J Oral Maxillofac 50:27-31,
Surg
1992
Information Seeking and Interactive Videodisc Preparation for Third Molar Extraction DEBORAH
N. ADER,
PHD,* ANGEL R. SEIBRING, BS,t PHILIP AND BARBARA G. MELAMED, PHDS
BHASKAR,
DMD,*
Patient response to interactive videodisc preparation for third molar extraction surgery was examined as a function of self-reported information-seeking style. Amount learned was compared among patients informed via an interactive videodisc, noninteractive videotape of the same material, or surgeon only. Anxiety levels and satisfaction with preparation were compared between the videodisc and videotape groups. At consultation, patients (n = 35) were randomly assigned to either the disc- or the tape-viewing group. First, subjects completed a demographic survey, state anxiety scale, quiz on knowledge about third molars and surgery risks and complications, and information-seeking scales. Immediately after viewing the video, subjects completed another anxiety scale and a multiplechoice quiz covering the material presented. Subsequently, another 25 patients undergoing the routine (surgeon-only) consultation procedure were given the same multiple-choice quiz following consultation. Quiz scores differed significantly among the groups; mean percent correct for the tape-viewing subjects was 85; for disc-viewing subjects 72.6; for surgeon-only subjects, 40. Self-rated information seeking was unrelated to amount of video viewed by disc subjects (on average, 64% of the videodisc was viewed), and disc subjects who rated themselves higher in information-seeking achieved the lowest postpreparation quiz scores. Subjects in the disc group were significantly more satisfied with the amount of preparation than the tape group. Although disc group subjects were significantly less knowledgeable following consultation than were tape group subjects, interactive videodisc preparation for third molar extraction appears to have some advantages over more traditional approaches. Further research is needed to determine whether this approach to preparing patients is suitable for widespread clinical use.
In recent years, interactive videodiscs designed to prepare patients for dental procedures have become available.’ The interactive technology in current clinical use presents menus of the video content on a monitor and allows patients to select what to view via remote control. The format is self-paced, allowing patients to skip sections, repeat sections, and test their knowledge, providing immediate reinforcement of correct answers and correction of mistakes. Both learning theory and research results suggest that interactive video is an effective, efficient educational tool.2 However, to date, no studies have been published ex-
Received from the Department of Oral and Maxillofacial Surgery, University of Florida. Gainesville. * Former Fellow t Predoctoral Trainee. t Formerly, Professor, Department of Clinical and Health Psychology; currently, Professor and Dean, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY. Supported by PHS/NIDR Behavioral Research Training in Dentistry, Grant T32 DE01733 Address correspondence and reprint requests to Dr Ader: Family Practice Faculty Development Center, 1600 Providence Dr, Waco, TX 76107. 0 1992 American Association of Oral and Maxillofacial Surgeons 0278-2391/92/5001-0006$3.00/O
27
28 amining the effects of videodisc preparation of patients for medical or dental procedures. Given the clinical and legal importance of ensuring that patients are wellinformed, it would be useful to determine the efficacy of interactive videodisc preparation for clinical procedures. Interactive videodiscs have primarily been produced for education and training, and studies in a variety of settings have shown better levels of learning/mastery, speed of learning, and/or amount of instructor intervention needed with videodisc compared with control methods. Applications studied have ranged from academic (eg, anatomy, language) to industrial (eg, IBM management training) to military (eg, sonar equipment maintenance).* However, it is unclear whether patient preparation is comparable to the education/training contexts that have been studied in the past. Psychological literature suggests that the helpfulness of information as a form of patient preparation may be influenced by patient personality factors or “coping styles.” 3-7One dimension of coping has been conceptualized as the degree to which patients desire or actively seek information, characterized as sensitization versus repression’ or monitoring versus blunting.’ Theoretically, patients are expected to do better psychologically when the amount of information presented is compatible with, rather than incompatible with, their existing information-seeking style. Specifically, researchers have suggested that matching preparation information with patients’ individual information-seeking styles may result in improved recovery and increased patient satisfaction.“.’ ‘.’ Several authors have suggested that patient anxiety level may mediate such effects”.“; eg, matching patient preference for information may minimize anxiety, thereby increasing patient satisfaction and promoting recovery. Research, however, has been equivocal. For example, Miller and Mangan’ ’ found that patients undergoing colposcopy were less aroused when the level of preparatory information was consistent with coping style, but Andrew3 did not find improvement in recovery from hernia surgery related to the interaction of preparation and information-seeking style. Interactive videodisc technology lends itself well to testing whether patient learning and outcome are enhanced when provision of information is matched to information-seeking style; theory suggests that this interactive format should produce better-informed, more satisfied patients, possibly facilitating recovery. Further, to determine the clinical usefulness of interactive videodisc technology, research is needed to determine how patients use interactive videodiscs and how much information they acquire from discs compared with other methods of preparation. This study was designed to compare interactive videodisc to noninteractive vid-
VIDEO PREPARATION FOR THIRD MOLAR EXTRACTION
eotape and standard surgeon consultation as modes of preparation for patients undergoing third molar extractions. Hypotheses We hypothesized that 1) patients who rate themselves higher in information seeking on self-report measures will watch more of the interactive videodisc than will patients who report relatively low information seeking. 2) Patients will learn more from watching an interactive videodisc about third molar extractions than from a noninteractive videotape presenting the same information or from consultation with the oral surgeon. Video group and self-rated information seeking will interact: high information-seekers in the disc group will score highest on a quiz covering the video information. 3) Patients who rate themselves higher in information seeking will show a prevideo to postvideo decrease in anxiety, whereas those lower in self-rated information seeking will show no change or some increase in anxiety after preparation. Videodisc-viewing patients, because of their ability to match amount of information viewed to amount desired, will show lower postvideo anxiety than videotape-viewing patients.4 Patients reporting less information seeking will use more medication, initiate more contact with the oral surgeon, and report less postsurgical satisfaction than high information seekers. Methods SUBJECTS
Subjects were 35 patients (16 male, 19 female) presenting for third molar extraction consultation at the Oral and Maxillofacial Surgery Outpatient Clinic of a large tertiary-care hospital. Mean age was 24.4 years; mean education level, 13.2 years. MATERIALSANDEQUIPMENT
The videodisc used was Volume 2 in the Dental Patient Education Series produced by Videodiscovery (Seattle, WA), Inc, “Preparing for Dental Extractions.” The main menu of the video consisted of four sections: Wisdom Teeth, Extractions, Risks, and Recovery, each with its own submenu. The disc was played on a Pioneer (San Diego, CA) laservision player (model LDV6000A) connected to a 25-in Sony (Tokyo, Japan) color monitor. The videodisc content was recorded on continuous videotape and played on the same color monitor for the tape-viewing group (a small subsection not relevant to third molar extractions was excluded). Two scales were used to measure information-seeking style: the Miller Behavioral Style Scale (MBSS),9 a
29
ADER ET AL
general measure of information seeking under threat, and the Krantz Health Opinion Survey (HOS),13 a health-specific information-seeking and behavioral involvement survey. State anxiety was assessed using the State-Trait Anxiety Inventory (STAI A-Scale).14 A 15item multiple-choice quiz covering material presented in the videos was developed by the authors.
PROCEDURE Before the consultation, subjects completed a shortanswer quiz assessing their general knowledge about third molar extraction (subjects were asked to list two risks of leaving wisdom teeth in, two normal postoperative symptoms associated with extraction, and two possible complications of the surgery). Subjects also completed a demographic questionnaire and the MBSS, HOS, and STAI at this time. They were randomly assigned to view either the interactive video (disc group) or the noninteractive video (tape group). After a brief interaction with the oral surgeon, subjects viewed the video, then immediately completed the multiple-choice quiz and the STAI. Immediately before surgery (usually several weeks after the consultation), subjects again completed the anxiety scale and the quiz. They were given a pain and medication diary to fill out during the week following surgery. At their 1-week follow-up visit, subjects rated their satisfaction with preparation for surgery (on a seven-point scale, with 1 representing totally satisfied and 7 totally dissatisfied), their preferences for future methods of preparation (one or more of the following: surgeon, surgeon’s assistant or clinic staff, written information, videotape, or interactive video) and returned the diary. To compare amount learned from video versus the usual presentation of information, an additional 25 patients presenting to the clinic for third molar extraction consultation were asked to complete the quiz immediately following their consultation with the surgeon.
Results t tests showed no significant differences between the disc and tape groups on prevideo knowledge about third molar extraction, anxiety, or any other preconsultation variables. The disc group included 6 men and 12 women; the tape group 10 men and 7 women. The groups did not differ in any other demographic variables.
Table 1. Viewed
Mean Percent of Third Molar Videodisc
Disc Content
Mean % Viewed
Background on wisdom teeth The extraction procedure Risks Interviews with former patients Recovery
59 82 65 53 61
Total
64
Neither measure of information seeking (HOS information scale, MBSS monitoring scale) correlated significantly with amount of video viewed by subjects in the disc group. The behavioral involvement scale of the HOS and the blunting scale of the MBSS were also unrelated to amount of video viewed.
AMOUNTLEARNED The hypothesis that quiz scores would differ among the tape, disc, and surgeon-only groups was tested using analysis of variance. The data were trimmed of one subject (from the tape group) with an outlying quiz score (33%) whose education level (10th grade) made him nonrepresentative of the sample. Mean percent correct on the postpreparation quiz for disc subjects was 72.6; for tape subjects, 85; for clinic-prepared subjects, 40 (F = 56.31, P < .OOOl). Post hoc analyses using Tukey’s test revealed that each of the three groups differed significantly from the others. Separate hierarchical multiple regressions using the HOS information scale and MBSS monitoring minus blunting (MB) score were computed to test the hypothesis regarding the interaction of video group and self-rated information seeking. To control for variation in preconsultation knowledge about third molar extraction, the prevideo short-answer quiz score was entered into the model first. Information-seeking score was entered second, followed by group and then the interaction term. The model using the HOS scale was not significant; however r2 = .43, P < .O1 for the model using the MB score. There was no significant main effect of MB, but the interaction between MB and group produced a significant increase in r2 (Ar2 = .195, P < .Ol). Contrary to our hypothesis, as self-rated information seeking increased, quiz score decreased for disc subjects. Tape subjects’ quiz scores increased with greater reported information seeking (Fig 1).
AMOUNT OF VIDEODISC VIEWED ANXIETY
On average, subjects in the disc group watched 64% of the video. Table 1 presents the mean percentage of each videodisc section viewed by subjects in this group.
Mean initial anxiety score for the entire sample was 36.1; immediately after video, 33.7: immediately pre-
30
VIDEO PREPARATION
“U
I
0
;
;
seeks less lnformatlon
;
MB
;
lb
1;
seeks more Information
FIGURE 1. Interaction of video group and reported information seeking on third molar quiz score. Solid line, disc group; dotted line, tape group.
surgery, 46.2. A mixed-design ANOVA found no significant differences in state anxiety for group, time, or the interaction. Anxiety was also found to be uncorrelated with self-rated information seeking. PATIENT SATISFACTION
Follow-up data were available for 22 subjects, 11 in each of the two video groups. The disc group reported significantly higher satisfaction with the overall amount of preparation received than subjects in the tape group (t = 2.77, P < .02). Nine disc subjects endorsed a preference for future preparation with an interactive videodisc; only two indicated interest in future preparation with noninteractive videotape. The majority of subjects in both groups indicated a desire for future preparation to include both the surgeon and written information. An insufficient number of subjects completed and returned the pain and medication diary (seven disc subjects, six tape subjects) to analyze for group and information-seeking effects. Discussion Patients prepared for third molar extraction by video presentation (disc or tape) learn more about the procedure, risks, and recovery than those prepared in the standard manner (surgeon presentation of information). Because the interactive videodisc requires more active attention and participation than the noninter-
FOR THIRD MOLAR EXTRACTION
active tape, it was expected that disc subjects as a group would engage in more active information processing and therefore learn more than tape subjects. However, the interactive videodisc did not produce more knowledgeable patients than the videotape, regardless of selfreported preference for information. The fact that, on average, disc subjects viewed only 64% of the total video, whereas the tape subjects were presented with lOO%, probably accounts for this finding. The fact that self-rated information seeking was unrelated to the amount of video that disc subjects chose to view calls into question the appropriateness of the MBSS and HOS in this population. Both scales ask subjects to predict their responses during medical procedures and threatening situations. Subjects in this study were not faced with seeking/avoiding information during the extraction procedure, but in anticipation of the procedure; the extractions were often scheduled to occur weeks after the consultation visit. STAI scores indicate that, in fact, subjects were not aroused either before or immediately following consultation; mean prevideo and postvideo A-scale scores were not elevated relative to normative groups (the failure to find predicted group differences in anxiety may be due to this “floor” effect). In addition, the information-seeking scales used are not specific to dental settings/procedures: the behavior subjects report during medical procedures or in other threatening situations may not be directly relevant to the third molar consultation situation. The obtained interaction between video group and reported information seeking may be partly an artifact of the above problems with the MBSS in this setting. Theoretically, patients who generally tend to seek information should have scored higher on the quiz, regardless of video condition. It is unclear why disc subjects scores should systematically decrease with higher reported information seeking. Unmeasured factors such as external time constraints and familiarity with computers, videocassette recorders, and remote controls may also have contributed to this effect. Conclusion Previous research in other settings has demonstrated advantages of interactive videodiscs over traditional teaching techniques; similarly, this study shows that videodisc-prepared patients were better-informed than their surgeon-prepared counterparts, albeit less wellinformed than videotape-prepared subjects. In addition, disc-viewing subjects were more satisfied with the amount of information they received, and indicated they would like to use interactive discs in preparation for future surgery. These results suggest that the interactive videodisc can be an effective method of preparing
31
ADER ET AL
patients for third molar extraction, Further research is needed to determine the suitability and cost-effectiveness of interactive videodiscs for widespread clinical use.
6.
7.
Acknowledgment The authors wish to acknowledge the supportof Drs Marc Heft and Frank Dolwick. The materials used were provided courtesy of Dr Asuman Kiyak. University of Washington, and Videodiscovery, Seattle, WA.
8.
9.
References 10. 1. Videodiscovery. Inc. Dental Patient Education Series. Volume II: Preparing for Dental Extractions, Seattle, WA, 1988 2. DeBloois M, Maki K, Hall A: Effectiveness of interactive videodisc training: A comprehensive review. The Videodisc Monitor. Future Systems, Inc, 1988 3. Andrew, JM: Recovery from surgery with and without preparatory instruction for three coping styles. J Pers Sot Psycho1
151:223, 1970 4. Melamed BG. SiegelLJ: Reduction of anxiety in children facing hospitalization and surgery by use of filmed modeling. J Consult Clin Psycho143:5 11, 1975 5. Miller SM, Green ML: Coping with stress and frustration, in
J Oral Maxlllofac
11.
12. 13.
14.
Lewis M, Saarni C (eds): The Socialization of Emotions. New York, NY Plenum, 1985 Suls J, Wan CK: Effects of sensory and procedural information on coping with stressful medical procedures and pain: a metaanalysis. J Consult Clin Psycho1 57:372. 1989 Taylor SE, Clarke LF: Does information improve adjustment to noxious medical procedures? in Saks MJ, Saxe L (eds): Advances in Applied Social Psychology (vol 3). Hillsdale, NJ, Erlbaum. 1986 Shipley RH, Butt JH, Horwitz BA: Preparation to reexperience a stressful medical examination: Effect of repetitious videotape exposure and coping style. J Consult Clin Psycho1 47:485, 1979 Miller S M: Monitors vs. blunters: Validation of a questionnaire to assess styles of information-seeking under threat. J Pets Sot Psycho1 521345, 1987 Auerbach SM, Martelh MF, Mercuri LG: Anxiety, information, interpersonal impacts, and adjustment to a stressful health care situation. J Pers Sot Psycho1 44: 1284, 1983 Miller SM, Mangan CE: Interacting effects of information and coping style in adapting to gynecologic stress: should the doctor tell all? J Pers Sot Psycho1 45:223, 1983 Janis IL: Psychological Stress. New York, NY, Wiley, 1958 Krantz DS. Baum A, Wideman M: Assessment of preferences for self-treatment and information on health care. J Pers Sot Psycho1 39:977, 1980 Spielberger CD, Gorsuch RL, Lushene RE: Manual for the StateTrait Anxiety Inventory. Palo Alto, CA. Consulting Psychologists Press, 1970
Surg
50:31-32.1992
Discussion Information Seeking and Interactive Videodisc Preparation for Third Molar Extraction Stephen A4. Auerbach, PhD, and Albert D. Farrell, PhD Virginiu Commonwealth University, Richmond
Ader, Seibring, Bhaskar, and Melamed compare a standard videotaped presentation with the same material presented via interactive videodisc. Several previous studies have shown the efficacy of using preparatory videotaped materials in alleviating stress associated with dental treatment,‘-* including oral surgery.3-4 Computer-interactive video systems are far more sophisticated than the typical videotape presentation. They not only have the capability of providing combinations of print information, audio, video graphics, film, lectures, and tests, but they can also provide individualized feedback and tailor the presentation of material to the individual. Respondents may interact with and control the presentation of materials through a keyboard, a “mouse” control, or a touchsensitive monitor screen.5 The present study provides an initial comparative assessment of the utility of one particular interactive videodisc system designed to prepare patients for third molar extraction. As such, it should be viewed as only a very preliminary evaluation of the technology in general as a patient preparatory device. Little information is presented about the specific capabilities, or the extensiveness of the branching incorporated
into this system. The fact that patients presented with the interactive videodisc viewed an average of 64% of the total video, and that patients in the noninteractive video condition were able to view the entire videotape. suggests that this system included fairly general information and did not make extensive use of branching. This may partially have been a function of the fact that third molar extraction is a relatively straightforward procedure with few possibilities for complications, and thus limited possibility for building in extensive branching. Further, though state anxiety scores were somewhat elevated before surgery, most patients probably view tooth extraction as having a low base rate of untoward consequences and this likely accounted for the fact that many patients chose not to explore many of the information options that were available. Preparatory interventions oriented around more complicated and variable procedures would permit fuller exploration of the range of capabilities of computer technology, and thus would provide a more definitive comparative evaluation of interactive videodiscs in this setting. The fact that Ader et al used individual patient difference measures (the MBSS and HOS) was a strength oftheir study, and in this respect should serve as a model for future research. It should be kept in mind, however, that high information seekers should not necessarily be expected to prefer or do better with computer-interactive videodiscs than videotapes or other presentation modes. Interactive videodiscs allow patients to control the amount and nature of information but do not necessarily maximize amount of information or (as found in the present study) learning.
Surg
1992
Information Seeking and Interactive Videodisc Preparation for Third Molar Extraction DEBORAH
N. ADER,
PHD,* ANGEL R. SEIBRING, BS,t PHILIP AND BARBARA G. MELAMED, PHDS
BHASKAR,
DMD,*
Patient response to interactive videodisc preparation for third molar extraction surgery was examined as a function of self-reported information-seeking style. Amount learned was compared among patients informed via an interactive videodisc, noninteractive videotape of the same material, or surgeon only. Anxiety levels and satisfaction with preparation were compared between the videodisc and videotape groups. At consultation, patients (n = 35) were randomly assigned to either the disc- or the tape-viewing group. First, subjects completed a demographic survey, state anxiety scale, quiz on knowledge about third molars and surgery risks and complications, and information-seeking scales. Immediately after viewing the video, subjects completed another anxiety scale and a multiplechoice quiz covering the material presented. Subsequently, another 25 patients undergoing the routine (surgeon-only) consultation procedure were given the same multiple-choice quiz following consultation. Quiz scores differed significantly among the groups; mean percent correct for the tape-viewing subjects was 85; for disc-viewing subjects 72.6; for surgeon-only subjects, 40. Self-rated information seeking was unrelated to amount of video viewed by disc subjects (on average, 64% of the videodisc was viewed), and disc subjects who rated themselves higher in information-seeking achieved the lowest postpreparation quiz scores. Subjects in the disc group were significantly more satisfied with the amount of preparation than the tape group. Although disc group subjects were significantly less knowledgeable following consultation than were tape group subjects, interactive videodisc preparation for third molar extraction appears to have some advantages over more traditional approaches. Further research is needed to determine whether this approach to preparing patients is suitable for widespread clinical use.
In recent years, interactive videodiscs designed to prepare patients for dental procedures have become available.’ The interactive technology in current clinical use presents menus of the video content on a monitor and allows patients to select what to view via remote control. The format is self-paced, allowing patients to skip sections, repeat sections, and test their knowledge, providing immediate reinforcement of correct answers and correction of mistakes. Both learning theory and research results suggest that interactive video is an effective, efficient educational tool.2 However, to date, no studies have been published ex-
Received from the Department of Oral and Maxillofacial Surgery, University of Florida. Gainesville. * Former Fellow t Predoctoral Trainee. t Formerly, Professor, Department of Clinical and Health Psychology; currently, Professor and Dean, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY. Supported by PHS/NIDR Behavioral Research Training in Dentistry, Grant T32 DE01733 Address correspondence and reprint requests to Dr Ader: Family Practice Faculty Development Center, 1600 Providence Dr, Waco, TX 76107. 0 1992 American Association of Oral and Maxillofacial Surgeons 0278-2391/92/5001-0006$3.00/O
27
28 amining the effects of videodisc preparation of patients for medical or dental procedures. Given the clinical and legal importance of ensuring that patients are wellinformed, it would be useful to determine the efficacy of interactive videodisc preparation for clinical procedures. Interactive videodiscs have primarily been produced for education and training, and studies in a variety of settings have shown better levels of learning/mastery, speed of learning, and/or amount of instructor intervention needed with videodisc compared with control methods. Applications studied have ranged from academic (eg, anatomy, language) to industrial (eg, IBM management training) to military (eg, sonar equipment maintenance).* However, it is unclear whether patient preparation is comparable to the education/training contexts that have been studied in the past. Psychological literature suggests that the helpfulness of information as a form of patient preparation may be influenced by patient personality factors or “coping styles.” 3-7One dimension of coping has been conceptualized as the degree to which patients desire or actively seek information, characterized as sensitization versus repression’ or monitoring versus blunting.’ Theoretically, patients are expected to do better psychologically when the amount of information presented is compatible with, rather than incompatible with, their existing information-seeking style. Specifically, researchers have suggested that matching preparation information with patients’ individual information-seeking styles may result in improved recovery and increased patient satisfaction.“.’ ‘.’ Several authors have suggested that patient anxiety level may mediate such effects”.“; eg, matching patient preference for information may minimize anxiety, thereby increasing patient satisfaction and promoting recovery. Research, however, has been equivocal. For example, Miller and Mangan’ ’ found that patients undergoing colposcopy were less aroused when the level of preparatory information was consistent with coping style, but Andrew3 did not find improvement in recovery from hernia surgery related to the interaction of preparation and information-seeking style. Interactive videodisc technology lends itself well to testing whether patient learning and outcome are enhanced when provision of information is matched to information-seeking style; theory suggests that this interactive format should produce better-informed, more satisfied patients, possibly facilitating recovery. Further, to determine the clinical usefulness of interactive videodisc technology, research is needed to determine how patients use interactive videodiscs and how much information they acquire from discs compared with other methods of preparation. This study was designed to compare interactive videodisc to noninteractive vid-
VIDEO PREPARATION FOR THIRD MOLAR EXTRACTION
eotape and standard surgeon consultation as modes of preparation for patients undergoing third molar extractions. Hypotheses We hypothesized that 1) patients who rate themselves higher in information seeking on self-report measures will watch more of the interactive videodisc than will patients who report relatively low information seeking. 2) Patients will learn more from watching an interactive videodisc about third molar extractions than from a noninteractive videotape presenting the same information or from consultation with the oral surgeon. Video group and self-rated information seeking will interact: high information-seekers in the disc group will score highest on a quiz covering the video information. 3) Patients who rate themselves higher in information seeking will show a prevideo to postvideo decrease in anxiety, whereas those lower in self-rated information seeking will show no change or some increase in anxiety after preparation. Videodisc-viewing patients, because of their ability to match amount of information viewed to amount desired, will show lower postvideo anxiety than videotape-viewing patients.4 Patients reporting less information seeking will use more medication, initiate more contact with the oral surgeon, and report less postsurgical satisfaction than high information seekers. Methods SUBJECTS
Subjects were 35 patients (16 male, 19 female) presenting for third molar extraction consultation at the Oral and Maxillofacial Surgery Outpatient Clinic of a large tertiary-care hospital. Mean age was 24.4 years; mean education level, 13.2 years. MATERIALSANDEQUIPMENT
The videodisc used was Volume 2 in the Dental Patient Education Series produced by Videodiscovery (Seattle, WA), Inc, “Preparing for Dental Extractions.” The main menu of the video consisted of four sections: Wisdom Teeth, Extractions, Risks, and Recovery, each with its own submenu. The disc was played on a Pioneer (San Diego, CA) laservision player (model LDV6000A) connected to a 25-in Sony (Tokyo, Japan) color monitor. The videodisc content was recorded on continuous videotape and played on the same color monitor for the tape-viewing group (a small subsection not relevant to third molar extractions was excluded). Two scales were used to measure information-seeking style: the Miller Behavioral Style Scale (MBSS),9 a
29
ADER ET AL
general measure of information seeking under threat, and the Krantz Health Opinion Survey (HOS),13 a health-specific information-seeking and behavioral involvement survey. State anxiety was assessed using the State-Trait Anxiety Inventory (STAI A-Scale).14 A 15item multiple-choice quiz covering material presented in the videos was developed by the authors.
PROCEDURE Before the consultation, subjects completed a shortanswer quiz assessing their general knowledge about third molar extraction (subjects were asked to list two risks of leaving wisdom teeth in, two normal postoperative symptoms associated with extraction, and two possible complications of the surgery). Subjects also completed a demographic questionnaire and the MBSS, HOS, and STAI at this time. They were randomly assigned to view either the interactive video (disc group) or the noninteractive video (tape group). After a brief interaction with the oral surgeon, subjects viewed the video, then immediately completed the multiple-choice quiz and the STAI. Immediately before surgery (usually several weeks after the consultation), subjects again completed the anxiety scale and the quiz. They were given a pain and medication diary to fill out during the week following surgery. At their 1-week follow-up visit, subjects rated their satisfaction with preparation for surgery (on a seven-point scale, with 1 representing totally satisfied and 7 totally dissatisfied), their preferences for future methods of preparation (one or more of the following: surgeon, surgeon’s assistant or clinic staff, written information, videotape, or interactive video) and returned the diary. To compare amount learned from video versus the usual presentation of information, an additional 25 patients presenting to the clinic for third molar extraction consultation were asked to complete the quiz immediately following their consultation with the surgeon.
Results t tests showed no significant differences between the disc and tape groups on prevideo knowledge about third molar extraction, anxiety, or any other preconsultation variables. The disc group included 6 men and 12 women; the tape group 10 men and 7 women. The groups did not differ in any other demographic variables.
Table 1. Viewed
Mean Percent of Third Molar Videodisc
Disc Content
Mean % Viewed
Background on wisdom teeth The extraction procedure Risks Interviews with former patients Recovery
59 82 65 53 61
Total
64
Neither measure of information seeking (HOS information scale, MBSS monitoring scale) correlated significantly with amount of video viewed by subjects in the disc group. The behavioral involvement scale of the HOS and the blunting scale of the MBSS were also unrelated to amount of video viewed.
AMOUNTLEARNED The hypothesis that quiz scores would differ among the tape, disc, and surgeon-only groups was tested using analysis of variance. The data were trimmed of one subject (from the tape group) with an outlying quiz score (33%) whose education level (10th grade) made him nonrepresentative of the sample. Mean percent correct on the postpreparation quiz for disc subjects was 72.6; for tape subjects, 85; for clinic-prepared subjects, 40 (F = 56.31, P < .OOOl). Post hoc analyses using Tukey’s test revealed that each of the three groups differed significantly from the others. Separate hierarchical multiple regressions using the HOS information scale and MBSS monitoring minus blunting (MB) score were computed to test the hypothesis regarding the interaction of video group and self-rated information seeking. To control for variation in preconsultation knowledge about third molar extraction, the prevideo short-answer quiz score was entered into the model first. Information-seeking score was entered second, followed by group and then the interaction term. The model using the HOS scale was not significant; however r2 = .43, P < .O1 for the model using the MB score. There was no significant main effect of MB, but the interaction between MB and group produced a significant increase in r2 (Ar2 = .195, P < .Ol). Contrary to our hypothesis, as self-rated information seeking increased, quiz score decreased for disc subjects. Tape subjects’ quiz scores increased with greater reported information seeking (Fig 1).
AMOUNT OF VIDEODISC VIEWED ANXIETY
On average, subjects in the disc group watched 64% of the video. Table 1 presents the mean percentage of each videodisc section viewed by subjects in this group.
Mean initial anxiety score for the entire sample was 36.1; immediately after video, 33.7: immediately pre-
30
VIDEO PREPARATION
“U
I
0
;
;
seeks less lnformatlon
;
MB
;
lb
1;
seeks more Information
FIGURE 1. Interaction of video group and reported information seeking on third molar quiz score. Solid line, disc group; dotted line, tape group.
surgery, 46.2. A mixed-design ANOVA found no significant differences in state anxiety for group, time, or the interaction. Anxiety was also found to be uncorrelated with self-rated information seeking. PATIENT SATISFACTION
Follow-up data were available for 22 subjects, 11 in each of the two video groups. The disc group reported significantly higher satisfaction with the overall amount of preparation received than subjects in the tape group (t = 2.77, P < .02). Nine disc subjects endorsed a preference for future preparation with an interactive videodisc; only two indicated interest in future preparation with noninteractive videotape. The majority of subjects in both groups indicated a desire for future preparation to include both the surgeon and written information. An insufficient number of subjects completed and returned the pain and medication diary (seven disc subjects, six tape subjects) to analyze for group and information-seeking effects. Discussion Patients prepared for third molar extraction by video presentation (disc or tape) learn more about the procedure, risks, and recovery than those prepared in the standard manner (surgeon presentation of information). Because the interactive videodisc requires more active attention and participation than the noninter-
FOR THIRD MOLAR EXTRACTION
active tape, it was expected that disc subjects as a group would engage in more active information processing and therefore learn more than tape subjects. However, the interactive videodisc did not produce more knowledgeable patients than the videotape, regardless of selfreported preference for information. The fact that, on average, disc subjects viewed only 64% of the total video, whereas the tape subjects were presented with lOO%, probably accounts for this finding. The fact that self-rated information seeking was unrelated to the amount of video that disc subjects chose to view calls into question the appropriateness of the MBSS and HOS in this population. Both scales ask subjects to predict their responses during medical procedures and threatening situations. Subjects in this study were not faced with seeking/avoiding information during the extraction procedure, but in anticipation of the procedure; the extractions were often scheduled to occur weeks after the consultation visit. STAI scores indicate that, in fact, subjects were not aroused either before or immediately following consultation; mean prevideo and postvideo A-scale scores were not elevated relative to normative groups (the failure to find predicted group differences in anxiety may be due to this “floor” effect). In addition, the information-seeking scales used are not specific to dental settings/procedures: the behavior subjects report during medical procedures or in other threatening situations may not be directly relevant to the third molar consultation situation. The obtained interaction between video group and reported information seeking may be partly an artifact of the above problems with the MBSS in this setting. Theoretically, patients who generally tend to seek information should have scored higher on the quiz, regardless of video condition. It is unclear why disc subjects scores should systematically decrease with higher reported information seeking. Unmeasured factors such as external time constraints and familiarity with computers, videocassette recorders, and remote controls may also have contributed to this effect. Conclusion Previous research in other settings has demonstrated advantages of interactive videodiscs over traditional teaching techniques; similarly, this study shows that videodisc-prepared patients were better-informed than their surgeon-prepared counterparts, albeit less wellinformed than videotape-prepared subjects. In addition, disc-viewing subjects were more satisfied with the amount of information they received, and indicated they would like to use interactive discs in preparation for future surgery. These results suggest that the interactive videodisc can be an effective method of preparing
31
ADER ET AL
patients for third molar extraction, Further research is needed to determine the suitability and cost-effectiveness of interactive videodiscs for widespread clinical use.
6.
7.
Acknowledgment The authors wish to acknowledge the supportof Drs Marc Heft and Frank Dolwick. The materials used were provided courtesy of Dr Asuman Kiyak. University of Washington, and Videodiscovery, Seattle, WA.
8.
9.
References 10. 1. Videodiscovery. Inc. Dental Patient Education Series. Volume II: Preparing for Dental Extractions, Seattle, WA, 1988 2. DeBloois M, Maki K, Hall A: Effectiveness of interactive videodisc training: A comprehensive review. The Videodisc Monitor. Future Systems, Inc, 1988 3. Andrew, JM: Recovery from surgery with and without preparatory instruction for three coping styles. J Pers Sot Psycho1
151:223, 1970 4. Melamed BG. SiegelLJ: Reduction of anxiety in children facing hospitalization and surgery by use of filmed modeling. J Consult Clin Psycho143:5 11, 1975 5. Miller SM, Green ML: Coping with stress and frustration, in
J Oral Maxlllofac
11.
12. 13.
14.
Lewis M, Saarni C (eds): The Socialization of Emotions. New York, NY Plenum, 1985 Suls J, Wan CK: Effects of sensory and procedural information on coping with stressful medical procedures and pain: a metaanalysis. J Consult Clin Psycho1 57:372. 1989 Taylor SE, Clarke LF: Does information improve adjustment to noxious medical procedures? in Saks MJ, Saxe L (eds): Advances in Applied Social Psychology (vol 3). Hillsdale, NJ, Erlbaum. 1986 Shipley RH, Butt JH, Horwitz BA: Preparation to reexperience a stressful medical examination: Effect of repetitious videotape exposure and coping style. J Consult Clin Psycho1 47:485, 1979 Miller S M: Monitors vs. blunters: Validation of a questionnaire to assess styles of information-seeking under threat. J Pets Sot Psycho1 521345, 1987 Auerbach SM, Martelh MF, Mercuri LG: Anxiety, information, interpersonal impacts, and adjustment to a stressful health care situation. J Pers Sot Psycho1 44: 1284, 1983 Miller SM, Mangan CE: Interacting effects of information and coping style in adapting to gynecologic stress: should the doctor tell all? J Pers Sot Psycho1 45:223, 1983 Janis IL: Psychological Stress. New York, NY, Wiley, 1958 Krantz DS. Baum A, Wideman M: Assessment of preferences for self-treatment and information on health care. J Pers Sot Psycho1 39:977, 1980 Spielberger CD, Gorsuch RL, Lushene RE: Manual for the StateTrait Anxiety Inventory. Palo Alto, CA. Consulting Psychologists Press, 1970
Surg
50:31-32.1992
Discussion Information Seeking and Interactive Videodisc Preparation for Third Molar Extraction Stephen A4. Auerbach, PhD, and Albert D. Farrell, PhD Virginiu Commonwealth University, Richmond
Ader, Seibring, Bhaskar, and Melamed compare a standard videotaped presentation with the same material presented via interactive videodisc. Several previous studies have shown the efficacy of using preparatory videotaped materials in alleviating stress associated with dental treatment,‘-* including oral surgery.3-4 Computer-interactive video systems are far more sophisticated than the typical videotape presentation. They not only have the capability of providing combinations of print information, audio, video graphics, film, lectures, and tests, but they can also provide individualized feedback and tailor the presentation of material to the individual. Respondents may interact with and control the presentation of materials through a keyboard, a “mouse” control, or a touchsensitive monitor screen.5 The present study provides an initial comparative assessment of the utility of one particular interactive videodisc system designed to prepare patients for third molar extraction. As such, it should be viewed as only a very preliminary evaluation of the technology in general as a patient preparatory device. Little information is presented about the specific capabilities, or the extensiveness of the branching incorporated
into this system. The fact that patients presented with the interactive videodisc viewed an average of 64% of the total video, and that patients in the noninteractive video condition were able to view the entire videotape. suggests that this system included fairly general information and did not make extensive use of branching. This may partially have been a function of the fact that third molar extraction is a relatively straightforward procedure with few possibilities for complications, and thus limited possibility for building in extensive branching. Further, though state anxiety scores were somewhat elevated before surgery, most patients probably view tooth extraction as having a low base rate of untoward consequences and this likely accounted for the fact that many patients chose not to explore many of the information options that were available. Preparatory interventions oriented around more complicated and variable procedures would permit fuller exploration of the range of capabilities of computer technology, and thus would provide a more definitive comparative evaluation of interactive videodiscs in this setting. The fact that Ader et al used individual patient difference measures (the MBSS and HOS) was a strength oftheir study, and in this respect should serve as a model for future research. It should be kept in mind, however, that high information seekers should not necessarily be expected to prefer or do better with computer-interactive videodiscs than videotapes or other presentation modes. Interactive videodiscs allow patients to control the amount and nature of information but do not necessarily maximize amount of information or (as found in the present study) learning.
