Janique Johnson-Lafleur

Four levels of outcomes of information-seeking: A mixed methods study in primary health care

Primary health care practitioners routinely search for information within electronic knowledge resources. We proposed four levels of outcomes of information-seeking: situational relevance, cognitive impact, information use, and patient health outcomes. Our objective was to produce clinical vignettes for describing and testing these levels. We conducted a mixed methods study combining a quantitative longitudinal study and a qualitative multiple case study. Participants were 10 nurses, 10 medical residents, and 10 pharmacists. They had access to an online resource, and did 793 searches for treatment recommendations. Using the Information Assessment Method (IAM), participants rated their searches for each of the four levels. Rated searches were examined in interviews guided by log reports and a think-aloud protocol. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described the four levels of outcomes. Quantitative and qualitative data were merged into clinical vignettes. We produced 130 clinical vignettes. Specifically, 46 vignettes (35.4%) corresponded to clinical situations where information use was associated with one or more than one type of positive patient health outcome: increased patient knowledge (n = 28), avoidance of unnecessary or inappropriate intervention (n = 25), prevention of disease or health deterioration (n = 9), health improvement (n = 6), and increased patient satisfaction (n = 3). Results suggested information use was associated with perceived benefits for patients. This may encourage clinicians to search for information more often when they feel the need. Results supported the four proposed levels of outcomes, which can be transferable to other information-seeking contexts.

Physicians' assessment of the value of clinical information: Operationalization of a theoretical model

Inspired by the acquisition–cognition–application model (T. Saracevic & K.B. Kantor, 1997), we developed a tool called the Information Assessment Method to more clearly understand how physicians use clinical information. In primary healthcare, we conducted a naturalistic and longitudinal study of searches for clinical information. Forty-one family physicians received a handheld computer with the Information Assessment Method linked to one commercial electronic knowledge resource. Over an average of 320 days, 83% of 2,131 searches for clinical information were rated using the Information Assessment Method. Searches to address a clinical question, as well as the retrieval of relevant clinical information, were positively associated with the use of that information for a specific patient. Searches done out of curiosity were negatively associated with the use of clinical information. We found significant associations between specific types of cognitive impact and information use for a specific patient. For example, when the physician reported “My practice was changed and improved” as a result of this clinical information, the odds that information was used for a specific patient increased threefold. Our findings provide empirical data to support the applicability of the acquisition-cognition-application model, as operationalized through the Information Assessment Method, in primary healthcare. Capturing the use of research-based information in medicine opens the door to further study of the relationships between clinical information and health outcomes.

Development and Content Validation of the Information Assessment Method for Patients and Consumers

Background Online consumer health information addresses health problems, self-care, disease prevention, and health care services and is intended for the general public. Using this information, people can improve their knowledge, participation in health decision-making, and health. However, there are no comprehensive instruments to evaluate the value of health information from a consumer perspective. Objective We collaborated with information providers to develop and validate the Information Assessment Method for all (IAM4all) that can be used to collect feedback from information consumers (including patients), and to enable a two-way knowledge translation between information providers and consumers. Methods Content validation steps were followed to develop the IAM4all questionnaire. The first version was based on a theoretical framework from information science, a critical literature review and prior work. Then, 16 laypersons were interviewed on their experience with online health information and specifically their impression of the IAM4all questionnaire. Based on the summaries and interpretations of interviews, questionnaire items were revised, added, and excluded, thus creating the second version of the questionnaire. Subsequently, a panel of 12 information specialists and 8 health researchers participated in an online survey to rate each questionnaire item for relevance, clarity, representativeness, and specificity. The result of this expert panel contributed to the third, current, version of the questionnaire. Results The current version of the IAM4all questionnaire is structured by four levels of outcomes of information seeking/receiving: situational relevance, cognitive impact, information use, and health benefits. Following the interviews and the expert panel survey, 9 questionnaire items were confirmed as relevant, clear, representative, and specific. To improve readability and accessibility for users with a lower level of literacy, 19 items were reworded and all inconsistencies in using a passive or active voice have been solved. One item was removed due to redundancy. The current version of the IAM4all questionnaire contains 28 items. Conclusions We developed and content validated the IAM4all in partnership with information providers, information specialists, researchers and representatives of information consumers. This questionnaire can be integrated within electronic knowledge resources to stimulate users’ reflection (eg, their intention to use information). We claim that any organization (eg, publishers, community organizations, or patient associations), can evaluate and improve their online consumer health information from a consumers’ perspective using this method.

Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians

PURPOSE We wanted to describe family physicians’ use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. METHODS We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008–2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. RESULTS In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). CONCLUSION The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported.

An Online Knowledge Resource and Questionnaires as a Continuing Pharmacy Education Tool to Document Reflective Learning

Objective. To assess the use of an electronic knowledge resource to document continuing education activities and reveal educational needs of practicing pharmacists. Methods. Over a 38-week period, 67 e-mails were sent to 6,500 Canadian Pharmacists Association (CPhA) members. Each e-mail contained a link to an e-Therapeutics+ Highlight, a factual excerpt of selected content from an online drug and therapeutic knowledge resource. Participants were then prompted to complete a pop-up questionnaire. Results. Members completed 4,140 questionnaires. Participants attributed the information they learned in the Highlights to practice improvements (50.4%), learning (57.0%), and motivation to learn more (57.4%). Conclusions. Reading Highlight excerpts and completing Web-based questionnaires is an effective method of continuing education that could be easily documented and tracked, making it an effective tool for use with e-portfolios.

Perspectives of Migrant Youth, Parents and Clinicians on Community-Based Mental Health Services: Negotiating Safe Pathways

Youth mental health (YMH) services are greatly underutilized, particularly for migrant youth. Collaborative models of care offer promising avenues, but research on these treatment modalities is still scarce, particularly for migrants. The goal of this exploratory study is to better understand quality of care including factors improving access to care and collaborative YMH services use, efficacy and satisfaction, for this vulnerable population. This qualitative study relies on a multi-informants (youth, parents, clinicians) and multiple case study design to explore YMH collaborative services for migrant youth living in an urban setting (Montreal, Canada). Participants are five young patients (12–15 years old), one of their parents and their primary care therapist (N = 15). They come from migrant families, have a psychiatric diagnosis and have been receiving mental health services in a collaborative care setting for at least 6 months. Transcripts of semi-structured interviews for the five triads were thematically analyzed to draw similarities and contrasts between actors, across and within case-studies. Based on these findings, four themes emerged concerning the optimal care setting for collaborative YMH services for migrant families: (1) providing an equilibrium between communication, collaboration and privacy/confidentiality, (2) special attention to ensuring the continuity of care and the creation of a welcoming environment where trusting relationships can develop, (3) the inclusion of family intervention, and (4) the provision of collaborative decision-making pathways to care, addressing interprofessional and interinstitutional collaboration as well as cultural differences in explanatory models and values.

Collaborative youth mental health service users, immigration, poverty, and family environment

Background This article examines the association between immigration, poverty and family environment, and the emotional and behavioral problems reported by youth and their family receiving mental health (MH) services within a collaborative care model in a multiethnic neighborhood. Method Participants in this study were 140 parent–child dyads that are part of an ongoing longitudinal project looking at the association between individual, familial, social and organizational factors, and outcomes of youth receiving MH services in local health and social service organizations in the Montreal area. Measures included in this study were collected at the initial phase of the longitudinal project (Time 0). Parents completed a sociodemographic questionnaire and the Family Environment Scale (FES), and both parents and children completed the Strength and Difficulties questionnaire (SDQ). Results Results suggest that the family environment, especially family conflicts, has a significant role in the MH problems of children seeking help in collaborative MH services. In this specific population, results also show a trend, but not a statistically significant association, between poverty or immigration and emotional and behavioral problems. They suggest as well that boys show more MH problems, although this could be a contamination effect (parents’ perspective). Conclusions The results support the importance of interventions that not only target the child symptomatology but also address family dynamics, especially conflicts. Collaborative care models may be particularly well suited to allow for a coherent consideration of family environmental factors in youth mental health and to support primary care settings in addressing these issues.

Interdisciplinary case discussions as a training modality to teach cultural formulation in child mental health

The DSM-5 Cultural Formulation Interview (CFI) may become an important tool to help operationalize culture in the clinical realm. However, challenges exist in teaching its use to avoid the risk of stereotyping and oversimplification, which could result in misunderstanding and stigma. The aim of this article is to document whether the CFI can be taught using regular Interdisciplinary Case Discussion Seminars (ICDSs), proposed as continuing education in child mental health and as part of clinical rotations for new trainees. During a two-year evaluative research project, ICDSs were held monthly in three different primary care settings servicing recent immigrants in Montreal, Canada. ICDSs were recorded and analyzed to examine their effect on the cultural formulation process and focus groups were conducted to explore the subjective experience of the participant trainees and professionals. Results suggest that ICDSs are a helpful way to teach the use of the CFI. The group discussions helped participants to better capture the complexity of the cultural and social experience of the child and family by moving away from simple identity assignations, supporting an inquiry into structural dimensions, and considering stigma and inequality in their formulation. The multiple levels of diversity (individual, disciplinary, and interinstitutional) represented in the discussion groups helped clinicians to understand the cultural formulation as situated in a specific relational context and a particular moment and, in so doing, helped trainees to avoid cultural formulations that essentialize culture.