Comparing the Effectiveness of Traditional Training Method and the Combination of a Scenario Video With Recorded Video Observation in Enhancing Inhaler Operating Skills of Elderly Inpatients in Taiwan

Background: Elderly patients often have poor inhaler technique, resulting in ineffective deposition of medication in the lungs. Low motivation, a short attention span, and poor medication adherence pose substantial challenges for health educators when teaching inhaler techniques. Regarding a solution to these challenges, this study compared the effectiveness of a traditional training method with that of a tailored training program in enhancing the inhaler technique of elderly inpatients in Taiwan. Methods: Participants were randomly assigned to the tailored training group (TG) or routine training group (RG). The TG received three-step training involving scenario simulation videos, a standardized guiding video, and verbal corrections after the recorded videos (patient demonstration) had been played. The RG group received only verbal corrections from a respiratory therapist following self-demonstration after watching the inhaler guiding video. Inhaler technique was assessed by reviewing the videos recorded on days 1, 3, and 7. Data were analyzed using JASP, with descriptive statistics for patient characteristics. An independent-samples t test was used to compare critical error ratios, with statistical significance set at P < .05.The study was approved by the Institutional Review Board of Chang Gung Medical Foundation (approval no.202001107B0) and the procedures of this study adhered to the Declaration of Helsinki. Results: Achieving adequate inhalation was a challenging process; the success rate was 58.0% and 51.7% in the TG and RG, respectively. Analysis of the learning effect revealed a significant intergroup difference on day 7. The proportion of participants with critical inhaler technique errors was significantly lower in the TG group (TG = 0.42 ± 0.50, RG = 0.69 ± 0.47, P = .03). Conclusions: Compared with traditional methods, the proposed tailored training program was considerably more effective in improving the inhaler technique of elderly inpatients. Scenario simulations enhance patients’ understanding of asthma and chronic obstructive pulmonary disease resulting from inhaler misuse. Video observation also aids in rectifying errors and overcoming reluctance to acknowledge mistakes. These findings can serve as a reference educational model for healthcare providers in hospitals. However, studies on a larger scale are required.Patient characteristics TG(n=31)RG(n=29)pAge70.19 ± 10.8969.60 ± 10.720.916Gender (male)25 (80.6%)23 (79.3%)0.305COPD2 (6.5%)2 (6.9%)0.946Asthma1 (3.2%)4 (13.8%)0.144Coronary artery disease5 (16.1%)3 (10.3%)0.518Diabetes mellitus7 (22.6%)4 (13.8%)0.388Hypertension8 (25.8%)6 (20.7%)0.646Lung cancer7 (22.6%)5 (17.2%)0.613Chronic kidney disease3 (9.7%)2 (6.9%)0.946No disease history10 (32.6%)9 (31.0%)0.144Active smoker15 (48.4%)13 (44.8%)0.787Living with a caregiver24 (77.4%)24 (82.8%)0.613Educational level below elementary school23 (74.2%)19 (65.6%)0.472Inhaler Technique Checklist: Day 7TG(n=31)RG(n=29) Correctly opening the canister31 (100%)29 (100%) Correctly administering the medication31 (100%)29 (100%) Correctly filling the medication31 (100%)29 (100%) Correctly sealing the inhaler mouthpiece29 (93.5%)26 (89.7%) Correctly exhaling completely before inhaling24 (77.4%)19 (65.5%) Correctly inhaling with an adequate flow rate18 (58.0%)15 (51.7%) Correct hand–mouth coordination21 (67.7%)22 (75.9%) Correctly holding breath28 (90.3%)22 (75.9%) Correctly confirming the remaining dose30 (96.8%)28 (96.6%) Proportion of participants making a critical errorTG(n=31)RG(n=29)pFirst visit (day 1)0.87 ± 0.340.90 ± 0.310.76Second visit (day 3)0.58 ± 0.500.72 ± 0.460.25Final visit (day 7)0.42 ± 0.500.69 ± 0.470.03*    TG: tailored training group; RG: routine training group; COPD: chronic obstructive pulmonary disease; p < 0.05*.