Most pharma marketers probably haven’t considered that their latest health education strategy could be viewed as a print-out. One study suggests they should.

Healthcare communications agency HealthEd Group released a report on the most effective ways healthcare providers—other than doctors—communicate with patients. The result: a solid 55% of health professionals polled said they rely on paper-based communications when talking with patients over any other form of communication.

The surveyed educators included what the researchers called “healthcare extenders,” and included professionals such as nurse practitioners, registered dietitians, diabetes educators and social workers. “This is the group doing the translation…in terms of how to cope with a diagnosis or how to translate what treatment recommendations doctors made into adherence,” explained HealthEd’s Susan Collins, SVP, health education R&D.

These professionals are on healthcare’s front line, addressing patients’ and care partners’ anxieties and fielding questions about conditions and options. Asked how they use technology, a large proportion of extenders viewed themselves as the de facto search engine or curator of health information for patients and care partners, said Collins, winnowing down the tremendous amount of healthcare resources available, and steering them away from misinformation toward reputable sites.

“We actually go deeper and broader in our discussions than most MDs,” said Mindy Nichols, a certified diabetes educator and registered dietician. “The MD usually gives the diagnosis and suggestions to maintain control of the disease, and the certified diabetes educator assists with personal understanding of that diagnosis and prescription.”

The reason why so many print out paper information for their charges was straightforward: 61% said they didn’t pull out laptops and smartphones during appointments because educational technology was just too expensive. Others said regulations tamp down on their ability to be creative when presenting information.

However, the study noted that money wasn’t the only reason professionals used printed materials. Some patients not only prefer handouts, but educators said it’s far easier to customize an info pack when it’s printed than trying to mash together a series of digital communications.

Another reason behind extenders’ tendency to resort to print—older patients and others don’t always have access to technology, and this was cited by many as a barrier to using technology effectively.

“I usually use print education materials rather than sending patients online,” said Nichols, the certified diabetes educator. While 92%-97% of Americans have access to the web, it’s not necessarily in their home. “Occasionally I’ll send them online to their [glucose] meter supply company or their medical supply/pharmaceutical company…but for the most part, I give them print information.”

HealthEd also found that educational tools often don’t take into account health literacy. Only 12% of patients qualify as health literate (based on the National Assessment of Adult Literacy, another study), which means understanding what’s online, let alone finding reliable sources. That can make the digital world less valuable for them, and it’s an area respondents cited as being forgotten in the educational technology effort.

Those who do go online to track down information pose an educational challenge of their own: the survey showed that while 30% of educators said patients are unable to distinguish between credible and unreliable sources for health information, nearly 59% said patients are bringing in downloaded materials to discuss in an HCP clinical visit. Of those who have ventured online, respondents said 50% of the patients did so to learn about their health conditions, and 35% of them were looking for information about a specific medicine. The study also showed that educators don’t use technology to fill in communication gaps between visits. Although the Pew Research Center says 46% of Americans have smartphones within reach, only 29% of the polled educators left personal voicemails for patients between visits, 29% sent emails, and 10% sent text messages to check in.

With the move toward healthcare reform, Collins said she believes health extenders are poised to assume an even bigger role in care delivery. “More and more, this is the group that is so important, that we really [need to] take opportunities to listen to them,” she said.

But the aforementioned barriers have ramifications for marketers. “When pharma marketers think of the educational materials that they are providing through digital means or web,” said Collins, “they may not think about the fact those may be printed out and used in the clinical encounter or patient interaction.”