Pilot Trial Study Evaluating Whole Health Education® in Cardiac Rehabilitation
excerpted summary of:
Pilot Trial Study Evaluating Whole Health Education® in Cardiac Rehabilitation Report 01/02
|The Pilot Study set out to enroll 50 patients from the Cardiac Rehabilitation Department at Union Hospital. Patient population included a heart transplant recipient, patients with multiple pathologies, as well as obese, alcoholic, addictive and recalcitrant patients with varying cardiovascular disease. The patients were evaluated initially and at the end of six months using the SF36, a validated survey instrument widely used to measure quality of life. The evaluation also used a Clinical Data Collection Inventory (CDCI), which is a non-validated internal instrument|
Union Hospital is a 132-bed, community hospital located in Lynn, MA. It is also a part of the North Shore Medical Center and is a member of the Partners HealthCare System, founded by Massachusetts General Hospital and Brigham and Women’s Hospital, both teaching hospitals of Harvard Medical School. Whole Health Education is an invitational, non-directive model of health education which empowers individuals to understand the cause and effects of their conditions through demystifying health information.
The development of Whole Health Education began in 1977 by Dr. Georgianna Donadio, founder and director of the NESWHE [now National Institute of Whole Health in Boston, MA. NIWH trains educators in providing “Health Education for The Whole Person.” Whole Health Education is a peer-counseling model of health education based on respectful listening, “the big picture of health”® perspective and personalized health information research.
Patients were contacted via letter by the Pilot Study Coordinator, Anna Seubert, and those expressing interest were given an outline of the study protocol. If patients agreed to participate, they completed the SF36 and the CDCI. They then met with a Whole Health Educator for six, one-on-one sessions. Patients then completed another SF36 and CDCI six months later. The data from the Whole Health Education patients was compared with data from historical controls. These were patients who had only been through cardiac rehabilitation. The control patients had filled out baseline and six-month SF36 and CDCI questionnaires.
The control group was not studied at the same time as the treatment group, and no attempt at randomization was made. No attempt was made to pair subjects, and the study was not considered a controlled study. The study was approved by the Investigational Review Board at Union Hospital. Patients in the Whole Health Education application component of the study were enrolled in 1998 and 1999. Six certified Whole Health Educators and six Interns from the New England School of Whole Health Education participated in educating the patients in the study at Union Hospital.
The study was funded in part by Union Hospital and in part by The New England School of Whole Health Education. The Principal Investigator for the Pilot Study was Harvey Zarren, MD, FACC, a cardiologist in private practice and also Medical Director of the Department of Cardiac Rehabilitation at Union Hospital.
The Study was not powered to reach statistical significance. The sample size was small and the SF36 and CDCI may not have been reliable indicators of the experiences of the patients. Although no significant overall clinical differences were observed between the treatment group and the control group in SF36 data or in CDCI data, there were quality of life questions where patients receiving Whole Health Education did significantly better than the control group after six months. The questions focused on:
- Sharing feelings routinely –> 11% improvement
- Level of stress –> 6% improvement
- Perceptions of tendency to get sick compared to others –> 22% improvement
- Expectations of future health decline –> 21% improvement
- Perceptions of current health status –> 4% improvement
Patient Anecdotes at their six-month follow-up
For representations of the Whole Health Education experience, the best indicators are patients’ anecdotal comments: Many patients who experienced Whole Health Education said “No one has ever listened to me in such a deep, respectful fashion before.” Other comments from Whole Health Education patients included:
“The effects of this process have been very subtle but life-changing for me.”
“I am choosing to do things for myself that I have not thought about in a long time.”
“I finally have information that’s helping me to make different kinds of choices.”
“Never before in my life have I been listened to like this!”
“Thanks to following your program I am a completely new man.”
“I have a new approach to life including a change in eating habits, stress reduction, and improved physical health. I have made new friends and have fun socially. This has been a real plus in my life.”
“I have more knowledge of mitigating diet factors and habits for general health and control.”
“I have more information on what and what not to do.”
“I got enlightenment.”
“I’ve become stronger, got education for self-care and got support from wonderful people who worked with me.”
“I got information on the latest nutritional findings and recommendations about vitamin do’s and don’ts and exercise information to improve my heart and general health.”
“I got health!”
“I got to educate myself about diet, exercise, and change of lifestyle to reduce my risk of heart surgery.”
“I’ve become more energetic and I’ve felt much better after the program.”
“I have a firmer grip on understanding not only the outside forces that affect my health and hopefully ways to deflect or better manage these influences.”
“I got muscle tone and friendship with people.”
“I learned more about my body and its function and diet control and effects.”
“I got a healthier heart.”
“Thank you for your help, support and education. All of you gave me on a day-to-day basis peace and compassion: the most important pill. Good health and happiness to you and thank you.”
“I received knowledge of my body, ways to extend my life, and to live healthier.”
“I learned to feel good about myself and to enjoy life to the fullest.”
“I received knowledge of my ailment, treatments available and strengthening of my heart and body.”
“I learned why it’s important to exercise and eat correctly. Just to know there are other people like me is consoling.”
“I learned about a healthy heart, body and mind.”
“I learned to help myself with a spiritual program and meditation.”
“I know a few of the guys in rehab wished they had had the chance to work with the Whole Health Educators.”
“I received a better understanding of myself.”
The Pilot Study demonstrated that Whole Health Education was not only valuable but also desirable in the journey of cardiac patients towards wellness. The qualitative data, collected in the form of exit interviews with patients, interviews with staff, and unsolicited notes and letters was positive. Patients who had presented with behavior problems for staff became cooperative and related in a manner serving themselves and others in a much better fashion.
The Whole Health Educators had a lot of time with patients–time that patients valued in itself, apart from any informational content. That time was effective in allowing patients to see their conditions more clearly and to work through barriers to improved health. The relationship of Educators to patients provided behavior models that, along with the education content, allowed for persistent lifestyle changes.
The combination of Cardiac Rehabilitation and Whole Health Education allowed repetitive exposure of patients to information enabling them to make better decisions about behaviors creating wellness. Dr. Harvey Zarren, the Principal Investigator for the Pilot Study, said “As a physician, I find that Whole Health Educators are incredibly supportive in my attempt to help patients regain or maintain wellness.
The Educators reinforce knowledge, motivate patient behavior, and have the time to help remove barriers to wellness. Whole Health Education is a very potent, valuable tool in helping patients transform their lives. Whole Health Education can be a very effective ally in the health care practitioner’s efforts on behalf of patients.”
Other findings associated with the study and application of Whole Health Education
Excerpted: January 2001 Report by Harvey Zarren, M.D., F.A.C.C. “The pilot program demonstrated….patients who presented behavior problems for staff became cooperative, and related in a manner serving everyone in a much better fashion [and] allowed patients to see their condition more clearly and to work out barriers to health improvement.
The relationship of educator with patient gave people a behavior model that, with the content of the education, allowed for persistent lifestyle changes. Other patients, with behavior problems such as alcohol abuse have been exposed to Whole Health Education at the hospital. In each case, the invitational, respectful attitude of the educators has been instrumental in patient behavior changes leading towards wellness. Whole Health Education is a model of education that allows relationship skill building in an overt way.
It is totally supportive, not expensive, and incredibly effective. It invites people to learn rather than directing them as to what to do. It values participation and useful behavior rather than moralizing about a particular course of action. It is a model for all relationships.
Here is a method of education that can help to transform medical care for both patients and caregivers, allowing the healing experience to once more be a journey towards wellness for all. Whole Health Education at Union Hospital [is] in service to patients, health care professionals and health care itself.” — Harvey Zarren, MD, FACC, Medical Director, Department of Cardiac Rehabilitation, Union Hospital