Vera Granikov

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.

Feasibility of a knowledge translation CME program: Courriels Cochrane.

Introduction: Systematic literature reviews provide best evidence, but are underused by clinicians. Thus, integrating Cochrane reviews into continuing medical education (CME) is challenging. We designed a pilot CME program where summaries of Cochrane reviews (Courriels Cochrane) were disseminated by e‐mail. Program participants automatically received CME credit for each Courriel Cochrane they rated. The feasibility of this program is reported (delivery, participation, and participant evaluation). Method: We recruited French‐speaking physicians through the Canadian Medical Association. Program delivery and participation were documented. Participants rated the informational value of Courriels Cochrane using the Information Assessment Method (IAM), which documented their reflective learning (relevance, cognitive impact, use for a patient, expected health benefits). IAM responses were aggregated and analyzed. Results: The program was delivered as planned. Thirty Courriels Cochrane were delivered to 985 physicians, and 127 (12.9%) completed at least one IAM questionnaire. Out of 1109 Courriels Cochrane ratings, 973 (87.7%) contained 1 or more types of positive cognitive impact, while 835 (75.3%) were clinically relevant. Participants reported the use of information for a patient and expected health benefits in 595 (53.7%) and 569 (51.3%) ratings, respectively. Discussion: Program delivery required partnering with 5 organizations. Participants valued Courriels Cochrane. IAM ratings documented their reflective learning. The aggregation of IAM ratings documented 3 levels of CME outcomes: participation, learning, and performance. This evaluation study demonstrates the feasibility of the Courriels Cochrane as an approach to further disseminate Cochrane systematic literature reviews to clinicians and document self‐reported knowledge translation associated with Cochrane reviews.

Regulation profiles of e-cigarettes in the United States: a critical review with qualitative synthesis

BackgroundElectronic cigarettes (e-cigarettes) have been steadily increasing in popularity since their introduction to US markets in 2007. Debates surrounding the proper regulatory mechanisms needed to mitigate potential harms associated with their use have focused on youth access, their potential for nicotine addiction, and the renormalization of a smoking culture. The objective of this study was to describe the enacted and planned regulations addressing this novel public health concern in the US.MethodsWe searched LexisNexis Academic under Federal Regulations and Registers, as well as State Administrative Codes and Registers. This same database was also used to find information about planned regulations in secondary sources. The search was restricted to US documents produced between January 1st, 2004, and July 14th, 2014.ResultsWe found two planned regulations at the federal level, and 74 enacted and planned regulations in 44 states. We identified six state-based regulation types, including i) access, ii) usage, iii) marketing and advertisement, iv) packaging, v) taxation, and vi) licensure. These were further classified into 10 restriction subtypes: sales, sale to minors, use in indoor public places, use in limited venues, use by minors, licensure, marketing and advertising, packaging, and taxation. Most enacted restrictions aimed primarily to limit youth access, while few regulations enforced comprehensive restrictions on product use and availability.ConclusionsCurrent regulations targeting e-cigarettes in the US are varied in nature and scope. There is greater consensus surrounding youth protection (access by minors and/or use by minors, and/or use in limited venues), with little consensus on multi-level regulations, including comprehensive use bans in public spaces.

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.

Perceived outcomes of online parenting information according to self-selected participants from a population of website users

Looking for consumer health/well‐being information online is increasingly common. However, little is known about how people are using information targeted to a specific audience, and what happens as a result of this use. We partnered with ‘Naitre & Grandir’ (N&G), a magazine, website and newsletter offering trustworthy parenting information on child growth, development and health/well‐being. This study was designed to uncover the outcomes of online parenting information. We used the theory‐driven Information Assessment Method (IAM) to study parental perceptions regarding outcomes of specific N&G web pages. A research question was: Is there a difference between parents with a low level of education and income vs. other parents? Over an 8‐month study period, 4007 participants submitted 4862 IAM ratings that suggested N&G information was valuable in terms of situational relevance (93.7%), positive cognitive impact (92.9%), intention to use (85.7%), and expectation for child health/well‐being benefit (82.4%). In addition, results suggested participants with a low level of education and income were more likely to (i) seek and use information for the child of someone else, and (ii) expect being more engaged in decision‐making for their child, and being less worried regarding a problem concerning their child. Our results do not support an association between the combined level of income and education, and perceived outcomes of information. This is the first study to assess outcomes of emailed parenting information from a parental viewpoint. More research is needed to better understand outcomes of targeted online information, which may ultimately contribute to improve peoples health/well‐being.

Patient Information Aid: Promoting the Right to Know, Evaluate, and Share Consumer Health Information Found on the Internet

Promoting the use of online consumer health information is critical to achieving the democratic right to know and cannot be separated from facilitating the process of finding and understanding this information. In addition, being informed and being able to share information with a clinician are fundamental principles enabling patient engagement in health care and shared decision making. Online consumer health information may contribute to positive patient outcomes such as improved knowledge, and even better health, while in some situations it also leads to increased worry. This type of negative outcome represents a common experience. Our health is important and therefore anything that touches our health can increase anxiety. In our view, worrying is not a disorder; only occasionally it is an incapacitating cyberchondria. Since 2005, our research has been exploring health information outcomes from the consumers’ viewpoint. We are particularly interested in information outcomes such as the types of information use and the types of subsequent health outcomes. Thus, we are currently engaged in a participatory systematic mixed studies review aimed to identify these types of outcomes, and develop a Patient Information Aid, an aid to empower consumers and patients to find, understand, assess, and use online consumer health information.

Organizational Participatory Research in North America

This chapter focuses on North American (NA) participatory health research (PHR), particularly with organizations. We begin by presenting the definition of PHR put forth by NA leaders in 1995 and, then, sketching the contributions of those who have led the field since, developing, promoting, and advocating for PHR in Canada and the United States. We then define PHR with health organizations, that is, organizational participatory research (OPR). The remainder of the chapter focuses on the results of a qualitative analysis of the 16 North American examples we identified in a previous systematic review of OPR, as well as on our own work. We use the sequence of a research study, from developing relationships with research partners to determining the focus of the study, analyzing the data, and examining the results, to illustrate how OPR has been conducted in North America. Subsequently, we describe the changes in knowledge, attitudes, and behaviors that have been linked to these processes. We conclude with a discussion on challenges of OPR that North Americans have faced and how they have dealt with them.

Overcoming the digital divide? Low education low income parents are equally likely to report benefits associated with online parenting information: Overcoming the Digital Divide? Low Education Low Income Parents Are Equally Likely to Report Benefits Associated with Online Parenting Information

Seeking consumer health and wellbeing information online is increasingly common. However, little is known about how people are using information targeted to a specific audience, and what happens as a result of this use. We partnered with Naitre & grandir (N&G), a magazine, website and newsletter offering trustworthy parenting information on child growth, development and health/wellbeing. This study was designed to uncover the outcomes of using online parenting information. We used the theory‐driven Information Assessment Method (IAM) to study parental perception regarding outcomes of specific N&G webpages. We asked this research question: Is there a difference between parents with a low level of education and income vs. other parents? Over an 18‐month study period, 1886 participants submitted 2532 IAM ratings that suggested N&G information was valuable in terms of situational relevance (97.2%), positive cognitive impact (99.7%), intention to use (97.9%) and expectation of benefits for child health and well‐being (69.6%). Results suggested parents with a low level of education and income were less likely to expect that N&G information can improve their childs health and wellbeing. However, there were no differences regarding parental worries, problem prevention, problem management, information exchange (e.g., with professionals) and confidence in decision‐making associated with information use. Results suggest trustworthy online parenting information for all persons, including parents with a low literacy level, can contribute to overcome the digital divide. To our knowledge, this is the first study to assess outcomes of emailed parenting information from a parental viewpoint. In future research, we will describe health and wellbeing outcomes illustrated through stories collected from parents.