An Audiovisual Intervention for Patients in an X-Ray Room
An Audiovisual Intervention for Patients in an X-Ray Room
The study took place in the Jeroen Bosch Hospital in Den Bosch, the Netherlands. This hospital has four digital x-ray rooms, two of which are equipped with an audiovisual intervention developed by Philips Healthcare. This system is based on distraction of patients using a combination of dynamic colored ambient lighting, video projections, and sound.
The study was conducted on 4 consecutive days; ie, 1 day for each condition. Participants were assigned to one of the following four conditions based on the day their examination was scheduled: (1) patients did not receive the audiovisual intervention (control condition), (2) patients received the audiovisual intervention (AVI), (3) patients received the audiovisual intervention and received information about it (AVI + info), and (4) patients received the audiovisual intervention, information about it, and were offered a choice of the audiovisual theme (AVI + info + choice).
Four themes were provided to participants in conditions 2, 3, and 4. All themes show nature imagery, which is well known to help reduce anxiety. For each theme, the music was quiet and slow in order to be experienced as relaxing and it matched the theme of the video. In conditions 2 and 3, a theme was randomly chosen by the researcher, making sure that each of the four themes was presented to an equal number of participants. Patients in condition 4 could choose among the four themes.
State anxiety, need for control, active coping, and satisfaction with the hospital were measured.
State Anxiety. State anxiety was measured by means of the shortened eight-item version of the State Anxiety Inventory (STAI-S). State anxiety refers to the intensity of anxiety experienced in reaction to a specific event, in this case the diagnostic x-ray procedure. The scores on the eight-item version were converted to the 20-item version to enable comparison to other studies; hence, scores can range between 20 and 80 with higher scores indicating a higher level of state anxiety. In addition to assessing state anxiety before and after the diagnostic procedure, patients were asked to indicate on a seven-point Likert scale how nervous they were (1) with regard to the procedure and (2) with regard to the diagnosis.
Need for Control. Need for control was measured by the Krantz Health Opinion Survey (KHOS). The behavioral involvement scale consists of nine items that measure to what degree a person actively seeks to exert control in a medical environment. The information scale consists of seven items that measure to what degree an individual wants to be informed about medical decisions. A seven-point Likert scale ranging from 1 (totally disagree) to 7 (totally agree) was chosen, rather than the original dichotomous response. This is in line with previous studies that have used other response formats. Higher scores indicate a higher need for behavioral involvement and information respectively.
Active Coping. Coping style was measured with six items of the active coping dimension of the Utrecht Coping List (UCL). This dimension measures to what degree an individual tries to disentangle a situation and actively looks for solutions to a problem. Participants rated each item on a four-point Likert scale ranging from "rarely or never" to "very often." Higher scores indicate a higher level of active coping.
Satisfaction. Satisfaction was measured by asking patients to indicate how willing they were to recommend the hospital to a friend or colleague, which is known as Net Promoter Score (NPS). The NPS was scored on an 11-point Likert scale ranging from 0 (not at all likely) to 10 (extremely likely). The percentage of detractors was subtracted from the percentage of promoters to get an overall NPS. The NPS is typically used in marketing research to get an indication of customer loyalty. The scores are divided into three categories, the really satisfied (ie, the promoters, score 9–10), the passively satisfied (ie, the fence sitters, score 7–8), and the unsatisfied (ie, the detractors, score 0–6), because this clustering turned out to provide the best prediction of customer behavior.
All participants provided informed consent prior to the study. Before the x-ray, state anxiety was measured with the STAI-S and patients were asked to indicate how nervous they were with regard to the procedure and the diagnosis. Patients assigned to the control condition were then accompanied to an x-ray room without colored light, video projection, or music. Patients assigned to the experimental conditions were accompanied to an x-ray room with the audiovisual intervention and were given the following information: "The diagnostic x-ray room has colored light, a video projection, and music." This information was provided to make patients aware of the presence of the audiovisual intervention. Patients in condition 4 received the following additional information: "There are a number of different themes from which you can choose. Please indicate which theme you would like to have in the x-ray room." When patients returned from the diagnostic x-ray room, they completed the STAI-S, the active coping questions from the UCL and the NPS. Participants in conditions 2, 3, and 4 also completed the KHOS.
Method
Design
The study took place in the Jeroen Bosch Hospital in Den Bosch, the Netherlands. This hospital has four digital x-ray rooms, two of which are equipped with an audiovisual intervention developed by Philips Healthcare. This system is based on distraction of patients using a combination of dynamic colored ambient lighting, video projections, and sound.
The study was conducted on 4 consecutive days; ie, 1 day for each condition. Participants were assigned to one of the following four conditions based on the day their examination was scheduled: (1) patients did not receive the audiovisual intervention (control condition), (2) patients received the audiovisual intervention (AVI), (3) patients received the audiovisual intervention and received information about it (AVI + info), and (4) patients received the audiovisual intervention, information about it, and were offered a choice of the audiovisual theme (AVI + info + choice).
Four themes were provided to participants in conditions 2, 3, and 4. All themes show nature imagery, which is well known to help reduce anxiety. For each theme, the music was quiet and slow in order to be experienced as relaxing and it matched the theme of the video. In conditions 2 and 3, a theme was randomly chosen by the researcher, making sure that each of the four themes was presented to an equal number of participants. Patients in condition 4 could choose among the four themes.
Measures
State anxiety, need for control, active coping, and satisfaction with the hospital were measured.
State Anxiety. State anxiety was measured by means of the shortened eight-item version of the State Anxiety Inventory (STAI-S). State anxiety refers to the intensity of anxiety experienced in reaction to a specific event, in this case the diagnostic x-ray procedure. The scores on the eight-item version were converted to the 20-item version to enable comparison to other studies; hence, scores can range between 20 and 80 with higher scores indicating a higher level of state anxiety. In addition to assessing state anxiety before and after the diagnostic procedure, patients were asked to indicate on a seven-point Likert scale how nervous they were (1) with regard to the procedure and (2) with regard to the diagnosis.
Need for Control. Need for control was measured by the Krantz Health Opinion Survey (KHOS). The behavioral involvement scale consists of nine items that measure to what degree a person actively seeks to exert control in a medical environment. The information scale consists of seven items that measure to what degree an individual wants to be informed about medical decisions. A seven-point Likert scale ranging from 1 (totally disagree) to 7 (totally agree) was chosen, rather than the original dichotomous response. This is in line with previous studies that have used other response formats. Higher scores indicate a higher need for behavioral involvement and information respectively.
Active Coping. Coping style was measured with six items of the active coping dimension of the Utrecht Coping List (UCL). This dimension measures to what degree an individual tries to disentangle a situation and actively looks for solutions to a problem. Participants rated each item on a four-point Likert scale ranging from "rarely or never" to "very often." Higher scores indicate a higher level of active coping.
Satisfaction. Satisfaction was measured by asking patients to indicate how willing they were to recommend the hospital to a friend or colleague, which is known as Net Promoter Score (NPS). The NPS was scored on an 11-point Likert scale ranging from 0 (not at all likely) to 10 (extremely likely). The percentage of detractors was subtracted from the percentage of promoters to get an overall NPS. The NPS is typically used in marketing research to get an indication of customer loyalty. The scores are divided into three categories, the really satisfied (ie, the promoters, score 9–10), the passively satisfied (ie, the fence sitters, score 7–8), and the unsatisfied (ie, the detractors, score 0–6), because this clustering turned out to provide the best prediction of customer behavior.
Procedure
All participants provided informed consent prior to the study. Before the x-ray, state anxiety was measured with the STAI-S and patients were asked to indicate how nervous they were with regard to the procedure and the diagnosis. Patients assigned to the control condition were then accompanied to an x-ray room without colored light, video projection, or music. Patients assigned to the experimental conditions were accompanied to an x-ray room with the audiovisual intervention and were given the following information: "The diagnostic x-ray room has colored light, a video projection, and music." This information was provided to make patients aware of the presence of the audiovisual intervention. Patients in condition 4 received the following additional information: "There are a number of different themes from which you can choose. Please indicate which theme you would like to have in the x-ray room." When patients returned from the diagnostic x-ray room, they completed the STAI-S, the active coping questions from the UCL and the NPS. Participants in conditions 2, 3, and 4 also completed the KHOS.
