: A scoping review of the variability and
effectiveness of interventions. Patient Educ Couns. 2021;104(9):2189-2199.
doi:10.1016/j.pec.2021.02.009
14. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a
New Taxonomy of Disease. National Academies Press; 2011:13284. doi:10.17226/13284
15. Ginsburg GS, Phillips KA. Precision Medicine: From Science To Value. Health Aff
(Millwood). 2018;37(5):694-701. doi:10.1377/hlthaff.2017.1624
16. Mitchell S, Jaccard E, Schmitz FM, et al. Investigating acceptability of a training programme
in precision medicine for frontline healthcare professionals: a mixed methods study. BMC
Med Educ. 2022;22(1):556. doi:10.1186/s12909-022-03613-2
17. Lamichhane P, Agrawal A. Precision medicine and implications in medical education. Ann
Med Surg. 2023;85(4):1342-1345. doi:10.1097/MS9.0000000000000298
18. Peng W, Seo HY, Choi J, Jia X. Imbalanced media portrayal: a content analysis of precision
medicine in US news of 2015–2021. Front Commun. 2024;9:1366952.
doi:10.3389/fcomm.2024.1366952
19. Chen S, Kuhn M, Prettner K, et al. The global economic burden of chronic obstructive
pulmonary disease for 204 countries and territories in 2020–50: a health-augmented
macroeconomic modelling study. Lancet Glob Health. 2023;11(8):e1183-e1193.
doi:10.1016/S2214-109X(23)00217-6
20. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low Health Literacy and
Health Outcomes: An Updated Systematic Review. Ann Intern Med. 2011;155(2):97.
doi:10.7326/0003-4819-155-2-201107190-00005
21. Klerings I, Weinhandl AS, Thaler KJ. Information overload in healthcare: too much of a
good thing? Z Für Evidenz Fortbild Qual Im Gesundheitswesen. 2015;109(4-5):285-290.
doi:10.1016/j.zefq.2015.06.005
22. Chandra S, Mohammadnezhad M, Ward P. Trust and Communication in a Doctor- Patient
Relationship: A Literature Review. J Healthc Commun. 2018;03(03). doi:10.4172/2472-
1654.100146
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
11
Acknowledgement:
We gratefully acknowledge the Centre for Lung Health for their support in facilitating our
collaboration with the patient-partner through their Community Stakeholder Committee.
Contributors: JM and SZ are the guarantor of the content of the manuscript, including the data
and analysis. Conceptualization (JM and SZ), literature review (JM and SZ), methodology (JM),
formal analysis (JM), first drafting of the manuscript (JM and SZ), validation (all authors),
review, editing and interpretations (all authors). All authors agreed to be accountable for all
aspects of the work.
Prior Presentations: The article was presented at the ISPOR 2025, May 13- May 16 at
Montreal, Canada.
All rights reserved. No reuse allowed without permission.
(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted September 2, 2025. ; https://doi.org/10.1101/2025.08.28.25334616doi: medRxiv preprint
