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1.  Interventions for promoting information and communication technologies adoption in healthcare professionals 
Background
Information and communication technologies (ICT) are defined as digital and analogue technologies that facilitate the capturing, processing, storage and exchange of information via electronic communication. ICTs have the potential to improve information management, access to health services, quality of care, continuity of services, and cost containment. Knowledge is lacking on conditions for successful ICT integration into practice.
Objectives
To carry out a systematic review of the effectiveness of interventions to promote the adoption of ICT by healthcare professionals.
Search methods
Specific strategies, defined with the help of an information specialist, were used to search the Cochrane Effective Practice and Organisation of Care Group (EPOC) register and additional relevant databases. We considered studies published from January 1990 until October 2007.
Selection criteria
Randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before/after studies (CBAs), and interrupted time series (ITS) that reported objectively measured outcomes concerning the effect of interventions to promote adoption of ICT in healthcare professionals’ practices.
Data collection and analysis
Two reviewers independently assessed each potentially relevant study for inclusion. We resolved discrepancies by discussion or a third reviewer. Two teams of two reviewers independently extracted data and assessed the quality of included studies. A meta-analysis of study outcomes was not possible, given the small number of included studies and the heterogeneity of intervention and outcomes measures. We conducted qualitative analyses, and have presented the results in a narrative format.
Main results
Ten studies met the inclusion criteria. Nine of them were RCTs. All studies involved physicians as participants (including postgraduate trainees), and one study also included other participants. Only two studies measured patient outcomes. Searching skills and/or frequency of use of electronic databases, mainly MEDLINE, were targeted in eight studies. Use of Internet for audit and feedback, and email for provider-patient communication, were targeted in two studies. Four studies showed small to moderate positive effects of the intervention on ICT adoption. Four studies were unable to demonstrate significant positive effects, and the two others showed mixed effects. No studies looked at the long-term effect or sustainability of the intervention.
Authors’ conclusions
There is very limited evidence on effective interventions promoting the adoption of ICTs by healthcare professionals. Small effects have been reported for interventions targeting the use of electronic databases and digital libraries. The effectiveness of interventions to promote ICT adoption in healthcare settings remains uncertain, and more well designed trials are needed.
doi:10.1002/14651858.CD006093.pub2
PMCID: PMC3973635  PMID: 19160265 CAMSID: cams377
Databases, Bibliographic [utilization]; Health Personnel [*statistics & numerical data]; Information Storage and Retrieval [*utilization]; Professional Practice [*statistics & numerical data]; Randomized Controlled Trials as Topic
2.  Development and Content Validation of the Information Assessment Method for Patients and Consumers 
JMIR Research Protocols  2014;3(1):e7.
Background
Online consumer health information addresses health problems, self-care, disease prevention, and health care services and is intended for the general public. Using this information, people can improve their knowledge, participation in health decision-making, and health. However, there are no comprehensive instruments to evaluate the value of health information from a consumer perspective.
Objective
We collaborated with information providers to develop and validate the Information Assessment Method for all (IAM4all) that can be used to collect feedback from information consumers (including patients), and to enable a two-way knowledge translation between information providers and consumers.
Methods
Content validation steps were followed to develop the IAM4all questionnaire. The first version was based on a theoretical framework from information science, a critical literature review and prior work. Then, 16 laypersons were interviewed on their experience with online health information and specifically their impression of the IAM4all questionnaire. Based on the summaries and interpretations of interviews, questionnaire items were revised, added, and excluded, thus creating the second version of the questionnaire. Subsequently, a panel of 12 information specialists and 8 health researchers participated in an online survey to rate each questionnaire item for relevance, clarity, representativeness, and specificity. The result of this expert panel contributed to the third, current, version of the questionnaire.
Results
The current version of the IAM4all questionnaire is structured by four levels of outcomes of information seeking/receiving: situational relevance, cognitive impact, information use, and health benefits. Following the interviews and the expert panel survey, 9 questionnaire items were confirmed as relevant, clear, representative, and specific. To improve readability and accessibility for users with a lower level of literacy, 19 items were reworded and all inconsistencies in using a passive or active voice have been solved. One item was removed due to redundancy. The current version of the IAM4all questionnaire contains 28 items.
Conclusions
We developed and content validated the IAM4all in partnership with information providers, information specialists, researchers and representatives of information consumers. This questionnaire can be integrated within electronic knowledge resources to stimulate users’ reflection (eg, their intention to use information). We claim that any organization (eg, publishers, community organizations, or patient associations), can evaluate and improve their online consumer health information from a consumers’ perspective using this method.
doi:10.2196/resprot.2908
PMCID: PMC3958673  PMID: 24550180
information use; information retrieval; push technology; consumer health information; consumer-centered outcomes; content validity
3.  In pursuit of a valid information assessment method for continuing education: a mixed methods study 
BMC Medical Education  2013;13:137.
Background
The Information Assessment Method (IAM) is a popular tool for continuing education and knowledge translation. After a search for information, the IAM allows the health professional to report what was the search objective, its cognitive impact, as well as any use and patient health benefit associated with the retrieved health information. In continuing education programs, professionals read health information, rate it using the IAM, and earn continuing education credit for this brief individual reflective learning activity. IAM items have been iteratively developed using literature reviews and qualitative studies. Thus, our research question was: what is the content validity of IAM items from the users’ perspective?
Methods
A two-step content validation study was conducted. In Step 1, we followed a mixed methods research design, and assessed the relevance and representativeness of IAM items. In this step, data from a longitudinal quantitative study and a qualitative multiple case study involving 40 family physicians were analyzed. In Step 2, IAM items were analyzed and modified based on a set of guiding principles by a multi-disciplinary expert panel.
Results
The content validity of 16 IAM items was supported, and these items were not changed. Nine other items were modified. Three new items were added, including two that were extensions of an existing item.
Conclusion
A content validated version of the IAM (IAM 2011) is available for the continuing education of health professionals.
doi:10.1186/1472-6920-13-137
PMCID: PMC3842783  PMID: 24094046
Content validity; Continuing medical education; Health informatics; Information assessment method; Primary health care; Knowledge translation
4.  Uncovering the Benefits of Participatory Research: Implications of a Realist Review for Health Research and Practice 
The Milbank Quarterly  2012;90(2):311-346.
Context
Participatory research (PR) is the co-construction of research through partnerships between researchers and people affected by and/or responsible for action on the issues under study. Evaluating the benefits of PR is challenging for a number of reasons: the research topics, methods, and study designs are heterogeneous; the extent of collaborative involvement may vary over the duration of a project and from one project to the next; and partnership activities may generate a complex array of both short- and long-term outcomes.
Methods
Our review team consisted of a collaboration among researchers and decision makers in public health, research funding, ethics review, and community-engaged scholarship. We identified, selected, and appraised a large-variety sample of primary studies describing PR partnerships, and in each stage, two team members independently reviewed and coded the literature. We used key realist review concepts (middle-range theory, demi-regularity, and context-mechanism-outcome configurations [CMO]) to analyze and synthesize the data, using the PR partnership as the main unit of analysis.
Findings
From 7,167 abstracts and 591 full-text papers, we distilled for synthesis a final sample of twenty-three PR partnerships described in 276 publications. The link between process and outcome in these partnerships was best explained using the middle-range theory of partnership synergy, which demonstrates how PR can (1) ensure culturally and logistically appropriate research, (2) enhance recruitment capacity, (3) generate professional capacity and competence in stakeholder groups, (4) result in productive conflicts followed by useful negotiation, (5) increase the quality of outputs and outcomes over time, (6) increase the sustainability of project goals beyond funded time frames and during gaps in external funding, and (7) create system changes and new unanticipated projects and activities. Negative examples illustrated why these outcomes were not a guaranteed product of PR partnerships but were contingent on key aspects of context.
Conclusions
We used a realist approach to embrace the heterogeneity and complexity of the PR literature. This theory-driven synthesis identified mechanisms by which PR may add value to the research process. Using the middle-range theory of partnership synergy, our review confirmed findings from previous PR reviews, documented and explained some negative outcomes, and generated new insights into the benefits of PR regarding conflicts and negotiation between stakeholders, program sustainability and advancement, unanticipated project activity, and the generation of systemic change.
doi:10.1111/j.1468-0009.2012.00665.x
PMCID: PMC3460206  PMID: 22709390
Participatory research; action research; realist review; systematic review; partnership synergy theory; community-based participatory research
5.  Transforming primary healthcare by including the stakeholders involved in delivering care to people living in poverty: EQUIhealThY study protocol 
Background
Ensuring access to timely and appropriate primary healthcare for people living in poverty is an issue facing all countries, even those with universal healthcare systems. The transformation of healthcare practices and organization could be improved by involving key stakeholders from the community and the healthcare system in the development of research interventions. The aim of this project is to stimulate changes in healthcare organizations and practices by encouraging collaboration between care teams and people living in poverty. Our objectives are twofold: 1) to identify actions required to promote the adoption of professional practices oriented toward social competence in primary care teams; and 2) to examine factors that would encourage the inclusion of people living in poverty in the process of developing social competence in healthcare organizations.
Methods/design
This study will use a participatory action research design applied in healthcare organizations. Participatory research is an increasingly recognized approach that is helpful for involving the people for whom the research results are intended. Our research team consists of 19 non-academic researchers, 11 academic researchers and six partners. A steering committee composed of academic researchers and stakeholders will have a decision-making role at each step, including knowledge dissemination and recommendations for new interventions. In this project we will adopt a multiphase approach and will use a variety of methods, including photovoice, group discussions and interviews.
Discussion
The proposed study will be one of only a few using participatory research in primary care to foster changes aimed at enhancing quality and access to care for people living in poverty. To our knowledge this will be the first study to use photovoice in healthcare organizations to promote new interventions. Our project includes partners who are targeted for practice changes and improvements in delivering primary care to persons living in poverty. By involving knowledge users, including service recipients, our study is more likely to produce a transformation of professional practices and encourage healthcare organizations to take into account the needs of persons living in poverty.
doi:10.1186/1472-6963-13-92
PMCID: PMC3610178  PMID: 23497400
Participatory research; Poverty; Primary care; Photovoice; Knowledge transfer
6.  Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol 
Background
Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment.
Methods/design
A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians’ intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians’ access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs.
Conclusions
This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.
doi:10.1186/1472-6947-12-85
PMCID: PMC3472191  PMID: 22867107
(3–10); Evidence-based practice; Continuing professional education; Risk communication; Patient-centered care; Counselling; Clinical topic summary; Decision support; Knowledge translation; Implementation science
7.  Decision boxes for clinicians to support evidence-based practice and shared decision making: the user experience 
Background
This project engages patients and physicians in the development of Decision Boxes, short clinical topic summaries covering medical questions that have no single best answer. Decision Boxes aim to prepare the clinician to communicate the risks and benefits of the available options to the patient so they can make an informed decision together.
Methods
Seven researchers (including four practicing family physicians) selected 10 clinical topics relevant to primary care practice through a Delphi survey. We then developed two one-page prototypes on two of these topics: prostate cancer screening with the prostate-specific antigen test, and prenatal screening for trisomy 21 with the serum integrated test. We presented the prototypes to purposeful samples of family physicians distributed in two focus groups, and patients distributed in four focus groups. We used the User Experience Honeycomb to explore barriers and facilitators to the communication design used in Decision Boxes. All discussions were transcribed, and three researchers proceeded to thematic content analysis of the transcriptions. The coding scheme was first developed from the Honeycomb’s seven themes (valuable, usable, credible, useful, desirable, accessible, and findable), and included new themes suggested by the data. Prototypes were modified in light of our findings.
Results
Three rounds were necessary for a majority of researchers to select 10 clinical topics. Fifteen physicians and 33 patients participated in the focus groups. Following analyses, three sections were added to the Decision Boxes: introduction, patient counseling, and references. The information was spread to two pages to try to make the Decision Boxes less busy and improve users’ first impression. To try to improve credibility, we gave more visibility to the research institutions involved in development. A statement on the boxes’ purpose and a flow chart representing the shared decision-making process were added with the intent of clarifying the tool’s purpose. Information about the risks and benefits according to risk levels was added to the Decision Boxes, to try to ease the adaptation of the information to individual patients.
Conclusion
Results will guide the development of the eight remaining Decision Boxes. A future study will evaluate the effect of Decision Boxes on the integration of evidence-based and shared decision making principles in clinical practice.
doi:10.1186/1748-5908-7-72
PMCID: PMC3533695  PMID: 22862935
Evidence-based medicine; User experience; Risk communication; Usability; Patient-centered care; Counselling; Clinical topic summary; Decision support; Knowledge translation; Communication design
8.  An Online Knowledge Resource and Questionnaires as a Continuing Pharmacy Education Tool to Document Reflective Learning 
Objective. To assess the use of an electronic knowledge resource to document continuing education activities and reveal educational needs of practicing pharmacists.
Methods. Over a 38-week period, 67 e-mails were sent to 6,500 Canadian Pharmacists Association (CPhA) members. Each e-mail contained a link to an e-Therapeutics+ Highlight, a factual excerpt of selected content from an online drug and therapeutic knowledge resource. Participants were then prompted to complete a pop-up questionnaire.
Results. Members completed 4,140 questionnaires. Participants attributed the information they learned in the Highlights to practice improvements (50.4%), learning (57.0%), and motivation to learn more (57.4%).
Conclusions. Reading Highlight excerpts and completing Web-based questionnaires is an effective method of continuing education that could be easily documented and tracked, making it an effective tool for use with e-portfolios.
doi:10.5688/ajpe76582
PMCID: PMC3386033  PMID: 22761523
continuing pharmacy education; electronic knowledge resource; e-portfolio; information assessment method; reflective learning
9.  Do Family Physicians Retrieve Synopses of Clinical Research Previously Read as Email Alerts? 
Background
A synopsis of new clinical research highlights important aspects of one study in a brief structured format. When delivered as email alerts, synopses enable clinicians to become aware of new developments relevant for practice. Once read, a synopsis can become a known item of clinical information. In time-pressured situations, remembering a known item may facilitate information retrieval by the clinician. However, exactly how synopses first delivered as email alerts influence retrieval at some later time is not known.
Objectives
We examined searches for clinical information in which a synopsis previously read as an email alert was retrieved (defined as a dyad). Our study objectives were to (1) examine whether family physicians retrieved synopses they previously read as email alerts and then to (2) explore whether family physicians purposefully retrieved these synopses.
Methods
We conducted a mixed-methods study in which a qualitative multiple case study explored the retrieval of email alerts within a prospective longitudinal cohort of practicing family physicians. Reading of research-based synopses was tracked in two contexts: (1) push, meaning to read on email and (2) pull, meaning to read after retrieval from one electronic knowledge resource. Dyads, defined as synopses first read as email alerts and subsequently retrieved in a search of a knowledge resource, were prospectively identified. Participants were interviewed about all of their dyads. Outcomes were the total number of dyads and their type.
Results
Over a period of 341 days, 194 unique synopses delivered to 41 participants resulted in 4937 synopsis readings. In all, 1205 synopses were retrieved over an average of 320 days. Of the 1205 retrieved synopses, 21 (1.7%) were dyads made by 17 family physicians. Of the 1205 retrieved synopses, 6 (0.5%) were known item type dyads. However, dyads also occurred serendipitously.
Conclusion
In the single knowledge resource we studied, email alerts containing research-based synopses were rarely retrieved. Our findings help us to better understand the effect of push on pull and to improve the integration of research-based information within electronic resources for clinicians.
doi:10.2196/jmir.1683
PMCID: PMC3278087  PMID: 22130465
Electronic mail; clinical email channels; information retrieval; physicians, family
10.  Assessing the outcomes of participatory research: protocol for identifying, selecting, appraising and synthesizing the literature for realist review 
Background
Participatory Research (PR) entails the co-governance of research by academic researchers and end-users. End-users are those who are affected by issues under study (e.g., community groups or populations affected by illness), or those positioned to act on the knowledge generated by research (e.g., clinicians, community leaders, health managers, patients, and policy makers). Systematic reviews assessing the generalizable benefits of PR must address: the diversity of research topics, methods, and intervention designs that involve a PR approach; varying degrees of end-user involvement in research co-governance, both within and between projects; and the complexity of outcomes arising from long-term partnerships.
Methods
We addressed the above mentioned challenges by adapting realist review methodology to PR assessment, specifically by developing inductively-driven identification, selection, appraisal, and synthesis procedures. This approach allowed us to address the non-uniformity and complexity of the PR literature. Each stage of the review involved two independent reviewers and followed a reproducible, systematic coding and retention procedure. Retained studies were completed participatory health interventions, demonstrated high levels of participation by non-academic stakeholders (i.e., excluding studies in which end-users were not involved in co-governing throughout the stages of research) and contained detailed descriptions of the participatory process and context. Retained sets are being mapped and analyzed using realist review methods.
Results
The librarian-guided search string yielded 7,167 citations. A total of 594 citations were retained after the identification process. Eighty-three papers remained after selection. Principle Investigators (PIs) were contacted to solicit all companion papers. Twenty-three sets of papers (23 PR studies), comprising 276 publications, passed appraisal and are being synthesized using realist review methods.
Discussion
The systematic and stage-based procedure addressed challenges to PR assessment and generated our robust understanding of complex and heterogeneous PR practices. To date, realist reviews have focussed on evaluations of relatively uniform interventions. In contrast our PR search yielded a wide diversity of partnerships and research topics. We therefore developed tools to achieve conceptual clarity on the PR field, as a beneficial precursor to our theoretically-driven synthesis using realist methods. Findings from the ongoing review will be provided in forthcoming publications.
doi:10.1186/1748-5908-6-24
PMCID: PMC3072934  PMID: 21418604
11.  Developing and user-testing Decision boxes to facilitate shared decision making in primary care - a study protocol 
Background
Applying evidence is one of the most challenging steps of evidence-based clinical practice. Healthcare professionals have difficulty interpreting evidence and translating it to patients. Decision boxes are summaries of the most important benefits and harms of diagnostic, therapeutic, and preventive health interventions provided to healthcare professionals before they meet the patient. Our hypothesis is that Decision boxes will prepare clinicians to help patients make informed value-based decisions. By acting as primers, the boxes will enhance the application of evidence-based practices and increase shared decision making during the clinical encounter. The objectives of this study are to provide a framework for developing Decision boxes and testing their value to users.
Methods/Design
We will begin by developing Decision box prototypes for 10 clinical conditions or topics based on a review of the research on risk communication. We will present two prototypes to purposeful samples of 16 family physicians distributed in two focus groups, and 32 patients distributed in four focus groups. We will use the User Experience Model framework to explore users' perceptions of the content and format of each prototype. All discussions will be transcribed, and two researchers will independently perform a hybrid deductive/inductive thematic qualitative analysis of the data. The coding scheme will be developed a priori from the User Experience Model's seven themes (valuable, usable, credible, useful, desirable, accessible and findable), and will include new themes suggested by the data (inductive analysis). Key findings will be triangulated using additional publications on the design of tools to improve risk communication. All 10 Decision boxes will be modified in light of our findings.
Discussion
This study will produce a robust framework for developing and testing Decision boxes that will serve healthcare professionals and patients alike. It is the first step in the development and implementation of a new tool that should facilitate decision making in clinical practice.
doi:10.1186/1472-6947-11-17
PMCID: PMC3060840  PMID: 21385470
12.  Many family physicians will not manually update PDA software: an observational study 
Informatics in primary care  2009;17(4):225-230.
Background
In a prospective study to explore connections between clinical information delivery and information retrieval, 41 Canadian family physicians searched an Electronic Knowledge Resource as needed for practice. Research software, called the Information Assessment Method prompted family physicians to report on the situational relevance, perceived cognitive impact, and application of their retrieved information hits. Both the Information Assessment Method and the Electronic Knowledge Resource needed periodic updating to properly address our research questions.
Objective
To determine the frequency of software updates when manual or semi-automatic approaches are used by family physicians.
Methods
Each family physician received a handheld computer (PDA) that ran the Windows Mobile 6 operating system. For technical reasons, the Information Assessment Method and the Electronic Knowledge Resource were accessed offline on PDA. To update the Electronic Knowledge Resource and the Information Assessment Method, family physicians were asked to synchronize their PDA to their PC. Updating the Information Assessment Method was a manual process, whereas updating the Electronic Knowledge Resource was semi-automatic.
Results
We found: (1) about 25% of family physicians never or rarely updated PDA software on their own (2) a large number of software updates were never installed, and (3) the semi-automatic method was associated with a small increase in the proportion of installed software updates (58.9% versus 48.6% for the manual method).
Conclusions
When a wireless Internet connection is not used to update PDA software, sociotechnical issues complicate mobile data collection and data transfer.
PMCID: PMC2878612  PMID: 20359400 CAMSID: cams799
Computers handheld; software; family practice
13.  Combining classifiers for robust PICO element detection 
Background
Formulating a clinical information need in terms of the four atomic parts which are Population/Problem, Intervention, Comparison and Outcome (known as PICO elements) facilitates searching for a precise answer within a large medical citation database. However, using PICO defined items in the information retrieval process requires a search engine to be able to detect and index PICO elements in the collection in order for the system to retrieve relevant documents.
Methods
In this study, we tested multiple supervised classification algorithms and their combinations for detecting PICO elements within medical abstracts. Using the structural descriptors that are embedded in some medical abstracts, we have automatically gathered large training/testing data sets for each PICO element.
Results
Combining multiple classifiers using a weighted linear combination of their prediction scores achieves promising results with an f-measure score of 86.3% for P, 67% for I and 56.6% for O.
Conclusions
Our experiments on the identification of PICO elements showed that the task is very challenging. Nevertheless, the performance achieved by our identification method is competitive with previously published results and shows that this task can be achieved with a high accuracy for the P element but lower ones for I and O elements.
doi:10.1186/1472-6947-10-29
PMCID: PMC2891622  PMID: 20470429
14.  Impact of Research-based Synopses Delivered as Daily E-mail: A Prospective Observational Study 
We conducted a prospective observational study to (1) determine usage and construct validity of a method to gauge the cognitive impact of information derived from daily e-mail, and (2) describe self-reported impacts of research-based synopses (InfoPOEMs) delivered as e-mail. Ratings of InfoPOEMs using an Impact assessment scale provided (a) data on usage of the impact assessment method, (b) reports of impact by InfoPOEM and by doctor and (c) data for analysis of construct validity of the scale. Participants were family physicians or general practitioners who rated at least five InfoPOEMs delivered on e-mail. For each InfoPOEM rated, 0.1 continuing education credit was awarded by the College of Family Physicians of Canada.
Use of the impact assessment scale linked to a daily InfoPOEM was sustained during the 150-day study period. 1,007 participants submitted 61,493 reports of ‘cognitive impact’ by rating on average 61 InfoPOEMs (range 5–111). ‘I learned something new’ was most frequently reported. ‘I was frustrated as there was not enough information or nothing useful’ was the most frequently reported negative type of impact. The proportion of reports of ‘No Impact’ varied substantially across individual InfoPOEMs. Impact patterns suggested an 8 or 9-factor solution.
Our Impact assessment method facilitates knowledge transfer by promoting two-way exchange between providers of health information and family doctors. Providers of health information can use this method to better understand the impact of research-based synopses. Sustaining current practice and increasing knowledge about new developments in medicine are important outcomes arising from research-based synopses delivered as e-mail, in addition to practice change.
doi:10.1197/jamia.M2563
PMCID: PMC2274788  PMID: 18096905
15.  Systematically Assessing the Situational Relevance of Electronic Knowledge Resources: A Mixed Methods Study 
Electronic Knowledge Resources (EKRs) are increasingly used by physicians, but their situational relevance has not been systematically examined.
Objective
Systematically scrutinize the situational relevance of EKR-derived information items in and outside clinical settings.
Background
Physicians use EKRs to accomplish four cognitive objectives (C1-4), and three organizational objectives (O1-3): (C1) Answer questions/solve problems/support decision-making in a clinical context; (C2) fulfill educational-research objectives; (C3) search for personal interest or curiosity; (C4) overcome limits of human memory; (O1) share information with patients, families, or caregivers; (O2) exchange information with other health professionals; (O3) plan-manage-monitor tasks with other health professionals.
Methods
Longitudinal mixed methods multiple case study: Cases were 17 residents’ critical searches for information, using a commercial EKR, during a 2-month block of family practice. Usage data were automatically recorded. Each “opened” item of information was linked to an impact assessment questionnaire, and 1,981 evaluations of items were documented. Interviews with residents were guided by log files, which tracked use and impact of EKR-derived information items. Thematic analysis identified 156 critical searches linked to 877 information items. For each case, qualitative data were assigned to one of the seven proposed objectives.
Results
Residents achieved their search objectives in 85.9% of cases (situational relevance). Additional sources of information were sought in 52.6% of cases. Results support the seven proposed objectives, levels of comparative relevance (less, equally, more), and levels of stimulation of learning and knowledge (individual, organizational).
Conclusion
Our method of systematic assessment may contribute to user-based evaluation of EKRs.
doi:10.1197/jamia.M2203
PMCID: PMC1975787  PMID: 17600105
16.  Advancing theories, models and measurement for an interprofessional approach to shared decision making in primary care: a study protocol 
Background
Shared decision-making (SDM) is defined as a process by which a healthcare choice is made by practitioners together with the patient. Although many diagnostic and therapeutic processes in primary care integrate more than one type of health professional, most SDM conceptual models and theories appear to be limited to the patient-physician dyad. The objectives of this study are to develop a conceptual model and propose a set of measurement tools for enhancing an interprofessional approach to SDM in primary healthcare.
Methods/Design
An inventory of SDM conceptual models, theories and measurement tools will be created. Models will be critically assessed and compared according to their strengths, limitations, acknowledgement of interprofessional roles in the process of SDM and relevance to primary care. Based on the theory analysis, a conceptual model and a set of measurements tools that could be used to enhance an interprofessional approach to SDM in primary healthcare will be proposed and pilot-tested with key stakeholders and primary healthcare teams.
Discussion
This study protocol is informative for researchers and clinicians interested in designing and/or conducting future studies and educating health professionals to improve how primary healthcare teams foster active participation of patients in making health decisions using a more coordinated approach.
doi:10.1186/1472-6963-8-2
PMCID: PMC2265696  PMID: 18173848
17.  Cognitive Impact Assessment of Electronic Knowledge Resources: A Mixed Methods Evaluation Study of a Handheld Prototype 
Rationale
We recently proposed a new method to systematically assess the cognitive impact of knowledge resources on health professionals.
Objective
To describe promises and shortcomings of a handheld computer prototype of this method.
Background
We developed an impact scale, and combined this scale with a Computerized Ecological Momentary Assessment technique.
Method
We conducted a mixed methods evaluation study using a 7-item scale within a questionnaire linked to a commercial knowledge resource. Over two months of Family Medicine training, 17 residents assessed the impact of 1,981 information hits retrieved on handheld computer. From observations, log-reports, archives of hits and interviews, we examined issues associated with hardware, software and the questionnaire.
Findings
Fifteen residents found the questionnaire clearly written, and only one pointed to the questionnaire as a major reason for their low level of use of the resource. Residents reported technical problems (e.g. screen trouble) or limitations (e.g. limited tracking function) and socio-technical issues (e.g. software dependency).
Conclusion
Lessons from this study suggest improvements to guide future implementation of our method for assessing the cognitive impact of knowledge resources on health professionals.
PMCID: PMC1839687  PMID: 17238418
18.  A New Impact Assessment Method to Evaluate Knowledge Resources 
Rationale
Methods to systematically measure the impact of knowledge resources on health professionals would enhance evaluation of these resources in the real world.
Objective
To propose a new impact assessment method.
Background
We demonstrated the feasibility of combining a 4-level scale with Computerized Ecological Momentary Assessment (CEMA) for efficiently measuring the impact of a knowledge resource.
Method
We critically reviewed the world literature regarding the impact of clinical information-retrieval technology on trainees and doctors, and retained 26 papers for qualitative content analysis.
Findings
Of those, 21 use a nominal scale (yes/no), none systematically measures the impact of searches for information outside of a laboratory setting, and none uses an ordinal scale. The literature supports the proposed levels of impact, and suggests a fifth level.
Conclusion
A new impact assessment method is proposed, which combines a 5-level revised scale and CEMA.
PMCID: PMC1560543  PMID: 16779112
19.  Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model 
Most shared decision-making (SDM) models within healthcare have been limited to the patientphysician dyad. As a first step towards promoting an interprofessional approach to SDM in primary care, this article reports how an interprofessional and interdisciplinary group developed and achieved consensus on a new interprofessional SDM model. The key concepts within published reviews of SDM models and interprofessionalism were identified, analysed, and discussed by the group in order to reach consensus on the new interprofessional SDM (IP-SDM) model. The IP-SDM model comprises three levels: the individual (micro) level and two healthcare system (meso and macro) levels. At the individual level, the patient presents with a health condition that requires decision-making and follows a structured process to make an informed, value-based decision in concert with a team of healthcare professionals. The model acknowledges (at the meso level) the influence of individual team members' professional roles including the decision coach and organizational routines. At the macro level it acknowledges the influence of system level factors (i.e. health policies, professional organisations, and social context) on the meso and individual levels. Subsequently, the IP-SDM model will be validated with other stakeholders.
doi:10.3109/13561820.2010.490502
PMCID: PMC3018136  PMID: 20795835
Interprofessionalism; shared decision-making; conceptual models; theories; primary care
20.  Validating a conceptual model for an inter-professional approach to shared decision making: a mixed methods study 
Rationale, aims and objectives
Following increased interest in having inter-professional (IP) health care teams engage patients in decision making, we developed a conceptual model for an IP approach to shared decision making (SDM) in primary care. We assessed the validity of the model with stakeholders in Canada.
Methods
In 15 individual interviews and 7 group interviews with 79 stakeholders, we asked them to: (1) propose changes to the IP-SDM model; (2) identify barriers and facilitators to the model's implementation in clinical practice; and (3) assess the model using a theory appraisal questionnaire. We performed a thematic analysis of the transcripts and a descriptive analysis of the questionnaires.
Results
Stakeholders suggested placing the patient at its centre; extending the concept of family to include significant others; clarifying outcomes; highlighting the concept of time; merging the micro, meso and macro levels in one figure; and recognizing the influence of the environment and emotions. The most common barriers identified were time constraints, insufficient resources and an imbalance of power among health professionals. The most common facilitators were education and training in inter-professionalism and SDM, motivation to achieve an IP approach to SDM, and mutual knowledge and understanding of disciplinary roles. Most stakeholders considered that the concepts and relationships between the concepts were clear and rated the model as logical, testable, having clear schematic representation, and being relevant to inter-professional collaboration, SDM and primary care.
Conclusions
Stakeholders validated the new IP-SDM model for primary care settings and proposed few modifications. Future research should assess if the model helps implement SDM in IP clinical practice.
doi:10.1111/j.1365-2753.2010.01515.x
PMCID: PMC3170704  PMID: 20695950
conceptual model; decision coaching; inter-professionalism; primary care; shared decision making; validity

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