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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Knapp P, Moe-Byrne T, Martin-Kerry J, Sheridan R, Roche J, Coleman E, Bower P, Higgins S, Stones C, Graffy J, Preston J, Gamble C, Young B, Perry D, Dahlmann-Noor A, Abbas M, Khandelwal P, Ludden S, Azuara-Blanco A, McConnell E, Mandall N, Lawson A, Rogers CA, Smartt HJM, Heys R, Stones SR, Taylor DH, Ainsworth S, Ainsworth J. Providing multimedia information to children and young people increases recruitment to trials: pre-planned meta-analysis of SWATs. BMC Med 2023; 21:244. [PMID: 37403173 PMCID: PMC10320935 DOI: 10.1186/s12916-023-02936-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Randomised controlled trials are often beset by problems with poor recruitment and retention. Information to support decisions on trial participation is usually provided as printed participant information sheets (PIS), which are often long, technical, and unappealing. Multimedia information (MMI), including animations and videos, may be a valuable alternative or complement to a PIS. The Trials Engagement in Children and Adolescents (TRECA) study compared MMI to PIS to investigate the effects on participant recruitment, retention, and quality of decision-making. METHODS We undertook six SWATs (Study Within A Trial) within a series of host trials recruiting children and young people. Potential participants in the host trials were randomly allocated to receive MMI-only, PIS-only, or combined MMI + PIS. We recorded the rates of recruitment and retention (varying between 6 and 26 weeks post-randomisation) in each host trial. Potential participants approached about each host trial were asked to complete a nine-item Decision-Making Questionnaire (DMQ) to indicate their evaluation of the information and their reasons for participation/non-participation. Odds ratios were calculated and combined in a meta-analysis. RESULTS Data from 3/6 SWATs for which it was possible were combined in a meta-analysis (n = 1758). Potential participants allocated to MMI-only were more likely to be recruited to the host trial than those allocated to PIS-only (OR 1.54; 95% CI 1.05, 2.28; p = 0.03). Those allocated to combined MMI + PIS compared to PIS-only were no more likely to be recruited to the host trial (OR = 0.89; 95% CI 0.53, 1.50; p = 0.67). Providing MMI rather than PIS did not impact on DMQ scores. Once children and young people had been recruited to host trials, their trial retention rates did not differ according to intervention allocation. CONCLUSIONS Providing MMI-only increased the trial recruitment rate compared to PIS-only but did not affect DMQ scores. Combined MMI + PIS instead of PIS had no effect on recruitment or retention. MMIs are a useful tool for trial recruitment in children and young people, and they could reduce trial recruitment periods.
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Affiliation(s)
- Peter Knapp
- Department of Health Sciences & the Hull York Medical School, University of York, York, UK.
| | | | | | | | - Jenny Roche
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Peter Bower
- Centre for Primary Care, University of Manchester, Manchester, UK
| | | | | | | | - Jenny Preston
- Institute of Child Health, University of Liverpool, Liverpool, UK
| | - Carrol Gamble
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Daniel Perry
- Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK
| | | | - Mohamed Abbas
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anna Lawson
- Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Donovan G, Hall N, Smith F, Ling J, Wilkes S. Two-way Automated Text Messaging Support From Community Pharmacies for Medication Taking in Multiple Long-term Conditions: Human-Centered Design With Nominal Group Technique Development Study. JMIR Form Res 2022; 6:e41735. [PMID: 36542458 DOI: 10.2196/41735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Reviews of digital communication technologies suggest that they can be effective in supporting medication use; however, their use alongside nondigital components is unclear. We also explored the delivery of a digital communication intervention in a relatively novel setting of community pharmacies and how such an intervention might be delivered to patients with multiple long-term conditions. This meant that despite the large number of intervention examples available in the literature, design questions remained, which we wanted to explore with key stakeholders. Examples of how to involve stakeholders in the design of complex health care interventions are lacking; however, human-centered design (HCD) has been suggested as a potential approach. OBJECTIVE This study aimed to design a new community pharmacy text messaging intervention to support medication use for multiple long-term conditions, with patient and health care professional stakeholders in primary care. METHODS HCD was used to map the intervention "journey" and identify design questions to explore with patients and health care professionals. Six prototypes were developed to communicate the intervention concept, and a modified version of the Nominal Group Technique was used to gather feedback. Nominal group meetings generated qualitative data using questions about the aspects that participants liked for each prototype and any suggested changes. The discussion was analyzed using a framework approach to transform feedback into statements. These statements were then ranked using a web-based questionnaire to establish a consensus about what elements of the design were valued by stakeholders and what changes to the design were most important. RESULTS A total of 30 participants provided feedback on the intervention design concept over 5 nominal group meetings (21 health care professionals and 9 patients) with a 57% (17/30) response rate to the ranking questionnaire. Furthermore, 51 proposed changes in the intervention were generated from the framework analysis. Of these 51 changes, 27 (53%) were incorporated into the next design stage, focusing on changes that were ranked highest. These included suggestions for how text message content might be tailored, patient information materials, and the structure for pharmacist consultation. All aspects that the participants liked were retained in the future design and provided evidence that the proposed intervention concept had good acceptability. CONCLUSIONS HCD incorporating the Nominal Group Technique is an appropriate and successful approach for obtaining feedback from key stakeholders as part of an iterative design process. This was particularly helpful for our intervention, which combined digital and nondigital components for delivery in the novel setting of a community pharmacy. This approach enabled the collection and prioritization of useful multiperspective feedback to inform further development and testing of our intervention. This model has the potential to minimize research waste by gathering feedback early in the complex intervention design process.
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Affiliation(s)
| | - Nicola Hall
- University of Sunderland, Sunderland, United Kingdom
| | - Felicity Smith
- School of Pharmacy, University College London, London, United Kingdom
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, United Kingdom
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Donovan G, Hall N, Ling J, Smith F, Wilkes S. Influencing medication taking behaviors using automated two-way digital communication: A narrative synthesis systematic review informed by the Behavior Change Wheel. Br J Health Psychol 2022; 27:861-890. [PMID: 35080811 PMCID: PMC9541766 DOI: 10.1111/bjhp.12580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/28/2021] [Accepted: 12/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Around half of prescribed medications for long-term conditions are not taken as directed. Automated two-way digital communication, such as text messaging and interactive voice response technology, could deliver interventions to improve medication adherence, and subsequently health. However, exploration of how such interventions may improve medication adherence is limited. This review aimed to explore how automated two-way digital communication can improve medication taking with or without using non-digital intervention components, such as phone calls with healthcare professionals. METHODS A theory-informed narrative synthesis systematic review. Several databases were searched including CINAHL, Embase, Medline, and Web of Science using key words relating to 'medication adherence' and digital communication technologies. The Behavior Change Technique (BCT) coding using the BCT Taxonomy V1 and the Behavior Change Wheel were used to identify BCTs delivered within the included interventions. RESULTS A total of 3,018 records were screened with 43 study reports included in the review. Four medication-taking behaviors: taking medication, obtaining medication, self-testing, and asking for support were identified as targets for behavior change within the included interventions. Most BCTs within the digital communication component aimed to increase motivation for medication adherence, with non-digital intervention components included to address other medication taking barriers, such as physical and psychological capability. CONCLUSION Automated two-way digital communication can detect barriers to medication adherence by monitoring performance of the taking medication behavior. Monitoring outcomes from taking medication may increase reflective motivation to take medicines. Addressing physical opportunity to taking medication by facilitating the behavior obtaining medication may also increase adherence.
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Affiliation(s)
- Gemma Donovan
- Faculty of Health Sciences and WellbeingSchool of Pharmacy and Pharmaceutical SciencesUniversity of SunderlandUK
| | - Nicola Hall
- Faculty of Medical SciencesPopulation Health Sciences InstituteNewcastle UniversityUK
| | - Jonathan Ling
- Faculty of Health Sciences and WellbeingUniversity of SunderlandUK
| | | | - Scott Wilkes
- Faculty of Health Sciences and WellbeingSchool of MedicineUniversity of SunderlandUK
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Moe-Byrne T, Knapp P, Perry D, Achten J, Spoors L, Appelbe D, Roche J, Martin-Kerry JM, Sheridan R, Higgins S. Does digital, multimedia information increase recruitment and retention in a children's wrist fracture treatment trial, and what do people think of it? A randomised controlled Study Within A Trial (SWAT). BMJ Open 2022; 12:e057508. [PMID: 35831055 PMCID: PMC9280884 DOI: 10.1136/bmjopen-2021-057508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To evaluate digital, multimedia information (MMI) for its effects on trial recruitment, retention, decisions about participation and acceptability by patients, compared with printed information. DESIGN Study Within A Trial using random cluster allocation within the Forearm Fracture Recovery in Children Evaluation (FORCE) study. SETTING Emergency departments in 23 UK hospitals. PARTICIPANTS 1409 children aged 4-16 years attending with a torus (buckle) fracture, and their parents/guardian. Children's mean age was 9.2 years, 41.0% were female, 77.4% were ethnically White and 90.0% spoke English as a first language. INTERVENTIONS Participants and their parents/guardian received trial information either via multimedia, including animated videos, talking head videos and text (revised for readability and age appropriateness when needed) on tablet computer (MMI group; n=681), or printed participant information sheet (PIS group; n=728). OUTCOME MEASURES Primary outcome was recruitment rate to FORCE. Secondary outcomes were Decision-Making Questionnaire (nine Likert items, analysed summatively and individually), three 'free text' questions (deriving subjective evaluations) and trial retention. RESULTS MMI produced a small, not statistically significant increase in recruitment: 475 (69.8%) participants were recruited from the MMI group; 484 (66.5%) from the PIS group (OR=1.35; 95% CI 0.76 to 2.40, p=0.31). A total of 324 (23.0%) questionnaires were returned and analysed. There was no difference in total Decision-Making Questionnaire scores: adjusted mean difference 0.05 (95% CI -1.23 to 1.32, p=0.94). The MMI group was more likely to report the information 'very easy' to understand (89; 57.8% vs 67; 39.4%; Z=2.60, p=0.01) and identify information that was explained well (96; 62.3% vs 71; 41.8%). Almost all FORCE recruits were retained at the 6 weeks' timepoint and there was no difference in retention rate between the information groups: MMI (473; 99.6%); PIS (481; 99.4%). CONCLUSIONS MMI did not increase recruitment or retention in the FORCE trial, but participants rated multimedia as easier to understand and were more likely to evaluate it positively. TRIAL REGISTRATION NUMBER ISRCTN73136092 and ISRCTN13955395.
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Affiliation(s)
| | - Peter Knapp
- Health Sciences and the Hull York Medical School, University of York, York, UK
| | | | | | - Louise Spoors
- NDORMS, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Jenny Roche
- Health Sciences, University of York, York, UK
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Abu-Farha R, Alzoubi KH, Rizik M, Karout S, Itani R, Mukattash T, Alefishat E. Public Perceptions About Home Delivery of Medication Service and Factors Associated with the Utilization of This Service. Patient Prefer Adherence 2022; 16:2259-2269. [PMID: 36034332 PMCID: PMC9416318 DOI: 10.2147/ppa.s377558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/26/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Home medication delivery service is a major service for the public. It reduces overcrowding and unnecessary visits to health centers. This study aims to investigate the public perception of home delivery of medication service in Jordan and evaluate factors affecting the use of this service. METHODS The study was conducted in March 2022 using an online survey. Participants were asked to fill out a validated questionnaire to evaluate their perception of home delivery of medication service. RESULTS Among the 1032 adult participated in this study, the majority reported that they had heard of home delivery of medication service (n = 832, 80.6%). However, only 30.9% of them have used this service before. Results showed that 71.4% of the participants (n = 737) believe that home delivery of medication service is more convenient and accessible than in-store drug refill. In addition, 65.6% of the participants (n = 677) believed that home delivery of medication service is suitable only for refill-prescription drugs (65.0%). The main pros of the service as perceived by the study participants were to serve sick patients, elderly, and disabled people (n = 822, 79.7%). In contrast, the inability of patients to build a professional relationship with pharmacists using home delivery of medications service was the most perceived con of this service (n = 627, 60.8%). Finally, regression analysis revealed that older participants, those with chronic diseases, and those who visit community pharmacies two times or more per month revealed higher use of the service (P = <0.05). CONCLUSION This study has shown that most participants showed positive perceptions toward the home delivery of medication services. However, participants believed that this service may decrease pharmacist's patient contact time, thus affecting the quality of medication counseling. More comprehensive future studies are necessary to examine the financial aspects of such a service and its associated drawbacks.
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Affiliation(s)
- Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mai Rizik
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, 11931, Jordan
| | - Samar Karout
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Rania Itani
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Tareq Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Eman Alefishat
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
- Correspondence: Eman Alefishat, Email
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Pharmacist-Facilitated Interactive E-Learning for Patients Newly Initiated on Warfarin: A Randomised Controlled Study. PHARMACY (BASEL, SWITZERLAND) 2021; 10:pharmacy10010003. [PMID: 35076593 PMCID: PMC8788505 DOI: 10.3390/pharmacy10010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 01/31/2023]
Abstract
It is not known whether electronic-learning (e-learning) is effective for educating hospital inpatients about complex medications such as warfarin. This prospective randomised controlled study compared pharmacist-facilitated e-learning with standard pharmacist-delivered face-to-face education on patients’ or their unpaid carers’ knowledge of warfarin and satisfaction with warfarin education as well as the time that was spent by pharmacists in delivering warfarin education. Adult English-speaking patients (or their carers) who had been prescribed warfarin were randomised to receive standard pharmacist face-to-face education (control) or an e-learning module on a tablet device facilitated by a pharmacist (intervention). All of the participants received written warfarin information and were presented with the opportunity to ask any questions that they may have had to a pharmacist. Fifty-four participants completed the study (27 per group). The participants who received e-learning had median correct Oral Anticoagulation Knowledge (OAK) test scores of 85% compared to 80% for standard education (p = 0.14). The participants in both groups were satisfied with the information that they received. There was a trend towards pharmacists spending less time on warfarin education for the e-learning group than in the standard education group (25.5 vs. 33 min, respectively, p = 0.05). Education delivered via pharmacist-facilitated e-learning was non-inferior in terms of patient or carer warfarin knowledge compared to standard pharmacist-delivered education.
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Wongtaweepkij K, Krska J, Pongwecharak J, Jarernsiripornkul N. Experiences and Views of Medicine Information Among the General Public in Thailand. Patient Prefer Adherence 2020; 14:1073-1082. [PMID: 32636615 PMCID: PMC7335287 DOI: 10.2147/ppa.s257454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Written and electronic medicine information are important for improving patient knowledge and safe use of medicines. Written medicine information in Thailand is mostly in the form of printed package inserts (PIs), designed for health professionals, with few medicines having patient information leaflets (PILs). The aim of this study was to determine practices, needs and expectations of Thai general public about written and electronic medicine information and attitudes towards PILs. PATIENTS AND METHODS Cross-sectional survey, using self-completed questionnaires, was distributed directly to members of the general public in a large city, during January to March 2019. It explored experiences of using information, expectations, needs and attitudes, the latter measured using a 10-item scale. Differences between sub-groups were assessed, applying the Bonferroni correction to determine statistical significance. RESULTS Of the total 851 questionnaires distributed, 550 were returned (64.2%). The majority of respondents (88%) had received PIs, but only a quarter (26.2%) had received PILs. Most respondents (78.5%) had seen medicine information in online form. High educational level and income increased the likelihood of receiving PILs and electronic information. The majority of respondents (88.5%) perceived PILs as useful, but 70% considered they would still need information about medicines from health professionals. Indication, drug name and precautions were the most frequently read information in PIs and perceived as needed in PILs. Three-quarters of respondents would read electronic information if it were available, with more who had received a PIL having previously searched for such information compared to those who had not. All respondents had positive overall attitudes towards PILs. CONCLUSION Experiences of receiving PILs and electronic medicine information in Thailand are relatively limited. However, the general public considered PILs as a useful source of medicine information. Electronic medicine information was desired and should be developed to be an additional source of information for consumers.
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Affiliation(s)
- Kamonphat Wongtaweepkij
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Kent, UK
| | - Juraporn Pongwecharak
- Pharmacy Practice and Management Research Unit, Division of Pharmaceutical Care, Faculty of Pharmacy, Rangsit Center, Thammasat University, Pathumthani, Thailand
| | - Narumol Jarernsiripornkul
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Correspondence: Narumol Jarernsiripornkul Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen40002, ThailandTel +66-4334-8353Fax +66-4320-2379 Email
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Gagné M, Legault C, Boulet LP, Charbonneau L, Lemyre M, Giguere AMC, Poirier P. Impact of adding a video to patient education on quality of life among adults with atrial fibrillation: a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2019; 102:1490-1498. [PMID: 30956021 DOI: 10.1016/j.pec.2019.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 03/12/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess whether adding a video on atrial fibrillation (AF) to a face-to-face educational session improves quality of life (QoL), knowledge, and health resource utilization (HRU) among AF patients. METHODS In this parallel clinical trial, adults with AF received a face-to-face educational session on AF and were randomly allocated to watch an educational video or not. Self-reported questionnaires measured QoL (primary outcome; score 0-100), AF knowledge (score 0-25), and HRU. Data were collected before and after interventions. Within- and between-group changes were estimated by mixed models. RESULTS Sixty participants (age: 56 ± 13 years; men: n = 41) were allocated to watch the video after education (n = 30) or to receive education only (n = 30). Within groups over time, QoL and knowledge significantly improved. Knowledge increased by 2.3 units (95% confidence interval: 0.5-4.1) more in participants who watched the video than in others (P = 0.014). Changes in QoL and HRU were not different between groups. CONCLUSION Complementing education with a video on AF did not result in additional positive impacts on QoL and HRU among AF adults but led to greater improvements in AF knowledge. PRACTICE IMPLICATIONS The video on AF could be used as part of educational sessions to increase AF knowledge in AF patients.
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Affiliation(s)
- Myriam Gagné
- Knowledge Translation, Education, and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, Canada; Quebec Heart and Lung Institute-Laval University, Quebec City, Canada
| | - Claudie Legault
- Knowledge Translation, Education, and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, Canada; Quebec Heart and Lung Institute-Laval University, Quebec City, Canada
| | - Louis-Philippe Boulet
- Knowledge Translation, Education, and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, Canada; Quebec Heart and Lung Institute-Laval University, Quebec City, Canada; Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Lyne Charbonneau
- Quebec Heart and Lung Institute-Laval University, Quebec City, Canada
| | - Maryse Lemyre
- Quebec Heart and Lung Institute-Laval University, Quebec City, Canada
| | - Anik M C Giguere
- Faculty of Medicine, Laval University, Quebec City, QC, Canada; CHU de Quebec-Laval University Research Center, Population Health and Optimal Health Practices Research Unit, Quebec City, QC, Canada; Quebec Centre of Excellence on Aging, CHU de Québec-Laval University, Quebec City, QC, Canada
| | - Paul Poirier
- Knowledge Translation, Education, and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, Canada; Quebec Heart and Lung Institute-Laval University, Quebec City, Canada; Faculty of Pharmacy, Laval University, Quebec City, QC, Canada.
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Smith CA, Chang E, Gallego G, Khan A, Armour M, Balneaves LG. An education intervention to improve decision making and health literacy among older Australians: a randomised controlled trial. BMC Geriatr 2019; 19:129. [PMID: 31064336 PMCID: PMC6505289 DOI: 10.1186/s12877-019-1143-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background National policies seek to involve older Australian’s in decisions regarding their care; however, research has found varying levels of decision self-efficacy and health literacy skills. An increasing number of older Australians use complementary medicine (CM). We examined the effectiveness of a CM educational intervention delivered using a web or DVD plus booklet format to increase older adults’ decision self-efficacy and health literacy. Methods A randomised controlled trial was conducted. We recruited individuals aged over 65 years living in retirement villages or participating in community groups, in Sydney Australia. Participants were randomly allocated to receive a CM education intervention delivered using a website or DVD plus booklet versus booklet only. The primary outcome was decision self-efficacy. A secondary outcome included the Preparation for Decision-Making scale and health literacy. Outcomes were collected at 3 weeks, and 2 months from baseline, and analysed using an adjusted ANOVA, or repeated measures ANOVA. Result We randomised 153 participants. Follow up at 3 weeks and 2 months was completed by 131 participants. There was a 14% (n = 22) attrition rate. At the end of the intervention, we found no significant differences between groups for decision self-efficacy (mean difference (MD) 3.8, 95% confidence interval (CI) -2.0 to 9.6 p = 0.20), there were no differences between groups on nine health literacy domains, and the Preparation for Decision-Making scale. Over 80% of participants in both groups rated the content as excellent or good. Conclusion Decision self-efficacy improved for participants, but did not differ between groups. Decision self-efficacy and health literacy outcomes were not influenced by the delivery of education using a website, DVD or booklet. Participants found the resources useful, and rated the content as good or excellent. CM Web or DVD and booklet resources have the potential for wider application. Trial registration The trial was registered with the Australian New Zealand Clinical Trials Registry: ACTRN (ACTRN12616000135415). The trial was registered on 5 February 2016.
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Affiliation(s)
- Caroline A Smith
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia.
| | - Esther Chang
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Gisselle Gallego
- School of Medicine, The University of Notre Dame, Sydney, NSW, Australia
| | - Afshan Khan
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
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11
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Ferguson M, Maidment D, Henshaw H, Heffernan E. Evidence-Based Interventions for Adult Aural Rehabilitation: That Was Then, This Is Now. Semin Hear 2019; 40:68-84. [PMID: 30728650 PMCID: PMC6363556 DOI: 10.1055/s-0038-1676784] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
More than a decade after Arthur Boothroyd published "Adult Aural Rehabilitation: What Is It and Does It Work?," the four cornerstones of adult aural rehabilitation are re-examined in terms of research that we and others in the field have undertaken. The focus is on novel advances in high-quality research relating to interventions to support self-management for hearing aids and other listening devices (sensory management), knowledge and skill (instruction), auditory and cognitive training (perceptual training), and motivational engagement (counseling). Much of this new research has a theoretical underpinning (e.g., behavior change theory) to better guide the development and evaluation of interventions, with a focus on self-management and patient-centered approaches. New and emerging technologies that support e- and m-health delivery of interventions provide greater personalization and interactivity to promote self-management of hearing loss. Looking to the future, there remains a requirement for a set of relevant and appropriate outcome measures to evaluate the effectiveness of interventions trialed in clinical studies. There is a continuing need for high-quality evidence, underpinned by contemporary theory, to increase the likelihood that translational adult aural rehabilitation research that aims to benefit patients will be applied in future clinical practice.
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Affiliation(s)
- Melanie Ferguson
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - David Maidment
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Helen Henshaw
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Eithne Heffernan
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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12
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Han HR, Hong H, Starbird LE, Ge S, Ford AD, Renda S, Sanchez M, Stewart J. eHealth Literacy in People Living with HIV: Systematic Review. JMIR Public Health Surveill 2018; 4:e64. [PMID: 30201600 PMCID: PMC6231824 DOI: 10.2196/publichealth.9687] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/15/2018] [Accepted: 06/21/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In the era of eHealth, eHealth literacy is emerging as a key concept to promote self-management of chronic conditions such as HIV. However, there is a paucity of research focused on eHealth literacy for people living with HIV (PLWH) as a means of improving their adherence to HIV care and health outcome. OBJECTIVE The objective of this study was to critically appraise the types, scope, and nature of studies addressing eHealth literacy as a study variable in PLWH. METHODS This systematic review used comprehensive database searches, such as PubMed, EMBASE, CINAHL, Web of Science, and Cochrane, to identify quantitative studies targeting PLWH published in English before May 2017 with eHealth literacy as a study variable. RESULTS We identified 56 unique records, and 7 papers met the eligibility criteria. The types of study designs varied (descriptive, n=3; quasi-experimental, n=3; and experimental, n=1) and often involved community-based settings (n=5), with sample sizes ranging from 18 to 895. In regards to instruments used, 3 studies measured eHealth literacy with validated instruments such as the eHealth Literacy Scale (eHEALS); 2 studies used full or short versions of Test of Functional Health Literacy in Adults, whereas the remaining 2 studies used study-developed questions. The majority of studies included in the review reported high eHealth literacy among the samples. The associations between eHealth literacy and health outcomes in PLWH were not consistent. In the areas of HIV transmission risk, retention in care, treatment adherence, and virological suppression, the role of eHealth literacy is still not fully understood. Furthermore, the implications for future research are discussed. CONCLUSIONS Understanding the role of eHealth literacy is an essential step to encourage PLWH to be actively engaged in their health care. Avenues to pursue in the role of eHealth literacy and PLWH should consider the development and use of standardized eHealth literacy definitions and measures.
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Affiliation(s)
- Hae-Ra Han
- School of Nursing, The Johns Hopkins University, Baltimore, MD, United States
- Center for Cardiovascular and Chronic Care, The Johns Hopkins University, Baltimore, MD, United States
| | - Hyejeong Hong
- School of Nursing, The Johns Hopkins University, Baltimore, MD, United States
| | - Laura E Starbird
- School of Nursing, The Johns Hopkins University, Baltimore, MD, United States
| | - Song Ge
- School of Nursing, The Johns Hopkins University, Baltimore, MD, United States
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States
- Department of Nursing, University of Houston-Downtown, Houston, TX, United States
| | - Athena D Ford
- School of Nursing, The Johns Hopkins University, Baltimore, MD, United States
| | - Susan Renda
- School of Nursing, The Johns Hopkins University, Baltimore, MD, United States
| | - Michael Sanchez
- School of Nursing, The Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer Stewart
- School of Nursing, The Johns Hopkins University, Baltimore, MD, United States
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Buja A, Toffanin R, Claus M, Ricciardi W, Damiani G, Baldo V, Ebell MH. Developing a new clinical governance framework for chronic diseases in primary care: an umbrella review. BMJ Open 2018; 8:e020626. [PMID: 30056378 PMCID: PMC6067352 DOI: 10.1136/bmjopen-2017-020626] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Our goal is to conceptualise a clinical governance framework for the effective management of chronic diseases in the primary care setting, which will facilitate a reorganisation of healthcare services that systematically improves their performance. SETTING Primary care. PARTICIPANTS Chronic Care Model by Wagner et aland Clinical Governance statement by Scally et alwere taken for reference. Each was reviewed, including their various components. We then conceptualised a new framework, merging the relevant aspects of both. INTERVENTIONS We conducted an umbrella review of all systematic reviews published by the Cochrane Effective Practice and Organisation of Care Group to identify organisational interventions in primary care with demonstrated evidence of efficacy. RESULTS All primary healthcare systems should be patient-centred. Interventions for patients and their families should focus on their values; on clinical, professional and institutional integration and finally on accountability to patients, peers and society at large. These interventions should be shaped by an approach to their clinical management that achieves the best clinical governance, which includes quality assurance, risk management, technology assessment, management of patient satisfaction and patient empowerment and engagement. This approach demands the implementation of a system of organisational, functional and professional management based on a population health needs assessment, resource management, evidence-based and patient-oriented research, professional education, team building and information and communication technologies that support the delivery system. All primary care should be embedded in and founded on an active partnership with the society it serves. CONCLUSIONS A framework for clinical governance will promote an integrated effort to bring together all related activities, melding environmental, administrative, support and clinical elements to ensure a coordinated and integrated approach that sustains the provision of better care for chronic conditions in primary care setting.
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Affiliation(s)
- Alessandra Buja
- Unit of Hygiene and Public Health, Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, Laboratory of Health Care Services and Health Promotion Evaluation, University of Padova, Padova, Italy
| | | | - Mirko Claus
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, School of Hygiene and Preventive Medicine, University of Padova, Padova, Italy
| | - Walter Ricciardi
- Department of Public Health, Università Cattolica Sacro Cuore - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gianfranco Damiani
- Department of Public Health, Università Cattolica Sacro Cuore - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Vincenzo Baldo
- Unit of Hygiene and Public Health, Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, Laboratory of Health Care Services and Health Promotion Evaluation, University of Padova, Padova, Italy
| | - Mark H Ebell
- College of Public Health, University of Georgia, Athens, Greece, USA
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Johnson B, Handler D, Urrutia V, Alexandrov AW. Retention of Stroke Education Provided during Hospitalization: Does Provision of Required Education Increase Stroke Knowledge? INTERVENTIONAL NEUROLOGY 2018; 7:471-478. [PMID: 30410527 DOI: 10.1159/000488884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/16/2018] [Indexed: 12/24/2022]
Abstract
Background Provision of stroke education to patients is a Centers for Medicare/Medicaid (CMS) requirement. However, little is known about retention of the educational content. Methods Two pilot studies were conducted: Pilot A delivered CMS-required stroke education during hospitalization in a standardized manner and tested knowledge retention in patients returning to the Stroke Clinic for 1-month follow-up; Pilot B randomized patients to either a control group with standardized education or a test-enhanced learning group (target), with measurement of stroke knowledge retention at hospital discharge. Results A total of 198 patients/caregivers participated in Pilot A, with only 25% scoring 100% correct on required stroke education items. The question most commonly answered incorrectly (n = 117; 59%) was "personal risk factors for stroke," and 74 (37%) could not correctly identify stroke signs and symptoms. Pilot B found that significantly more target group patients could identify their personal stroke risk factors (100 vs. 67%; p = 0.04) and the purpose of their secondary prevention medications (87 vs. 40%; p = 0.02) compared to controls. Discussion While stroke education is required during hospitalization, its ability to produce retention may be poor. We propose study of test-enhanced learning methods through the Targeted Education in Stroke Trial (TEST) to examine the effect of novel teaching methods on patient/caregiver knowledge retention.
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Affiliation(s)
- Brenda Johnson
- Department of Neurology, College of Medicine, John Hopkins Medical Center, Baltimore, Maryland, USA
| | - Diane Handler
- Stroke Team, Unity Point Health - St. Luke's Hospital, Cedar Rapids, Iowa, USA
| | - Victor Urrutia
- Department of Neurology, College of Medicine, John Hopkins Medical Center, Baltimore, Maryland, USA
| | - Anne W Alexandrov
- Department of Neurology and Mobile Stroke Unit, College of Medicine, College of Nursing, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,NET SMART Program, Health Outcomes Institute, Fountain Hills, Arizona, USA
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Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under. Cochrane Database Syst Rev 2018; 5:CD011768. [PMID: 29775501 PMCID: PMC6494551 DOI: 10.1002/14651858.cd011768.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although complementary feeding is a universal practice, the methods and manner in which it is practiced vary between cultures, individuals and socioeconomic classes. The period of complementary feeding is a critical time of transition in the life of an infant, and inappropriate complementary feeding practices, with their associated adverse health consequences, remain a significant global public health problem. Educational interventions are widely acknowledged as effective in promoting public health strategy, and those aimed at improving complementary feeding practices provide information about proper complementary feeding practices to caregivers of infants/children. It is therefore important to summarise evidence on the effectiveness of educational interventions to improve the complementary feeding practices of caregivers of infants. OBJECTIVES To assess the effectiveness of educational interventions for improving the complementary feeding (weaning) practices of primary caregivers of children of complementary feeding age, and related health and growth outcomes in infants. SEARCH METHODS In November 2017, we searched CENTRAL, MEDLINE, Embase, 10 other databases and two trials registers. We also searched the reference lists of relevant studies and reviews to identify any additional studies. We did not limit the searches by date, language or publication status. SELECTION CRITERIA Randomised controlled trials (RCTs), comparing educational interventions to no intervention, usual practice, or educational interventions provided in conjunction with another intervention, so long as the educational intervention was only available in the experimental group and the adjunctive intervention was available to the control group. Study participants included caregivers of infants aged 4 to 24 months undergoing complementary feeding. Pregnant women who were expected to give birth and commence complementary feeding during the period of the study were also included. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on participants, settings, interventions, methodology and outcomes using a specifically-developed and piloted data extraction form. We calculated risk ratios (RR) and 95% confidence intervals (CIs) for dichotomous data, and mean differences (MD) and 95% CIs for continuous data. Where data permitted, we conducted a meta-analysis using a random-effects model. We assessed the included studies for risk of bias and also assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included 23 studies (from 35 reports) with a total of 11,170 caregiver-infant pairs who were randomly assigned to receive an educational intervention delivered to the caregiver or usual care. Nineteen of the included studies were community-based studies while four were facility-based studies. In addition, 13 of the included studies were cluster-randomised while the others were individually randomised. Generally, the interventions were focused on the introduction of complementary feeding at the appropriate time, the types and amount of complementary foods to be fed to infants, and hygiene. Using the GRADE criteria, we assessed the quality of the evidence as moderate, mostly due to inadequate allocation concealment and insufficient blinding.Educational interventions led to improvements in complementary feeding practices for age at introduction of complementary foods (average RR 0.88, 95% CI 0.83 to 0.94; 4 studies, 1738 children; moderate-quality evidence) and hygiene practices (average RR 1.38, 95% CI 1.23 to 1.55; 4 studies, 2029 participants; moderate-quality evidence). For duration of exclusive breastfeeding, pooled results were compatible with both a reduction and an increase in the outcome (average RR 1.58, 95% CI 0.77 to 3.22; 3 studies, 1544 children; very low-quality evidence). There was limited (low to very low-quality) evidence of an effect for all growth outcomes.Quality of evidenceThere is moderate to very low-quality evidence that educational interventions can improve complementary feeding practices but insufficient evidence to conclude that it impacts growth outcomes. AUTHORS' CONCLUSIONS Overall, we found evidence that education improves complementary feeding practices.
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Affiliation(s)
- Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching HospitalCalabarCross River StateNigeria540261
| | - Ededet Sewanu Edet
- University of Calabar Teaching HospitalDepartment of Community MedicineCalabarCross RiverNigeria540261
| | - Moriam T Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching HospitalCalabarCross River StateNigeria540261
| | - Friday Odey
- University of Calabar Teaching HospitalDepartment of PaediatricsPMB 1115CalabarCross River StateNigeria540261
| | - Deborah M Caldwell
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolAvonUKBS8 2PS
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Maden M, Cunliffe A, McMahon N, Booth A, Carey GM, Paisley S, Dickson R, Gabbay M. Use of programme theory to understand the differential effects of interventions across socio-economic groups in systematic reviews-a systematic methodology review. Syst Rev 2017; 6:266. [PMID: 29284538 PMCID: PMC5747153 DOI: 10.1186/s13643-017-0638-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Systematic review guidance recommends the use of programme theory to inform considerations of if and how healthcare interventions may work differently across socio-economic status (SES) groups. This study aimed to address the lack of detail on how reviewers operationalise this in practice. METHODS A methodological systematic review was undertaken to assess if, how and the extent to which systematic reviewers operationalise the guidance on the use of programme theory in considerations of socio-economic inequalities in health. Multiple databases were searched from January 2013 to May 2016. Studies were included if they were systematic reviews assessing the effectiveness of an intervention and included data on SES. Two reviewers independently screened all studies, undertook quality assessment and extracted data. A narrative approach to synthesis was adopted. RESULTS A total of 37 systematic reviews were included, 10 of which were explicit in the use of terminology for 'programme theory'. Twenty-nine studies used programme theory to inform both their a priori assumptions and explain their review findings. Of these, 22 incorporated considerations of both what and how interventions do/do not work in SES groups to both predict and explain their review findings. Thirteen studies acknowledged 24 unique theoretical references to support their assumptions of what or how interventions may have different effects in SES groups. Most reviewers used supplementary evidence to support their considerations of differential effectiveness. The majority of authors outlined a programme theory in the "Introduction" and "Discussion" sections of the review to inform their assumptions or provide explanations of what or how interventions may result in differential effects within or across SES groups. About a third of reviews used programme theory to inform the review analysis and/or synthesis. Few authors used programme theory to inform their inclusion criteria, data extraction or quality assessment. Twenty-one studies tested their a priori programme theory. CONCLUSIONS The use of programme theory to inform considerations of if, what and how interventions lead to differential effects on health in different SES groups in the systematic review process is not yet widely adopted, is used implicitly, is often fragmented and is not implemented in a systematic way.
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Affiliation(s)
- Michelle Maden
- Liverpool Reviews and Implementation Group (LRIG), Department of Health Services Research, University of Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| | - Alex Cunliffe
- Liverpool Reviews and Implementation Group (LRIG), Department of Health Services Research, University of Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| | - Naoimh McMahon
- Faculty of Health and Wellbeing, University of Central Lancashire, Brook Building, Preston, PR1 2HE UK
| | - Andrew Booth
- Evidence Based Information Practice, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | | | - Suzy Paisley
- Innovation and Knowledge Transfer (IKT), ScHARR, University of Sheffield, Sheffield, UK
| | - Rumona Dickson
- Liverpool Reviews and Implementation Group (LRIG), Department of Health Services Research, University of Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| | - Mark Gabbay
- Department of Health Services Research, University of Liverpool, Block B Waterhouse Building, 1–5 Brownlow St., Liverpool, L69 3GL UK
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Smith CA, Chang E, Gallego G, Balneaves LG. An education intervention to improve health literacy and decision making about supporting self-care among older Australians: a study protocol for a randomised controlled trial. Trials 2017; 18:441. [PMID: 28950888 PMCID: PMC5615792 DOI: 10.1186/s13063-017-2182-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older Australians are high consumers of complementary and alternative medicines (CM). To help older people to take an active role in their health, we will develop and evaluate a novel educational intervention to support decision self-efficacy, and improve health literacy skills. METHODS The primary hypothesis is that participants receiving a web/DVD plus booklet intervention compared with a booklet-only group will demonstrate an increase in decision self-efficacy. This study is a randomised controlled trial. One hundred and sixty-eight people aged 65 years and older will be recruited from community settings comprising retirement villages and community groups, based in Sydney, Australia. Participants will be randomly allocated to either the education intervention delivered by the Internet or a DVD plus booklet versus a control group (booklet only). The primary outcome measure is CM decision self-efficacy. Secondary outcomes are health literacy, knowledge and attitudes, and change in health-seeking behaviour. Participants' views on the ease of using the resources, the length of the modules, the amount of information, and participant understanding of the modules will be assessed. Outcomes will be collected on completion of the intervention at 3 weeks, and at a 2-month follow up from trial entry. DISCUSSION This trial has the potential to improve CM health literacy in older Australians. There are no educational resources designed to support decision self-efficacy and improve health literacy amongst older people related to CM. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12616000135415 . Registered on 5 February 2016.
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Affiliation(s)
- Caroline A. Smith
- National Institute of Complementary Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Esther Chang
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Gisselle Gallego
- School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Lynda G. Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, Manitoba R3T 2N2 Canada
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Pediatric Nurses' Perspectives on Medication Teaching in a Children's Hospital. J Pediatr Nurs 2017; 36:225-231. [PMID: 28888507 DOI: 10.1016/j.pedn.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/02/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To explore inpatient pediatric nurses' current experiences and perspectives on medication teaching. DESIGN AND METHODS A descriptive qualitative study was conducted at a Midwest pediatric hospital. Using convenience sampling, 26 nurses participated in six focus groups. Data were analyzed in an iterative group coding process. RESULTS Three themes emerged. 1) Medication teaching is an opportunity. 2) Medication teaching is challenging. Nurses experienced structural and process challenges to deliver medication teaching. Structural challenges included the physical hospital environment, electronic health record, and institutional discharge workflow while process challenges included knowledge, relationships and interactions with caregivers, and available resources. 3) Medication teaching is amenable to improvement. CONCLUSION Effective medication teaching with caregivers is critical to ensure safe, quality care for children after discharge. Nursing teaching practices have not changed, despite advances in technology and major changes in hospital care. Nurses face many challenges to conduct effective medication teaching. Improving current teaching practices is imperative in order to provide the best and safest care. PRACTICE IMPLICATIONS This study generated knowledge regarding pediatric nurses' teaching practices, values and beliefs that influence teaching, barriers, and ideas for how to improve medication teaching. Results will guide the development of targeted interventions to promote successful medication teaching practices.
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Throfast V, Hellström L, Hovstadius B, Petersson G, Ericson L. e-Learning for the elderly on drug utilization: A pilot study. Health Informatics J 2017; 25:227-239. [DOI: 10.1177/1460458217704245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Lina Hellström
- eHealth Institute, Linnaeus University, Sweden; Kalmar County Hospital, Sweden
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van Velthoven MH, Mastellos N, Majeed A, O'Donoghue J, Car J. Feasibility of extracting data from electronic medical records for research: an international comparative study. BMC Med Inform Decis Mak 2016; 16:90. [PMID: 27411943 PMCID: PMC4944506 DOI: 10.1186/s12911-016-0332-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic medical records (EMR) offer a major potential for secondary use of data for research which can improve the safety, quality and efficiency of healthcare. They also enable the measurement of disease burden at the population level. However, the extent to which this is feasible in different countries is not well known. This study aimed to: 1) assess information governance procedures for extracting data from EMR in 16 countries; and 2) explore the extent of EMR adoption and the quality and consistency of EMR data in 7 countries, using management of diabetes type 2 patients as an exemplar. METHODS We included 16 countries from Australia, Asia, the Middle East, and Europe to the Americas. We undertook a multi-method approach including both an online literature review and structured interviews with 59 stakeholders, including 25 physicians, 23 academics, 7 EMR providers, and 4 information commissioners. Data were analysed and synthesised thematically considering the most relevant issues. RESULTS We found that procedures for information governance, levels of adoption and data quality varied across the countries studied. The required time and ease of obtaining approval also varies widely. While some countries seem ready for secondary uses of data from EMR, in other countries several barriers were found, including limited experience with using EMR data for research, lack of standard policies and procedures, bureaucracy, confidentiality, data security concerns, technical issues and costs. CONCLUSIONS This is the first international comparative study to shed light on the feasibility of extracting EMR data across a number of countries. The study will inform future discussions and development of policies that aim to accelerate the adoption of EMR systems in high and middle income countries and seize the rich potential for secondary use of data arising from the use of EMR solutions.
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Affiliation(s)
| | - Nikolaos Mastellos
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - John O'Donoghue
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Josip Car
- Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, UK. .,Lee Kong Chian School of Medicine, Imperial College & Nanyang Technological University, Singapore, Singapore.
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Vormfelde SV, Abu Abed M, Hua TD, Schneider S, Friede T, Chenot JF. Educating orally anticoagulated patients in drug safety: a cluster-randomized study in general practice. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 111:607-14. [PMID: 25283757 DOI: 10.3238/arztebl.2014.0607] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Orally anticoagulated patients with insufficient knowledge about their treatment have a higher risk of complications. Standardized patient education could raise their level of knowledge and improve time spent within target INR range. METHODS This cluster randomized trial included 319 anticoagulated patients drawn from 22 general medical practices. 185 patients received patient education, conducted by practice nurses, consisting of a video, a brochure, and a questionnaire; 134 control patients received only the brochure. The primary endpoint was knowledge about treatment six months after the patient education session. The secondary endpoints were time in the INR (international normalized ratio) target range and complications of anticoagulation. RESULTS Patients in the intervention and control groups were of comparable mean age (73 vs. 72 years). They answered a comparable number of questions correctly before the intervention (6.8 ± 0.2 vs. 6.7 ± 0.2) but differed significantly on this measure at six months (9.9 ± 0.2 vs. 7.6 ± 0.2, mean difference 2.3 questions, 95% confidence interval [CI] 1.5-3.1, p< 0.001). In the six months prior to the intervention, the INR was in the target range 65 ± 2% vs. 66 ± 3% of the time; in the six months afterward, 71 ± 1% vs. 64 ± 3% of the time (mean difference 7 percentage points, 95% CI -2 to -16 percentage points, p = 0.11). The complication rates were comparable in the two groups (12% vs. 16%, p = 0.30). Patients in the intervention group approved of patient education sessions to a greater extent than control patients (87% vs. 56%). CONCLUSION Patient education was found to be practical, to improve knowledge relating to patient safety in a durable manner, and to meet with the approval of the patients who received it. There was a statistically non-significant trend toward an improvement of the time spent in the INR target range. In view of the major knowledge deficits of orally anticoagulated patients, standardized patient education ought to be made a part of their routine care.
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Affiliation(s)
- Stefan Viktor Vormfelde
- Department of Clinical Pharmacology, University Medical Center Göttingen, Department of General Practice, University Medical Center Göttingen, Department of Medical Statistics University Medical Center Göttingen, Institute for Community Medicine, Section General Practice and Family Medicine, University of Greifswald
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Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. Educational interventions for improving complementary feeding practices. Hippokratia 2015. [DOI: 10.1002/14651858.cd011768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Dachi Arikpo
- Institute of Tropical Diseases Research and Prevention; Nigerian Branch of the South African Cochrane Centre; University of Calabar Teaching Hospital, Moore Road Calabar Cross River State Nigeria 540261
| | - Ededet Sewanu Edet
- University of Calabar Teaching Hospital; Department of Community Medicine; Calabar Cross River Nigeria 540261
| | - Moriam T Chibuzor
- Nigerian Branch of South African Cochrane Centre; Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital Calabar Cross River Nigeria 540261
| | - Friday Odey
- University of Calabar Teaching Hospital; Department of Paediatrics; PMB 1115 Calabar Cross River State Nigeria 540261
| | - Deborah M Caldwell
- University of Bristol; School of Social and Community Medicine; Canynge Hall, 39 Whatley Road Bristol Avon UK BS8 2PS
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Affiliation(s)
- Emer Shanley
- HSE South; West Cork Community Care; Coolnagurrane Skibbereen Cork Ireland
| | - Zena EH Moore
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St. Stephen's Green Dublin Ireland D2
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Prey JE, Woollen J, Wilcox L, Sackeim AD, Hripcsak G, Bakken S, Restaino S, Feiner S, Vawdrey DK. Patient engagement in the inpatient setting: a systematic review. J Am Med Inform Assoc 2014; 21:742-50. [PMID: 24272163 PMCID: PMC4078275 DOI: 10.1136/amiajnl-2013-002141] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/31/2013] [Accepted: 11/05/2013] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. METHODS PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement ('self-efficacy', 'patient empowerment', 'patient activation', or 'patient engagement'), (2) involved health information technology ('technology', 'games', 'electronic health record', 'electronic medical record', or 'personal health record'), and (3) took place in the inpatient setting ('inpatient' or 'hospital'). Only English language studies were reviewed. RESULTS 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. CONCLUSIONS Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness.
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Affiliation(s)
- Jennifer E Prey
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Janet Woollen
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Lauren Wilcox
- Department of Computer Science, Columbia University, New York, New York, USA
| | - Alexander D Sackeim
- College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, New York, USA School of Nursing, Columbia University, New York, New York, USA
| | - Susan Restaino
- Department of Medicine, Columbia University, New York, New York, USA NewYork Presbyterian Hospital, New York, New York, USA
| | - Steven Feiner
- Department of Computer Science, Columbia University, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
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25
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Giordano A, Lugaresi A, Confalonieri P, Granella F, Radice D, Trojano M, Martinelli V, Solari A, Giordano A, Martinelli V, Lugaresi A, Pucci E, Granella F, Trojano M, Solari A, Martinelli V, Pucci E, Messmer Uccelli M, Lugaresi A, Giordano A, Granella F, Solari A, Giordano A, Ferrari G, Martini F, Solari A, Radice D, D’Annunzio G, Lugaresi A, Farina D, Travaglini D, Pietrolongo E, Onofrj M, Torri Clerici V, Bonanno S, Brambilla L, Confalonieri P, Martinelli V, Radaelli M, Messina J, Comi G, Tortorella C, Luciannatelli E, Trojano M, Senesi C, Tsantes E, Granella F, Conti MZ, Rottoli MR, Bellantonio P, Fischetti M, Fantozzi R, Pala A, Traccis S, Di Battista G, Bianchi M, Benedetti MD, Gaetani L, Di Filippo M, Carolei A, Totaro R, Lanzillo R, Brescia Morra V, Coppola R, Cottone S, Chiavazza C, Cavalla P, Leonardi C, Aguglia U, Ziuliani C, Valla P, Sasanelli F, Valentino P, Quattrone A, Martino PG, Russo M, Vita G, Immovilli P. Implementation of the ‘Sapere Migliora’ information aid for newly diagnosed people with multiple sclerosis in routine clinical practice: a late-phase controlled trial. Mult Scler 2014; 20:1234-43. [DOI: 10.1177/1352458513519180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/11/2013] [Indexed: 11/16/2022]
Abstract
Background: The SIMS-Trial showed that the ‘Sapere Migliora’ information aid (IA) for newly diagnosed people with multiple sclerosis (PwMS) effectively improved patient knowledge and satisfaction with care. Objectives: The objectives of this paper are to assess the effectiveness of the IA in clinical practice and to compare the whole IA with the take-home booklet/website component alone. Methods: After updating the IA and replacing the CD with a website, a prospective, open-label non-randomised controlled trial compared the whole IA (group A, five SIMS-Trial centres) to take-home (group B, 16 centres). One month after the intervention, participants completed the MS Knowledge Questionnaire (MSKQ), care satisfaction questionnaire (COSM-R) (primary study outcomes), Hospital and Anxiety Depression Scale, and ad hoc questionnaire appraising the IA. Results: We enrolled 159 newly diagnosed PwMS (May 2012–March 2013). Drop-outs were four of 77 (5%, group A) and 11/82 (13%, group B). Primary endpoint (highest tertile both for MSKQ and COSM-R section 2 scores) was achieved by 38/77 (49%) group A and 33/82 (40%) group B ( p = 0.25). Attainment of secondary outcomes was also similar between groups. Conclusions: This study shows that the entire IA is not superior to the booklet/website alone, and that both are comparable in efficacy to the intervention arm of the SIMS-Trial. Trial registration number: ISRCTN78940214.
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Affiliation(s)
- A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Italy
| | - A Lugaresi
- Department of Neuroscience and Imaging, University G. d’Annunzio of Chieti-Pescara, Italy
| | - P Confalonieri
- Department of Neuroimmunology, Foundation IRCCS Neurological Institute C. Besta, Italy
| | - F Granella
- Department of Neurosciences, Neurology Unit, University of Parma, Italy
| | - D Radice
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Italy
| | - M Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Italy
| | - V Martinelli
- Department of Neurology, Scientific Institute Hospital San Raffaele, Italy
| | - A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Italy
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Nicholson A, Lewis SR, Lee A, Smith AF, Coldwell CH. Different formats and timing of educational interventions for surgical patients. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Prictor M, Hill S. Cochrane Consumers and Communication Review Group: leading the field on health communication evidence. J Evid Based Med 2013; 6:216-20. [PMID: 24325413 DOI: 10.1111/jebm.12066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/27/2013] [Indexed: 01/11/2023]
Abstract
This paper presents an overview of the history and achievements of the Cochrane Consumers and Communication Review Group, part of the international Cochrane Collaboration. It surveys the Group's establishment and structure, the scope of its Cochrane Reviews and the growth in its publication output over its 16-year history. The paper examines the Group's developmental work in interventions and outcomes related to patient communication and involvement, as well as methodological resources for review authors. It also outlines the Review Group's research partnerships with state, national and international agencies, particularly in the areas of chronic disease management, medicines use, public involvement, and vaccines communication. The Group's strong contribution to an evidence-base for health communication and participation are acknowledged.
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Affiliation(s)
- Megan Prictor
- Cochrane Consumers and Communication Review Group, School of Public Health and Human Biosciences, Faculty of Health Sciences, La Trobe University, Australia
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