C. Nadine Wathen

Believe It or Not: Factors Influencing Credibility on the Web.

This article reviews selected literature related to the credibility of information, including (1) the general markers of credibility, and how different source, message and receiver characteristics affect peoples perceptions of information; (2) the impact of information medium on the assessment of credibility; and (3) the assessment of credibility in the context of information presented on the Internet. The objective of the literature review is to synthesize the current state of knowledge in this area, develop new ways to think about how people interact with information presented via the Internet, and suggest next steps for research and practical applications. The review examines empirical evidence, key reviews, and descriptive material related to credibility in general, and in terms of on-line media. A general discussion of credibility and persuasion and a description of recent work on the credibility and persuasiveness of computer-based applications is presented. Finally, the article synthesizes what we have learned from various fields, and proposes a model as a framework for much-needed future research in this area.

Interventions to prevent child maltreatment and associated impairment

Although a broad range of programmes for prevention of child maltreatment exist, the effectiveness of most of the programmes is unknown. Two specific home-visiting programmes-the Nurse-Family Partnership (best evidence) and Early Start-have been shown to prevent child maltreatment and associated outcomes such as injuries. One population-level parenting programme has shown benefits, but requires further assessment and replication. Additional in-hospital and clinic strategies show promise in preventing physical abuse and neglect. However, whether school-based educational programmes prevent child sexual abuse is unknown, and there are currently no known approaches to prevent emotional abuse or exposure to intimate-partner violence. A specific parent-training programme has shown benefits in preventing recurrence of physical abuse; no intervention has yet been shown to be effective in preventing recurrence of neglect. A few interventions for neglected children and mother-child therapy for families with intimate-partner violence show promise in improving behavioural outcomes. Cognitive-behavioural therapy for sexually abused children with symptoms of post-traumatic stress shows the best evidence for reduction in mental-health conditions. For maltreated children, foster care placement can lead to benefits compared with young people who remain at home or those who reunify from foster care; enhanced foster care shows benefits for children. Future research should ensure that interventions are assessed in controlled trials, using actual outcomes of maltreatment and associated health measures.

Screening for Intimate Partner Violence in Health Care Settings: A Randomized Trial

CONTEXT Whether intimate partner violence (IPV) screening reduces violence or improves health outcomes for women is unknown. OBJECTIVE To determine the effectiveness of IPV screening and communication of positive results to clinicians. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial conducted in 11 emergency departments, 12 family practices, and 3 obstetrics/gynecology clinics in Ontario, Canada, among 6743 English-speaking female patients aged 18 to 64 years who presented between July 2005 and December 2006, could be seen individually, and were well enough to participate. INTERVENTION Women in the screened group (n=3271) self-completed the Woman Abuse Screening Tool (WAST); if a woman screened positive, this information was given to her clinician before the health care visit. Subsequent discussions and/or referrals were at the discretion of the treating clinician. The nonscreened group (n=3472) self-completed the WAST and other measures after their visit. MAIN OUTCOME MEASURES Women disclosing past-year IPV were interviewed at baseline and every 6 months until 18 months regarding IPV reexposure and quality of life (primary outcomes), as well as several health outcomes and potential harms of screening. RESULTS Participant loss to follow-up was high: 43% (148/347) of screened women and 41% (148/360) of nonscreened women. At 18 months (n = 411), observed recurrence of IPV among screened vs nonscreened women was 46% vs 53% (modeled odds ratio, 0.82; 95% confidence interval, 0.32-2.12). Screened vs nonscreened women exhibited about a 0.2-SD greater improvement in quality-of-life scores (modeled score difference at 18 months, 3.74; 95% confidence interval, 0.47-7.00). When multiple imputation was used to account for sample loss, differences between groups were reduced and quality-of-life differences were no longer significant. Screened women reported no harms of screening. CONCLUSIONS Although sample attrition urges cautious interpretation, the results of this trial do not provide sufficient evidence to support IPV screening in health care settings. Evaluation of services for women after identification of IPV remains a priority. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00182468.

“I Try to Take Care of It Myself.” How Rural Women Search for Health Information

Rural living poses special challenges (and opportunities) for the significant health information intermediary role that women enact. The authors describe interviews with 40 women living in a rural, medically underserved county in south-western Ontario, Canada, who discussed their information-seeking experiences and the strategies used to find information about a chronic health concern or an acute medical problem. The womens stories reveal that they define health very broadly and that their information seeking is influenced by contextual factors, such as rural living and gender roles, that interplay with their self-reliance, health literacy, and the availability and willingness of others in professional and non-professional roles to give support within relationships of care. The authors discuss themes emerging from the interviews in connection with the apparent mismatch between womens lived realities and the policy assumptions supporting the development of e-health strategies for providing health information to people living in rural and remote communities.

Why physicians and nurses ask (or don’t) about partner violence: a qualitative analysis

BackgroundIntimate partner violence (IPV) against women is a serious public health issue and is associated with significant adverse health outcomes. The current study was undertaken to: 1) explore physicians’ and nurses’ experiences, both professional and personal, when asking about IPV; 2) determine the variations by discipline; and 3) identify implications for practice, workplace policy and curriculum development.MethodsPhysicians and nurses working in Ontario, Canada were randomly selected from recognized discipline-specific professional directories to complete a 43-item mailed survey about IPV, which included two open-ended questions about barriers and facilitators to asking about IPV. Text from the open-ended questions was transcribed and analyzed using inductive content analysis. In addition, frequencies were calculated for commonly described categories and the Fisher’s Exact Test was performed to determine statistical significance when examining nurse/physician differences.ResultsOf the 931 respondents who completed the survey, 769 (527 nurses, 238 physicians, four whose discipline was not stated) provided written responses to the open-ended questions. Overall, the top barriers to asking about IPV were lack of time, behaviours attributed to women living with abuse, lack of training, language/cultural practices and partner presence. The most frequently reported facilitators were training, community resources and professional tools/protocols/policies. The need for additional training was a concern described by both groups, yet more so by nurses. There were statistically significant differences between nurses and physicians regarding both barriers and facilitators, most likely related to differences in role expectations and work environments.ConclusionsThis research provides new insights into the complexities of IPV inquiry and the inter-relationships among barriers and facilitators faced by physicians and nurses. The experiences of these nurses and physicians suggest that more supports (e.g., supportive work environments, training, mentors, consultations, community resources, etc.) are needed by practitioners. These findings reflect the results of previous research yet offer perspectives on why barriers persist. Multifaceted and intersectoral approaches that address individual, interpersonal, workplace and systemic issues faced by nurses and physicians when inquiring about IPV are required. Comprehensive frameworks are needed to further explore the many issues associated with IPV inquiry and the interplay across these issues.

Treatment of Child Neglect: A Systematic Review

Objective: Child neglect is the most common type of child maltreatment. Our objective was to systematically evaluate the available evidence regarding the effectiveness of child neglect treatment programs, including those focused on victims of childhood neglect and (or) their caregivers. Method: We comprehensively searched the Medline, Psycinfo, and Eric databases from January 1980 to May 2003. Two authors independently reviewed 54 studies that met inclusion criteria. Fourteen articles met our design criterion and were assessed for their methodological quality according to guidelines developed by the US Preventive Services Task Force. Results: Of the 14 studies included in the review, 2 were rated as good, and 3 were rated as fair. We found evidence that 2 specific types of play therapy and a therapeutic day treatment program had beneficial effects for children. Further, parents and children in families where neglect had occurred showed improvement with multisystemic therapy. Conclusions: Rigorous studies of treatments for neglected children and their families are lacking. Well-designed and well-conducted evaluations are urgently required to identify effective treatments, which should then be made available to children and their caregivers.

Should health professionals screen all women for domestic violence

Background to the debate: The US and Canadian task forces on preventive health recently declared that there is not enough evidence to recommend for or against routine universal screening of women for domestic violence. Yet some experts argue that routine enquiry is justified.

Interventions to promote breast-feeding: applying the evidence in clinical practice

In this document, the Canadian Task Force on Preventive Health Care (CTFPHC) updates its earlier breast-feeding recommendations[1][1] by presenting evidence on interventions that improve the initiation or duration of breast-feeding (or both). Breast-feeding has been shown in both developing and

Health information seeking in context: how women make decisions regarding hormone replacement therapy.

This multimethod study explored womens information seeking behaviour and decision making regarding menopause, hormone replacement therapy (HRT), and use of complementary and alternative medicines (CAM) during menopause. This research was underway during the mass media release of the Womens Health Initiative (WHI) estrogen–progestin trial results, allowing an examination of the impact of this news on womens decisions. There were two studies: first, 20 women who currently were or previously had used HRT were interviewed about their experiences with menopause and HRT-related information seeking and decision making. Following this, 285 demographically representative Canadian women aged 45–65 who were current or former HRT users completed a questionnaire. Results indicate that womens information behaviour differed according to which decision they were making (starting versus stopping HRT, considering CAM), as did the sources they consulted. In general, there has been a paucity of good information to help women who are deciding to stop HRT. The types and sources of CAM information often are found to be less than credible and helpful. When information is lacking, women rely on informal sources, and on their own judgement, to make decisions. The results are discussed in the context of information behaviour and help-seeking theory.

The experiential health information processing model: supporting collaborative web-based patient education.

BackgroundFirst generation Internet technologies such as mailing lists or newsgroups afforded unprecedented levels of information exchange within a variety of interest groups, including those who seek health information. With emergence of the World Wide Web many communication applications were ported to web browsers. One of the driving factors in this phenomenon has been the exchange of experiential or anecdotal knowledge that patients share online, and there is emerging evidence that participation in these forums may be having an impact on peoples health decision making. Theoretical frameworks supporting this form of information seeking and learning have yet to be proposed.ResultsIn this article, we propose an adaptation of Kolbs experiential learning theory to begin to formulate an experiential health information processing model that may contribute to our understanding of online health information seeking behaviour in this context.ConclusionAn experiential health information processing model is proposed that can be used as a research framework. Future research directions include investigating the utility of this model in the online health information seeking context, studying the impact of collaborating in these online environments on patient decision making and on health outcomes are provided.