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Okabayashi S, Kitazawa K, Kawamura T, Nakayama T. E-Learning Material of Evidence-Based Medicine for Laypersons. Health Lit Res Pract 2022; 6:e290-e299. [PMID: 36475980 PMCID: PMC9726227 DOI: 10.3928/24748307-20221113-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a need for evidence-based medicine (EBM) education for laypersons. However, there are few materials or opportunities to learn EBM for Japanese laypersons. OBJECTIVE The aim of this study was to develop and test the usability of e-learning material on EBM for health-conscious laypersons in Japan. METHODS This study was conducted in two steps. First, content elements for the material were identified using purposive evaluation and a prototype of the e-learning material was developed. Following this, usability testing of the material was conducted. A questionnaire survey and qualitative semi-structured focus group interviews were conducted with health-conscious laypersons. Subsequently, the material was refined and finalized. KEY RESULTS A total of 217 descriptions related to EBM were extracted from 12 materials and were integrated into 56 major elements. Each element was rated from the viewpoint of usefulness for laypersons and reviewed by four expert panelists, and finally 18 elements were confirmed, most of which were critical appraisal skills related to critical health literacy. For the usability testing after constructing the material, 25 laypersons participated, and 19 (76%) felt very/rather much interest in the contents of the material in the questionnaire. The results of five focus group interviews showed that the effectiveness of the e-learning material was influenced by the story and characters, and whether the contents of the material were consistent with interviewees' daily interests. CONCLUSIONS The e-learning material on EBM was found to be of interest to health-conscious laypersons and appeared to be useful in participants' daily lives. This study successfully developed novel e-learning material on the essential components of EBM for laypersons in Japan. [HLRP: Health Literacy Research and Practice. 2022;6(4):e290-e299.] Plain Language Summary: This study developed and tested the usability of e-learning material to encourage health-conscious laypersons in Japan to learn the fundamentals of evidence-based medicine. Most of the contents of the material are related to critical health literacy. The usability testing showed that the material was of interest to non-health professionals and useful for dealing with health information in their daily lives.
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Affiliation(s)
- Satoe Okabayashi
- Address correspondence to Satoe Okabayashi, MD, MPH, DrPH, Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan;
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Kuchenmüller T, Boeira L, Oliver S, Moat K, El-Jardali F, Barreto J, Lavis J. Domains and processes for institutionalizing evidence-informed health policy-making: a critical interpretive synthesis. Health Res Policy Syst 2022; 20:27. [PMID: 35246139 PMCID: PMC8894559 DOI: 10.1186/s12961-022-00820-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/25/2022] [Indexed: 02/08/2023] Open
Abstract
Background While calls for institutionalization of evidence-informed policy-making (EIP) have become stronger in recent years, there is a paucity of methods that governments and organizational knowledge brokers can use to sustain and integrate EIP as part of mainstream health policy-making. The objective of this paper was to conduct a knowledge synthesis of the published and grey literatures to develop a theoretical framework with the key features of EIP institutionalization. Methods
We applied a critical interpretive synthesis (CIS) that allowed for a systematic, yet iterative and dynamic analysis of heterogeneous bodies of literature to develop an explanatory framework for EIP institutionalization. We used a “compass” question to create a detailed search strategy and conducted electronic searches to identify papers based on their potential relevance to EIP institutionalization. Papers were screened and extracted independently and in duplicate. A constant comparative method was applied to develop a framework on EIP institutionalization. The CIS was triangulated with the findings of stakeholder dialogues that involved civil servants, policy-makers and researchers. Results We identified 3001 references, of which 88 papers met our eligibility criteria. This CIS resulted in a definition of EIP institutionalization as the “process and outcome of (re-)creating, maintaining and reinforcing norms, regulations, and standard practices that, based on collective meaning and values, actions as well as endowment of resources, allow evidence to become—over time—a legitimate and taken-for-granted part of health policy-making”. The resulting theoretical framework comprised six key domains of EIP institutionalization that capture both structure and agency: (1) governance; (2) standards and routinized processes; (3) partnership, collective action and support; (4) leadership and commitment; (5) resources; and (6) culture. Furthermore, EIP institutionalization is being achieved through five overlapping stages: (i) precipitating events; (ii) de-institutionalization; (iii) semi-institutionalization (comprising theorization and diffusion); (iv) (re)-institutionalization; and (v) renewed de-institutionalization processes. Conclusions This CIS advances the theoretical and conceptual discussions on EIP institutionalization, and provides new insights into an evidence-informed framework for initiating, strengthening and/or assessing efforts to institutionalize EIP. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00820-7.
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Affiliation(s)
- Tanja Kuchenmüller
- Research for Health, Science Division, World Health Organization, Geneva, Switzerland.
| | | | - Sandy Oliver
- Social Research Institute, University College London, London, United Kingdom.,Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Kaelan Moat
- McMaster Health Forum/WHO Collaborating Centre for Evidence-Informed Policy, McMaster University, Hamilton, ON, Canada.,Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Fadi El-Jardali
- Knowledge to Policy (K2P) Center/WHO Collaborating Centre for Evidence-Informed Policy and Practice, American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | | | - John Lavis
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.,McMaster Health Forum/WHO Collaborating Centre for Evidence-Informed Policy, McMaster University, Hamilton, ON, Canada.,Department of Health Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Abstract
Patient engagement in cancer research involves the inclusion of patient voices into research to ensure knowledge generated will improve the lives of all cancer patients. Patients involved in research have an interest in science, an experience with cancer and want to work directly with researchers to ensure patient concerns are heard. There are many opportunities for patient engagement in laboratory and clinical research, throughout the lifecycle of the project from conception to completion. Researchers and patient advocates can take practical steps to ensure their engagement is effective and meaningful. Adding the patient voice in research honors those who have died, so future cancer patients have access to new therapies to live longer and better lives.
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Affiliation(s)
- Patricia A Spears
- University of North Carolina at Chapel Hill, 170 Manning Drive, Chapel Hill, NC 27599, USA.,Patient Author UNC Lineberger Comprehensive Cancer Center, Patient Advocates for Research Council, Chapel Hill, NC 27599, USA
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Han G, Mayer M, Canner J, Lindsley K, Datar R, Le J, Bar-Cohen A, Bowie J, Dickersin K. Development, implementation and evaluation of an online course on evidence-based healthcare for consumers. BMC Health Serv Res 2020; 20:928. [PMID: 33032599 PMCID: PMC7542874 DOI: 10.1186/s12913-020-05759-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based healthcare (EBHC) principles are essential knowledge for patient and consumer ("consumer") engagement as research and research implementation stakeholders. The aim of this study was to assess whether participation in a free, self-paced online course affects confidence in explaining EBHC topics. The course comprises six modules and evaluations which together take about 6 h to complete. METHODS Consumers United for Evidence-based Healthcare (CUE) designed, tested and implemented a free, online course for consumers, Understanding Evidence-based Healthcare: A Foundation for Action ("Understanding EBHC"). The course is offered through the Johns Hopkins Bloomberg School of Public Health. Participants rated their confidence in explaining EBHC topics on a scale of 1 (lowest) to 5 (highest), using an online evaluation provided before accessing the course ("Before") and after ("After") completing all six course modules. We analyzed data from those who registered for the course from May 31, 2007 to December 31, 2018 (n = 15,606), and among those persons, the 11,522 who completed the "Before" evaluation and 4899 who completed the "After" evaluation. Our primary outcome was the overall mean of within-person change ("overall mean change") in self-reported confidence levels on EBHC-related topics between "Before" and "After" evaluations among course completers. Our secondary outcomes were the mean within-person change for each of the 11 topics (mean change by topic). RESULTS From May 31, 2007 to December 31, 2018, 15,606 individuals registered for the course: 11,522 completed the "Before" evaluation, and 4899 of these completed the "After" evaluation (i.e., completed the course). The overall mean change in self-reported confidence levels (ranging from 1 to 5) from the "Before" to "After" evaluation was 1.27 (95% CI, 1.24-1.30). The mean change by topic ranged from 1.00 (95% CI, 0.96-1.03) to 1.90 (95% CI, 1.87-1.94). CONCLUSION Those who seek to involve consumer stakeholders can offer Understanding EBHC as a step toward meaningful consumer engagement. Future research should focus on long-term impact assessment of online course such as ours to understand whether confidence is retained post-course and applied appropriately.
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Affiliation(s)
- Genie Han
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, 707, Baltimore, MD, 21205, USA.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E6012, Baltimore, MD, 21205, USA.
| | - Musa Mayer
- Metastatic Breast Cancer Alliance, New York, USA
| | | | | | - Reva Datar
- School of Public Health, University of Maryland College Park, College Park, USA
| | - Jimmy Le
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, 707, Baltimore, MD, 21205, USA
| | | | - Janice Bowie
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, 707, Baltimore, MD, 21205, USA
| | - Kay Dickersin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, 707, Baltimore, MD, 21205, USA
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Austvoll‐Dahlgren A, Johansen M. "A waste of time without patients": The views of patient representatives attending a workshop in evidence-based practice. J Evid Based Med 2018; 11:191-199. [PMID: 29938926 PMCID: PMC6175114 DOI: 10.1111/jebm.12303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 01/23/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Shared decision-making is a central element of evidence-based practice (EBP). Training in EBP has traditionally focused on providers, but there is an increasing interest in developing such educational resources for patients. The aim of this study is to explore the views of patient representatives attending a workshop in EBP. METHODS We conducted three focus groups with participants attending EBP workshops in 2013, 2014, and 2015. We used the framework method for content analysis. We reviewed the transcribed interviews independently and assigned initial codes and final categories to the transcriptions. We created an analytical framework and a flow diagram to visualize the category hierarchy and the relationship between categories. RESULTS We identified two main themes; "How to facilitate training in evidence-based practice for patients," and "Outputs of training in evidence based practice for patients." Training in EBP for patient representatives "should reflect the principles EBP," and include interaction with both health professionals and other representatives. The educational needs of representatives are much the same as those of health professionals, and the training should therefore be "on a par with professionals." The relevance of such training may depend on the representatives' mandate, and costs might be an important barrier. Important outputs of such training include "becoming a knowledge manager," "enabling participation and informed decisions" and "re-defining the patient representatives' role." CONCLUSIONS The findings of this study suggest that training in EBP is attractive to patient representatives with outputs perceived important. Organizers should consider the principles of EBP when planning such training.
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Souliotis K, Peppou LE, Agapidaki E, Tzavara C, Debiais D, Hasurdjiev S, Sarkozy F. Health democracy in Europe: Cancer patient organization participation in health policy. Health Expect 2018; 21:474-484. [PMID: 29094422 PMCID: PMC5867319 DOI: 10.1111/hex.12638] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patient organization participation in health policy decision making is an understudied area of inquiry. A handful of qualitative studies have suggested that the growing number of patient organizations in Europe and their increasing involvement in policy issues do not result in high political effectiveness. However, existing research is largely country-specific. OBJECTIVE To examine the degree and impact of cancer patient organization (CPO) participation in health policy decision making in EU-28 and to identify their correlates. METHODS A total of 1266 members of CPOs participated in this study, recruited from a diversity of sources. CPO participation in health policy was assessed with the Health Democracy Index, a previously developed instrument measuring the degree and impact of patient organization participation in various realms of health policy. Additional questions collected information about participants' and the CPO's characteristics. Data were gleaned in the form of an online self-reported instrument. RESULTS The highest degree of CPO participation was observed with respect to hospital boards, reforms in health policy and ethics committees for clinical trials. On the contrary, the lowest was discerned with regard to panels in other important health-related organizations and in the Ministry of Health. The reverse pattern of results was observed concerning the Impact subscale. As regards the correlates of CPO participation, legislation bore the strongest association with the Degree subscale, while organizational factors emerged as the most important variables with regard to the Impact subscale. CONCLUSIONS Research findings indicate that a high degree of CPO participation does not necessarily ensure a high impact. Efforts to promote high and effective CPO participation should be geared towards the establishment of a health-care law based on patient rights as well as to the formation of coalitions among CPOs and the provision of training to its members.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political SciencesUniversity of PeloponneseCorinthGreece
| | | | - Eirini Agapidaki
- Faculty of Social and Political SciencesUniversity of PeloponneseCorinthGreece
| | - Chara Tzavara
- Department of Hygiene, Epidemiology and Medical StatisticsCentre for Health Services ResearchMedical SchoolNational & Kapodistrian University of AthensAthensGreece
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Austvoll-Dahlgren A, Nsangi A, Semakula D. Interventions and assessment tools addressing key concepts people need to know to appraise claims about treatment effects: a systematic mapping review. Syst Rev 2016; 5:215. [PMID: 28034307 PMCID: PMC5200965 DOI: 10.1186/s13643-016-0389-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People's ability to appraise claims about treatment effects is crucial for informed decision-making. Our objective was to systematically map this area of research in order to (a) provide an overview of interventions targeting key concepts that people need to understand to assess treatment claims and (b) to identify assessment tools used to evaluate people's understanding of these concepts. The findings of this review provide a starting point for decisions about which key concepts to address when developing new interventions, and which assessment tools should be considered. METHODS We conducted a systematic mapping review of interventions and assessment tools addressing key concepts important for people to be able to assess treatment claims. A systematic literature search was done by a reserach librarian in relevant databases. Judgement about inclusion of studies and data collection was done by at least two researchers. We included all quantitative study designs targeting one or more of the key concepts, and targeting patients, healthy members of the public, and health professionals. The studies were divided into four categories: risk communication and decision aids, evidence-based medicine and critical appraisal, understanding of controlled trials, and science education. Findings were summarised descriptively. RESULTS We included 415 studies, of which the interventions and assessment tools we identified included only a handful of the key concepts. The most common key concepts in interventions were "Treatments usually have beneficial and harmful effects," "Treatment comparisons should be fair," "Compare like with like," and "Single studies can be misleading." A variety of assessment tools were identified, but only four assessment tools included 10 or more key concepts. CONCLUSIONS There is great potential for developing learning and assessment tools targeting key concepts that people need to understand to assess claims about treatment effects. There is currently no instrument covering assessment of all these key concepts.
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Affiliation(s)
- Astrid Austvoll-Dahlgren
- Knowledge Centre for the Health Services, Norwegian Institute of Public Health, BOKS 7004 St. Olavsplass, 0130 Oslo, Norway
| | - Allen Nsangi
- Makerere University College of Health Sciences, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
| | - Daniel Semakula
- Makerere University College of Health Sciences, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
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Stock S, Altin S, Palmowski S, Berger B, Passon A. Patients' advocates and counselors: Perceived needs in education and training. PATIENT EDUCATION AND COUNSELING 2015; 98:1431-1438. [PMID: 26320823 DOI: 10.1016/j.pec.2015.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 05/27/2015] [Accepted: 06/20/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Since there is a lack of knowledge on the occupational needs of patient representatives (PRs) and counselors (PCs), we performed a study eliciting perceived skills and informational needs in evidence-based medicine (EbM) and health economics (HE) and investigated preferences for training. METHODS Semi-structured interviews and an online survey were conducted among PRs and PCs in Germany. Questions covered perceived skills and informational needs in EbM and HE and preferences for training in both fields. Interview data was analyzed using the grounded theory method. Survey results were analyzed by means of descriptive statistics. RESULTS Nine personal interviews, one group discussion and 50 survey forms were analyzed. Respondents reported better skills in EbM compared to HE but felt a need for training in both fields. Important barriers mentioned were difficulties in reading scientific articles written in English and understanding statistics. Preferences for training included regionally widespread offers, availability of refresher classes, and a mixture of presence-based and online courses. CONCLUSION PRs and PCs perceive a considerable need for formal training in EbM and HE and have clear expectations of the format and design. PRACTICE IMPLICATION Trainings in EbM and HE could help to enhance patient and public involvement (PPI) in Germany.
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Affiliation(s)
- Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, Gleueler Straße 176-178, 50935 Köln, Germany.
| | - Sibel Altin
- Institute of Health Economics and Clinical Epidemiology, University Hospital Cologne, Gleueler Straße 176-178, 50935 Köln, Germany
| | - Stefan Palmowski
- Faculty of Health Sciences, University of Witten Herdecke, Center for Integrative Medicine, Gerhard Kienle Institute for Medical Theory, Integrative and Anthroposophic Medicine, Gerhard Kienle Weg 4, D-58313 Herdecke, Germany
| | - Bettina Berger
- Faculty of Health Sciences, University of Witten Herdecke, Center for Integrative Medicine, Gerhard Kienle Institute for Medical Theory, Integrative and Anthroposophic Medicine, Gerhard Kienle Weg 4, D-58313 Herdecke, Germany
| | - Anna Passon
- Federal Joint Committee (G-BA), Wegelystr. 8, D-10623 Berlin, Germany
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Gibson A, Boddy K, Maguire K, Britten N. Exploring the impact of providing evidence-based medicine training to service users. RESEARCH INVOLVEMENT AND ENGAGEMENT 2015; 1:10. [PMID: 29062499 PMCID: PMC5611604 DOI: 10.1186/s40900-015-0010-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 08/03/2015] [Indexed: 05/25/2023]
Abstract
PLAIN ENGLISH SUMMARY Within health services research in the UK, there has been growing interest in evidence-based medicine (EBM) and patient and public involvement (PPI) in research. These two movements have a common goal of improving the quality and transparency of clinical decision making. So far, there has been relatively little discussion about how these two movements might relate to each other, despite their common concern. Indeed, some in the PPI movement have expressed doubts about the implications of EBM for PPI because they worry that its emphasis on evidence from clinical trials marginalises the importance of a patient's individual experiences in clinical decision making. The purpose of this paper is to examine the potential for EBM and PPI to complement one another. We analysed the feedback of 10 members of the Peninsula Public Involvement Group (PenPIG) who attended EBM workshops. These workshops trained people in the basics of EBM and were primarily attended by health professionals. We used thematic analysis, a qualitative data analysis method, to explore the responses. We found that participation in the workshops appears to have increased the ability and confidence of members of the public to actively participate as both producers and consumers of research evidence. We conclude that there is an untapped potential for EBM and PPI to complement one another in their shared desire to improve the quality and transparency of clinical decision making. ABSTRACT Background Within the UK, health services research in the 1990s was marked by growing interest in evidence-based medicine (EBM) and in the potential of patient and public involvement (PPI) in research. However, there has been relatively little discussion of how these two developments might relate to each other, despite their common concern to improve the quality and transparency of clinical decision making. Indeed, some in the user involvement movement have expressed doubts about the implications of EBM for PPI. The purpose of this paper is to examine the potential for EBM and PPI to complement one another. Methods We used a case study design. Fifteen EBM workshops, involving PPI members, were conducted between June 2010 and December 2014. All 13 lay participants, who attended the first five workshops, were asked to fill in a standard feedback proforma designed by a member of the NIHR Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula (PenCLAHRC) Public Involvement Group (PenPIG). Ten responses were received, and these were analysed thematically. Results Four themes emerged from the thematic analysis: research knowledge, research skills, shared clinical decision making and learning environment. Participation in the workshops appears to have increased the ability and confidence of members of the public to actively participate as both producers and consumers of research evidence. Conclusions There is an untapped potential for EBM and PPI to complement one another in their shared desire to improve the quality and transparency of clinical decision making.
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Affiliation(s)
- Andy Gibson
- Department of Health and Social Sciences, University of West England, Glenside Campus, Room 2G27, Bristol, UK
| | - Kate Boddy
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG UK
| | - Kath Maguire
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG UK
| | - Nicky Britten
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, Veysey Building, Salmon Pool Lane, Exeter, EX2 4SG UK
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Austvoll-Dahlgren A, Oxman AD, Chalmers I, Nsangi A, Glenton C, Lewin S, Morelli A, Rosenbaum S, Semakula D, Sewankambo N. Key concepts that people need to understand to assess claims about treatment effects. J Evid Based Med 2015; 8:112-25. [PMID: 26107552 DOI: 10.1111/jebm.12160] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/25/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE People are confronted with claims about the effects of treatments and health policies daily. Our objective was to develop a list of concepts that may be important for people to understand when assessing claims about treatment effects. METHODS An initial list of concepts was generated by the project team by identifying key concepts in literature and tools written for the general public, journalists, and health professionals, and consideration of concepts related to assessing the certainty of evidence for treatment effects. We invited key researchers, journalists, teachers and others with expertise in health literacy and teaching or communicating evidence-based health care to patients to act as the project's advisory group. RESULTS Twenty-nine members of the advisory group provided feedback on the list of concepts and judged the list to be sufficiently complete and organised appropriately. The list includes 32 concepts divided into six groups: (i) Recognising the need for systematic reviews of fair tests, (ii) Judging whether a comparison of treatments is fair comparison, (iii) Understanding the role of chance, (iv) Considering all the relevant fair comparisons, (v) Understanding the results of fair comparisons of treatments, (vi) Judging whether fair comparisons of treatments are relevant. CONCLUSION The concept list provides a starting point for developing and evaluating resources to improve people's ability to assess treatment effects. The concepts are considered to be universally relevant, and include considerations that can help people assess claims about the effects of treatments, including claims that are found in mass media reports, in advertisements and in personal communication.
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Affiliation(s)
- Astrid Austvoll-Dahlgren
- Norwegian Knowledge Centre for the Health Services, Prevention, Health promotion, and Organisation Unit, Oslo, Norway
| | - Andrew D Oxman
- Norwegian Knowledge Centre for the Health Services, Global Health Unit, Oslo, Norway
| | | | - Allen Nsangi
- Makerere University College of Health Sciences, New Mulago Hospital Complex, Kampala, Uganda
| | - Claire Glenton
- Norwegian Knowledge Centre for the Health Services, Global Health Unit, Oslo, Norway
| | - Simon Lewin
- Norwegian Knowledge Centre for the Health Services, Global Health Unit, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Angela Morelli
- Norwegian Knowledge Centre for the Health Services, Global Health Unit, Oslo, Norway
| | - Sarah Rosenbaum
- Norwegian Knowledge Centre for the Health Services, Communication Unit, BOKS 7004 St.Olavsplass, 0130 Oslo, Norway
| | - Daniel Semakula
- Makerere University College of Health Sciences, New Mulago Hospital Complex, Kampala, Uganda
| | - Nelson Sewankambo
- Makerere University College of Health Sciences, New Mulago Hospital Complex, Kampala, Uganda
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Britten N, Denford S, Harris-Golesworthy F, Jibson S, Pyart N, Stein K. Patient involvement in drug licensing: A case study. Soc Sci Med 2015; 131:289-96. [DOI: 10.1016/j.socscimed.2014.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 09/15/2014] [Accepted: 10/13/2014] [Indexed: 11/15/2022]
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Odierna DH, Forsyth SR, White J, Bero LA. The cycle of bias in health research: a framework and toolbox for critical appraisal training. Account Res 2014; 20:127-41. [PMID: 23432773 DOI: 10.1080/08989621.2013.768931] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Recognizing bias in health research is crucial for evidence-based decision making. We worked with eight community groups to develop materials for nine modular, individualized critical appraisal workshops we conducted with 102 consumers (four workshops), 43 healthcare providers (three workshops), and 33 journalists (two workshops) in California. We presented workshops using a "cycle of bias" framework, and developed a toolbox of presentations, problem-based small group sessions, and skill-building materials to improve participants' ability to evaluate research for financial and other conflicts of interest, bias, validity, and applicability. Participant feedback indicated that the adaptability of the toolbox and our focus on bias were critical elements in the success of our workshops.
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Affiliation(s)
- Donna H Odierna
- University of California, San Francisco, Department of Clinical Pharmacy, San Francisco, California 94118, USA
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Austvoll-Dahlgren A, Danielsen S, Opheim E, Bjørndal A, Reinar LM, Flottorp S, Oxman AD, Helseth S. Development of a complex intervention to improve health literacy skills. Health Info Libr J 2013; 30:278-93. [PMID: 24251890 PMCID: PMC4383652 DOI: 10.1111/hir.12037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/08/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Providing insight into the developmental processes involved in building interventions is an important way to ensure methodological transparency and inform future research efforts. The objective of this study was to describe the development of a web portal designed to improve health literacy skills among the public. METHODS The web portal was tailored to address three key barriers to obtaining information, using the conceptual frameworks of shared decision-making and evidence-based practice and based on explicit criteria for selecting the content and form of the intervention. RESULTS The web portal targeted the general public and took the form of structured sets of tools. Content included: an introduction to research methods, help on how to find evidence-based health information efficiently based on the steps of evidence-based practice, an introduction to critical appraisal, information about patient participation rights in decision-making, and a decision aid for consultations. CONCLUSIONS The web portal was designed in a systematic and transparent way and address key barriers to obtaining and acting upon reliable health information. The web portal provides open access to the tools and can be used independently by health care users, or during consultations with health professionals.
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Affiliation(s)
- Astrid Austvoll-Dahlgren
- Prevention, Health Promotion and Organisation Unit, Norwegian Knowledge Centre for the Health ServicesOslo, Norway
| | - Stein Danielsen
- Department of Cardio-thoracic Surgery, Oslo University HospitalOslo, Norway
| | | | - Arild Bjørndal
- Regional Centre for Child and Adolescent Mental HealthOslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of OsloOslo, Norway
| | - Liv Merete Reinar
- Primary Health Care Unit, Norwegian Knowledge Centre for the Health ServicesOslo, Norway
| | - Signe Flottorp
- Prevention, Health Promotion and Organisation Unit, Norwegian Knowledge Centre for the Health ServicesOslo, Norway
- Department of Public Health and Primary Health Care, University of BergenBergen, Norway
| | - Andrew David Oxman
- Global Health Unit, Norwegian Knowledge Centre for the Health ServicesOslo, Norway
| | - Sølvi Helseth
- Faculty of Health Sciences, Oslo and Akershus University College of Applied SciencesOslo, Norway
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Odierna DH, White J, Forsyth S, Bero LA. Critical appraisal training increases understanding and confidence and enhances the use of evidence in diverse categories of learners. Health Expect 2012; 18:273-87. [PMID: 23252397 DOI: 10.1111/hex.12030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Training in evidence-based medicine is most commonly offered to physicians, medical students and health-care decision-makers. SETTING AND PARTICIPANTS We partnered with community organizations to recruit participants and develop trainings for consumers, non-physician health-care providers and journalists in California. INTERVENTION We conducted half-day and one-day workshops in critical appraisal of health evidence. Workshops consisted of didactic presentations, small-group practice sessions and class discussions. OUTCOME MEASURES We measured knowledge and confidence immediately before and after the workshops and at follow-up 6 months later. We also asked participants to describe their use of health evidence before the workshops and at follow-up. RESULTS At baseline, 41% of the consumers, 45% of the providers and 57% of the journalists correctly answered questions about health evidence. Scores increased by about 20% (P < 0.05) in all groups at the end of the workshops and remained significantly over baseline at follow-up. At baseline, 26% of the participants were confident in their understanding of critical appraisal concepts, significantly increasing to 54% after the workshops and sustained (53%) at follow-up. During discussions, participants' comments often focused on funding and the potential effects of financial conflicts of interest on study findings. Participants did not use evidence more frequently at follow-up but said that they applied workshop skills in evaluating research, communicating with others and making decisions about health care. CONCLUSION It is possible to successfully conduct critical appraisal workshops to aid health-related decision making for groups who have previously not had access to this kind of training.
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Affiliation(s)
- Donna H Odierna
- Department of Clinical Pharmacy, University of California, San Francisco, CA, USA
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Matic-Strametz M, Strametz R, Bohrt K, Ochsendorf F, Weberschock T. [Students in Training to Become Biology Teachers - a controlled phase II trial (NCT01567267)]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2012; 107:53-61. [PMID: 23415344 DOI: 10.1016/j.zefq.2012.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/05/2012] [Accepted: 11/06/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Consumers increasingly demand to take part in healthcare decisions as described by the concept of shared decision making. In order to ensure this happens the patient must be able to critically appraise the healthcare information provided, which is called critical health literacy. Critical health literacy can be taught to patients at the onset of their disease to enable them to obtain information about interventions and alternatives. For the primary prevention of common diseases like hypertension or diabetes mellitus, though, it is necessary to empower consumers to critically appraise medical information since this information is routinely presented in the mass media. This might be achieved through educational intervention programmes at school. METHODS The study was designed as a prospective controlled trial with students in training to become biology teachers at Siegen University (Germany). The intervention group received a short-term educational intervention (24 units) in human biology based on the principles of Evidence-based Medicine (EbM) and Good Scientific Practice (GSP) combined with elements of problem-based learning. The control group received a short-term intervention in human biology of equal duration, but without the elements of EbM and GSP. Knowledge and skills were evaluated by validated questionnaires and case studies in a pre-, interim, and post-interventional test in both groups. In addition, biology trainee teachers in the intervention group also planned and conducted a one-hour problem-based learning session with high school students, which was evaluated by video. RESULTS The increase in knowledge (7.9±3.8 points vs. 2.7±2.5 points, p≤0.001) and appraisal skills (24.1±6.7 points vs. 14.6±6.3, p≤0.001) after the intervention was relevant and significant compared to baseline results and also compared to the control group that did not show any significant progress in knowledge (3.9±2.4 points vs. 2.7±1.7) and appraisal skills (16.2±5.9 points vs. 14.4±5.6). All the participants in the intervention group passed both the preparation and the conduction of their problem-based learning session with high school students with at least 50 % of the maximum number of points. Satisfaction among students in training to become biology teachers (median grade of 2 [good] in the German grading system) and students (89 % of students agreed this to be an interesting method) were high in the intervention group. DISCUSSION/CONCLUSION This preliminary study showed a relevant increase in knowledge about EbM and skills in critically appraising interventional studies. Participating students were able to conduct problem-based learning sessions for high school students about the principles of EbM and GSP. The results justify a larger randomised controlled trial to evaluate both effects and applicability to different school settings.
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Affiliation(s)
- Mirjana Matic-Strametz
- Arbeitsgruppe Evidenzbasierte Medizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt; Hessenkolleg, Frankfurt.
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Competence training in evidence-based medicine for patients, patient counsellors, consumer representatives and health care professionals in Austria: a feasibility study. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2012; 107:44-52. [PMID: 23415343 DOI: 10.1016/j.zefq.2012.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 11/05/2012] [Accepted: 11/05/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Informed and shared decision-making require competences for both partners - healthcare professionals and patients. There is a lack of training courses in evidence-based medicine for patients and counsellors. OBJECTIVE We investigated feasibility, acceptability and the potential effects of a 2 x 2.5 days training course on critical health competences in patients, patient counsellors, consumer representatives and healthcare professionals in Austria. METHODS We adapted a previously developed curriculum for patient and consumer representatives. The adaptation comprised the specific needs of our target group in Austria and was founded on Carl Rogers' theory of person-centred education. For the formative evaluation a questionnaire was applied to address the domains: 1) organisational conditions (time and duration of the course, location, and information given in advance, registration); 2) assistance outside the courses; 3) teaching methods (performance of lecturers, teaching materials, structure of modules and blocks) and 4) satisfaction; 5) subjective assessment of competences. Participants evaluated the course, using a 5-point Likert scale. Long-term implementation was assessed using semi-structured interviews three to six months after the course. To estimate the increase in critical health competences we used the validated Critical Health Competence Test (CHC test). RESULTS Eleven training courses were conducted including 142 participants: patients (n=21); self-help group representatives (n=17); professional counsellors (n=29); healthcare professionals (n=10); psychologists (n=8); teachers (n=10) and others (n=29). 97 out of 142 (68 %) participants returned the questionnaire. On average, participants strongly agreed or agreed to 1) organisational conditions: 71 % / 23 %; 2) assistance outside the courses: 96 % / 10 %; 3) teaching methods: 60 % / 28 %; and 4) satisfaction: 78 % / 20 %, respectively. Interviews showed that the training course raised awareness, activated and empowered participants. Participants passed the CHC test with mean person parameters of 463±111 (pre-test, n=120) and 547±135 (post-test, n=91). For participants who returned both tests (n=71) person parameters were comparable: pre-test 466±121 versus post-test 574±100, p<0,001. CONCLUSION Training in evidence-based medicine for patients, patient counsellors, consumer representatives and healthcare professionals is feasible. For a broad implementation, train-the trainer courses and further research are needed.
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Mosconi P, Satolli R, Colombo C, Villani W. Does a consumer training work? a follow-up survey of the PartecipaSalute training programs. Health Res Policy Syst 2012; 10:27. [PMID: 22938140 PMCID: PMC3464673 DOI: 10.1186/1478-4505-10-27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 08/06/2012] [Indexed: 11/14/2022] Open
Abstract
Background When properly trained through training programs on epidemiology, clinical research and healthcare policy, members of patients’/consumers’ organizations could be helpful for a patient-oriented healthcare system. Since 2006 the not for profit project PartecipaSalute has organized periodic editions of a training program for representatives of citizens’/patients’ organizations. After five editions of this training program, a survey of the long-term satisfaction and the impact on activities has been carried out. Methods A 17-questions follow-up questionnaire has been developed. The sample comprised 99 people who had taken part in at least one program edition. Results The overall response rate was 89% (89 responders/99 participants). About 98% of participants expressed general satisfaction with the training program and with the knowledge gained. Medical and informative topics were rated better than technical ones for their usefulness (96% versus 86%). The results of the survey showed a strong impact of the training course on single participants, while a weak outcome on the activities of the organizations was reported. Conclusions The training program was positively rated, and improvements in personal knowledge were reported. Less impact was reported on organizations’ activities. Participants showed a remarkable willingness to get more involved in healthcare decisions, and to boost their knowledge of health and research issues. The results show the importance of follow-up to understand the real value of training program and to better organize future programs.
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Affiliation(s)
- Paola Mosconi
- Laboratory of Medical Research and Consumer Involvement, Mario Negri Institute for Pharmacological Research, Via La Masa 19, Milan, 20156, Italy.
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Wale JL, Belizán M, Nadel J, Jeffrey C, Vij SL. The Cochrane Library review titles that are important to users of health care, a Cochrane Consumer Network project. Health Expect 2011; 16:e146-63. [PMID: 21895902 DOI: 10.1111/j.1369-7625.2011.00723.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Cochrane Consumer Network is an internet-based community of international users of health care contributing to the work of The Cochrane Collaboration, whose mission is to inform healthcare decision making through development of systematic reviews of best evidence on healthcare interventions. OBJECTIVE To prioritize existing review titles listed on The Cochrane Library from a healthcare user perspective, with particular emphasis on patients, carers and health consumers. DESIGN An online survey was developed and after piloting was made available internationally. The broad dissemination strategy targeted Consumer Network members and Cochrane Review Group editorial staff to identify champions who notified patient support groups and participated in snowballing. The first part of the survey defined criteria that could be applied to review titles and asked survey respondents to rank them. The second part asked respondents to select a health area and prioritize review titles that were of importance to them. Each health area corresponded to a Cochrane Review Group. RESULTS AND DISCUSSION Sufficient responses were obtained from 522 valid responses to prioritize review topics in 19 health areas. A total of 321 respondents completed the titles assessment. The types of prioritized interventions were determined by the health area. An important observation was the emphasis on lifestyle and non-medication therapies in many of the included health areas. The clearest exception to this broad observation was where acute care is required such as antibiotics for acute respiratory tract and HIV-associated infections and for cardiac conditions. For some cancers, advanced cancer interventions were prioritized. The most important criteria were for the title to convey a clear meaning and the title conveyed that the review would have an impact on health and well-being. The least important criteria were that the topic was newsworthy or prioritized in the healthcare system. CONCLUSION This project was able to identify priority Cochrane review topics for users of health care in 19 of the 50 areas of health care covered by The Cochrane Collaboration. Reviews addressing lifestyle and non-medical interventions were strongly represented in the prioritized review titles. These findings highlight the importance of developing readable, informative lay summaries to support evidence-based decision making by healthcare users.
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Affiliation(s)
- Janet L Wale
- Cochrane Consumer Network, Australia, South Africa, United States of America, South Africa, Germany
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19
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Berger B, Steckelberg A, Meyer G, Kasper J, Mühlhauser I. Training of patient and consumer representatives in the basic competencies of evidence-based medicine: a feasibility study. BMC MEDICAL EDUCATION 2010; 10:16. [PMID: 20149247 PMCID: PMC2843725 DOI: 10.1186/1472-6920-10-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 02/11/2010] [Indexed: 05/18/2023]
Abstract
BACKGROUND Evidence-based medicine (EBM) has become standard approach in medicine. Patients and health authorities increasingly claim active patient roles in decision making. Education to cope with these roles might be useful. We investigated the feasibility, acceptability and possible impact of EBM training courses for patient and consumer representatives. METHODS We designed a generic one-week EBM course based on previous experience with EBM courses for non-medical health professionals. A course specific competence test has been developed and validated to measure EBM skills. Formative and summative evaluation of the course comprised: 1) EBM skills; 2) individual learning goals; 3) self-reported implementation after six months using semi-structured interviews; 4) group-based feedback by content analysis. EBM skills' achievement was compared to results gathered by a group of undergraduate University students of Health Sciences and Education who had attended a comparable EBM seminar. RESULTS Fourteen EBM courses were conducted including 161 participants without previous EBM training (n = 54 self-help group representatives, n = 64 professional counsellors, n = 36 patient advocates, n = 7 others); 71% had a higher education degree; all but five finished the course. Most participants stated personal learning goals explicitly related to practicing EBM such as acquisition of critical appraisal skills (n = 130) or research competencies (n = 67). They rated the respective relevance of the course on average with 80% (SD 4) on a visual analogue scale ranging from 0 to 100%.Participants passed the competence test with a mean score of 14.7 (SD 3.0, n = 123) out of 19.5 points. The comparison group of students achieved a mean score of 14.4 (SD 3.3, n = 43). Group-based feedback revealed increases of self confidence, empowerment through EBM methodology and statistical literacy, and acquisition of new concepts of patient information and counselling. Implementation of EBM skills was reported by 84 of the 129 (65%) participants available for follow-up interviews. Barriers included lack of further support, limited possibilities to exchange experiences, and feeling discouraged by negative reactions of health professionals. CONCLUSIONS Training in basic EBM competencies for selected patient and consumer representatives is feasible and accepted and may affect counselling and advocacy activities. Implementation of EBM skills needs support beyond the training course.
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Affiliation(s)
- Bettina Berger
- Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King Platz 6, 20146 Hamburg, Germany
| | - Anke Steckelberg
- Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King Platz 6, 20146 Hamburg, Germany
| | - Gabriele Meyer
- Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King Platz 6, 20146 Hamburg, Germany
| | - Jürgen Kasper
- Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King Platz 6, 20146 Hamburg, Germany
| | - Ingrid Mühlhauser
- Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King Platz 6, 20146 Hamburg, Germany
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Oxman AD, Vandvik PO, Lavis JN, Fretheim A, Lewin S. SUPPORT Tools for evidence-informed health Policymaking (STP) 2: Improving how your organisation supports the use of research evidence to inform policymaking. Health Res Policy Syst 2009; 7 Suppl 1:S2. [PMID: 20018109 PMCID: PMC3271829 DOI: 10.1186/1478-4505-7-s1-s2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This article is part of a series written for people responsible for making decisions about health policies and programmes and for those who support these decision makers. In this article, we address ways of organising efforts to support evidence-informed health policymaking. Efforts to link research to action may include a range of activities related to the production of research that is both highly relevant to – and appropriately synthesised for – policymakers. Such activities may include a mix of efforts used to link research to action, as well as the evaluation of such efforts. Little is known about how best to organise the range of activity options available and, until recently, there have been relatively few organisations responsible for supporting the use of research evidence in developing health policy. We suggest five questions that can help guide considerations of how to improve organisational arrangements to support the use of research evidence to inform health policy decision making. These are: 1. What is the capacity of your organisation to use research evidence to inform decision making? 2. What strategies should be used to ensure collaboration between policymakers, researchers and stakeholders? 3. What strategies should be used to ensure independence as well as the effective management of conflicts of interest? 4. What strategies should be used to ensure the use of systematic and transparent methods for accessing, appraising and using research evidence? 5. What strategies should be used to ensure adequate capacity to employ these methods?
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Affiliation(s)
- Andrew D Oxman
- Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway.
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Steckelberg A, Hülfenhaus C, Kasper J, Rost J, Mühlhauser I. How to measure critical health competences: development and validation of the Critical Health Competence Test (CHC Test). ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2009; 14:11-22. [PMID: 17902033 DOI: 10.1007/s10459-007-9083-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 09/12/2007] [Indexed: 05/17/2023]
Abstract
Consumers' autonomy regarding health increasingly requires competences to critically appraise health information. Critical health literacy refers to the concept of evidence-based medicine. Instruments to measure these competences in curriculum evaluation and surveys are lacking. We aimed to develop and validate an instrument to measure critical health competences (CHC test). Development and testing of the questionnaire covered three phases: (1) test construction (and feasibility, (2) first field test of scalability and items revision (3) second field test to validate the instrument. Model fit analyses were performed for both field tests for Rasch-, Mixed Rasch- and Hybrid model. Participants were secondary school and university students with and without prior training in evidence-based medicine (1. field test n = 322; with training n = 87; 2. field test n = 107; with training n = 13). The second field test resulted in Rasch scalability of all items in one person class. Mean values (+/-SD) of person parameters were 716.14 (+/-53.74) for trained students and 470.11 (+/-59.63) for untrained students. Reliability of the instrument was 0.91 (WINMIRA ANOVA). In conclusion the CHC instrument is a feasible, reliable and valid instrument to measure critical health literacy. The generalizability of the instrument is to be explored in ongoing studies in different educational settings.
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Affiliation(s)
- Anke Steckelberg
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany.
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Saunders C, Girgis A, Butow P, Crossing S, Penman A. From inclusion to independence--training consumers to review research. Health Res Policy Syst 2008; 6:3. [PMID: 18328108 PMCID: PMC2292183 DOI: 10.1186/1478-4505-6-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 03/09/2008] [Indexed: 11/10/2022] Open
Abstract
Health and medical research invariably impacts on the lives of everyday people. Organisations in the developed world are increasingly involving the public in health research projects, and research governance structures and processes. The form the involvement takes varies, as does the level of involvement, from individuals, to groups, to the wider community. Lay community members can be trained to independently review health and medical research, and wider societal involvement in funding decisions, can be effectively fostered. The theoretical foundation, design and development of a task based consumer-training program, including a number of enabling factors to support the success of such training are presented. This work is likely to be of value to those planning to train consumers in technical or complex areas.
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Affiliation(s)
- Carla Saunders
- School of Medicine and Public Health, The University of Newcastle, Wallsend, NSW, Australia.
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Mosconi P, Colombo C, Satolli R, Liberati A. PartecipaSalute, an Italian project to involve lay people, patients' associations and scientific-medical representatives in the health debate. Health Expect 2007; 10:194-204. [PMID: 17524012 PMCID: PMC5060390 DOI: 10.1111/j.1369-7625.2007.00444.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Paola Mosconi
- Istituto di Ricerche Farmacologiche, Mario Negri, Via Eritrea 62, 20157 Milan, Italy. E‐mail:
| | - Cinzia Colombo
- Istituto di Ricerche Farmacologiche, Mario Negri, Via Eritrea 62, 20157 Milan, Italy. E‐mail:
| | - Roberto Satolli
- Istituto di Ricerche Farmacologiche, Mario Negri, Via Eritrea 62, 20157 Milan, Italy. E‐mail:
| | - Alessandro Liberati
- Istituto di Ricerche Farmacologiche, Mario Negri, Via Eritrea 62, 20157 Milan, Italy. E‐mail:
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Zavestoski S, Morello-Frosch R, Brown P, Mayer B, McCormick S, Altman RG. EMBODIED HEALTH MOVEMENTS AND CHALLENGES TO THE DOMINANT EPIDEMIOLOGICAL PARADIGM. AUTHORITY IN CONTENTION 2004. [DOI: 10.1016/s0163-786x(04)25010-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Brown P, Zavestoski S, McCormick S, Mayer B, Morello-Frosch R, Gasior Altman R. Embodied health movements: new approaches to social movements in health. SOCIOLOGY OF HEALTH & ILLNESS 2004; 26:50-80. [PMID: 15027990 DOI: 10.1111/j.1467-9566.2004.00378.x] [Citation(s) in RCA: 183] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Social movements organised around health-related issues have been studied for almost as long as they have existed, yet social movement theory has not yet been applied to these movements. Health social movements (HSMs) are centrally organised around health, and address: (a) access to or provision of health care services; (b) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality; and/or (c) disease, illness experience, disability and contested illness. HSMs can be subdivided into three categories: health access movements seek equitable access to health care and improved provision of health care services; constituency-based health movements address health inequality and health inequity based on race, ethnicity, gender, class and/or sexuality differences; and embodied health movements (EHMs) address disease, disability or illness experience by challenging science on etiology, diagnosis, treatment and prevention. These groups address disproportionate outcomes and oversight by the scientific community and/or weak science. This article focuses on embodied health movements, primarily in the US. These are unique in three ways: 1) they introduce the biological body to social movements, especially with regard to the embodied experience of people with the disease; 2) they typically include challenges to existing medical/scientific knowledge and practice; and 3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research and expanded funding. This article employs various elements of social movement theory to offer an approach to understanding embodied health movements, and provides a capsule example of one such movement, the environmental breast cancer movement.
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Affiliation(s)
- Phil Brown
- Department of Sociology, Brown University, Providence, RI 02912, USA.
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Abstract
There have been four key steps in the advent of breast cancer advocacy: priming the market, engaging consumers, establishing political advocacy, and taking the advocacy mainstream. Breast cancer was surrounded by secrecy until the 1980s, when brave individuals such as former First Ladies Betty Ford and Nancy Reagan, and founder of the Susan G. Komen Foundation, Nancy Brinker (Susan Komen's sister), began speaking publicly about the personal impact of the disease, which increased awareness of breast cancer and made it more acceptable to talk about it openly. At the same time, statistics about breast cancer were presented in new ways that the public could understand. Public health advocates played a key role in the second step, engaging consumers, when they established guidelines in the 1980s that encouraged women to perform breast self-examinations (BSEs) and have screening mammograms and clinical breast examinations (CBEs). Other events that helped engage consumers were increased media coverage of breast cancer issues, the founding of the Komen Race for the Cure in 1983, and the establishment of other programs that both educated the public and raised funds. Funds from these efforts enabled advocates to hold educational forums and produce educational materials in different media and tailored to different audiences and to become active in the funding of research. The third step, political action, became possible when breast cancer advocates joined together in the 1980s and 1990s to work toward legislative, regulatory, and funding changes, such as passage of the Mammography Quality Standards Act and increased funding for the National Cancer Institute. These efforts contributed to a more than quadrupling of federal funding for breast cancer research in the 1990s. Going mainstream, the final step in the advocacy process, entailed establishing a solid base of support to ensure that the message about breast cancer stays strong and fresh. This has been achieved by engaging the business, government, and scientific communities as partners in advocacy.
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Affiliation(s)
- Susan Braun
- Susan G. Komen Breast Cancer Foundation, Dallas, Texas 75244, USA.
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