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Russell RD, He J, Black LJ, Begley A. Evaluating Experiences in a Digital Nutrition Education Program for People With Multiple Sclerosis: A Qualitative Study. Health Expect 2024; 27:e70012. [PMID: 39207907 PMCID: PMC11361266 DOI: 10.1111/hex.70012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/11/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a complex immune-mediated disease with no currently known cure. There is growing evidence to support the role of diet in reducing some of the symptoms and disease progression in MS, and we previously developed and tested the feasibility of a digital nutrition education program for people with MS. OBJECTIVE The aim of this study was to explore factors that influenced engagement in the digital nutrition education program, including features influencing capability, opportunity and motivation to change their dietary behaviours. METHODS Semi-structured interviews were conducted with people who had MS, and who completed some or all of the program until data saturation was reached. Interviews were analysed inductively using thematic analysis. Themes were deductively mapped against the COM-B (Capability, Opportunity, Motivation, Behaviour) behaviour change model. RESULTS Sixteen interviews were conducted with participants who completed all (n = 10) or some of the program (n = 6). Four themes emerged: (1) acquiring and validating nutrition knowledge; (2) influence of time and social support; (3) getting in early to improve health and (4) accounting for food literacy experiences. DISCUSSION This is the first online nutrition program with suitable behavioural supports for people with MS. It highlights the importance of disease-specific and evidence-based nutrition education to support people with MS to make dietary changes. Acquiring nutrition knowledge, coupled with practical support mechanisms, such as recipe booklets and goal setting, emerged as crucial for facilitating engagement with the program. CONCLUSIONS When designing education programs for people with MS and other neurological conditions, healthcare professionals and program designers should consider flexible delivery and building peer support to address the needs and challenges faced by participants. PATIENT OR PUBLIC CONTRIBUTION Members of the MS Nutrition Research Program Stakeholder Reference Group, which includes people with MS and MS health professionals, provided input during the development of the nutrition education program and study design stages.
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Affiliation(s)
- R D Russell
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - J He
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - L J Black
- Curtin School of Population Health, Curtin University, Perth, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Australia
| | - A Begley
- Curtin School of Population Health, Curtin University, Perth, Australia
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Cubis L, McDonald S, Dean P, Ramme R, D'Cruz K, Topping M, Fisher F, Winkler D, Douglas J. Using the Knowledge to Action framework to improve housing and support for people with Multiple Sclerosis. BRAIN IMPAIR 2024; 25:IB23102. [PMID: 39094010 DOI: 10.1071/ib23102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 06/24/2024] [Indexed: 08/04/2024]
Abstract
Background People with Multiple Sclerosis (MS) have unique housing and support needs that are essential for maintaining independence at home; however, there is limited research to guide the design of community living options for this population. The aim of this study was to examine housing and support needs and preferences of people with MS with the intention to inform the planning of a co-designed intervention based on the study's findings. Methods Using the Knowledge to Action (KTA) framework, quantitative (n =79) and qualitative (n =6) data from people with MS were extracted and integrated from projects completed by the research team that explored the housing and support needs and preferences of people with disability. Results were synthesised and presented to a reference group for validation, contextualisation, and adaptation to the Australian context. Results High physical support needs were common across participants. People most commonly required home modifications to improve accessibility, such as ramps, equipment such as heating and cooling, and assistive technology. Many people required more than 8 hours per day of paid support. Moving into individualised housing facilitated independence and community reintegration. People reported gaps between what they wanted from support workers and what they received, citing individual and systemic barriers. Conclusion People with MS have support needs that require proactive and responsive funding arrangements, housing design and support provision. In line with KTA principles, findings will inform the planning of a co-designed intervention that involves people with lived experience of MS and other stakeholders to influence policy and improve home and living outcomes for this population.
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Affiliation(s)
- Lee Cubis
- Living with Disability Research Centre, La Trobe University, Melbourne, Vic, Australia; and Summer Foundation, Melbourne, Vic, Australia
| | - Sharyn McDonald
- Living with Disability Research Centre, La Trobe University, Melbourne, Vic, Australia; and School of Communication and Creative Arts, Deakin University, Melbourne, Vic, Australia; and School of Information and Communication Studies, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Pamela Dean
- Living with Disability Research Centre, La Trobe University, Melbourne, Vic, Australia
| | - Robin Ramme
- Living with Disability Research Centre, La Trobe University, Melbourne, Vic, Australia
| | - Kate D'Cruz
- Living with Disability Research Centre, La Trobe University, Melbourne, Vic, Australia; and Summer Foundation, Melbourne, Vic, Australia
| | - Megan Topping
- Living with Disability Research Centre, La Trobe University, Melbourne, Vic, Australia; and Summer Foundation, Melbourne, Vic, Australia
| | - Fiona Fisher
- Calvary Health Care Bethlehem, Caulfield South, Vic, Australia
| | - Di Winkler
- Living with Disability Research Centre, La Trobe University, Melbourne, Vic, Australia; and Summer Foundation, Melbourne, Vic, Australia
| | - Jacinta Douglas
- Living with Disability Research Centre, La Trobe University, Melbourne, Vic, Australia; and Summer Foundation, Melbourne, Vic, Australia
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3
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Li J, Street RL. What Encourages Patients to Recommend Their Doctor After an Online Medical Consultation? The Influence of Patient-Centered Communication, Trust, and Negative Health Information Seeking Experiences. HEALTH COMMUNICATION 2024:1-12. [PMID: 39044550 DOI: 10.1080/10410236.2024.2383801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The doctor-patient relationship in China has become increasingly tense, with patients lacking trust in doctors. Meanwhile, online healthcare flourished, accelerated by the COVID-19 pandemic. This study utilized the direct and indirect pathway model of clinician-patient communication to health outcomes and online trust theory to examine the associations between online patient-centered communication (OPCC), benevolence and ability trust in doctors, negative online health information seeking experiences, and willingness to recommend doctors. The findings revealed that benevolence and ability trust mediated the relationship between OPCC and willingness to recommend doctors. Additionally, when participants had a high level of negative online health information seeking experiences, OPCC had a stronger effect on ability trust; meanwhile, the mediation effect of ability trust between the relationship of OPCC and willingness to recommend was stronger. This study also discussed theoretical and practical implications.
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Affiliation(s)
- Jinxu Li
- Department of Communication and Journalism, Texas A&M University
| | - Richard L Street
- Department of Communication and Journalism, Texas A&M University
- Department of Medicine, Baylor College of Medicine
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Ingravallo F, D'Alterio A, Rossetti A, Antelmi E, Plazzi G. Disclosing the Risk Associated with Isolated REM Behavior Disorder: The Sleep Experts' Perspective. Mov Disord Clin Pract 2024; 11:488-495. [PMID: 38341655 PMCID: PMC11078490 DOI: 10.1002/mdc3.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/21/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Isolated rapid-eye-movement sleep behavior disorder (iRBD) is associated with a high risk for phenoconversion to a neurodegenerative disorder, but the optimal approach for disclosure of this risk to patients is still debated. OBJECTIVES The aim of this study was to explore views and experiences of iRBD experts regarding risk disclosure. METHODS In this qualitative study, semi-structured interviews with sleep experts caring for patients with iRBD were analyzed through a conventional content analysis approach. RESULTS We interviewed 22 iRBD experts (eight female, average age of 51.8 years) from 18 Italian sleep centers; 21/22 regularly disclosed the risks associated with iRBD, usually after the video-polysomnography, and 8/22 regularly mentioned phenoconversion rates. Content analysis allowed us to identify three main themes. First, sleep experts reported several points in favor of risk disclosure, especially related to the principle of beneficence, but some highlighted the need for specific learning on the topic. Second, experts favored a patient-tailored disclosure that should not upset the patient unnecessarily, since phenoconversion is uncertain. Third, risk disclosure was seen by participants as a relational task that should be carried out in person in the context of a trusting patient-physician relationship, while they had contrasting views regarding patients' previous knowledge. CONCLUSIONS Sleep experts generally preferred a tailored and reassuring approach to risk disclosure within a framework of relational autonomy. The results of this study indicate the need for specific education, training, and recommendations concerning risk disclosure that should also include patients' and families' preferences.
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Affiliation(s)
- Francesca Ingravallo
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Alessandra D'Alterio
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Andrea Rossetti
- Department of Medical and Surgical Sciences (DIMEC)University of BolognaBolognaItaly
| | - Elena Antelmi
- Department of Engineering and Medicine of Innovation (DIMI)University of VeronaVeronaItaly
| | - Giuseppe Plazzi
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
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Bevens W, Davenport R, Neate S, Yu M, Jelinek P, Jelinek GA, Reece J. Web-Based Health Information Seeking by People Living With Multiple Sclerosis: Qualitative Investigation of the Multiple Sclerosis Online Course. J Med Internet Res 2024; 26:e53372. [PMID: 38335016 PMCID: PMC10891496 DOI: 10.2196/53372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Digital technologies have afforded people living with multiple sclerosis (MS) access to telehealth consultations, diagnostic tools, and monitoring. Although health care professionals remain the most trusted source of information, the internet has emerged as a valuable resource for providing MS-related information, particularly during the COVID-19 pandemic. Notably, people living with MS are increasingly seeking educational content for a range of topics related to the self-management of MS; however, web-based information seeking remains largely underevaluated. To address this gap and ensure that web-based health-related information is accessible and engaging, this study used qualitative methods to analyze the reflections from participants of web-based educational programs for people living with MS. OBJECTIVE This study aimed to explore the motivations, behaviors, and expectations of web-based health information seeking for people living with MS. METHODS We conducted semistructured interviews for 38 people living with MS 1 month after they completed the novel MS Online Course, which provided information on modifiable lifestyle-related risk factors for people living with MS. Of the 38 participants, 22 (58%) completed the intervention course and 16 (42%) completed the standard care course. Inductive thematic analysis was used within a qualitative paradigm, and 2 authors coded each interview separately and arrived at themes with consensus. RESULTS We identified 2 themes: motivation to learn and MS information on the web. The diagnosis of MS was described as a pivotal moment for precipitating web-based information seeking. People living with MS sought lifestyle-related information to facilitate self-management and increase control of their MS. Although social media sites and MS websites were considered useful for providing both support and information, discretion was needed to critically appraise information. Recognizable institutions were frequently accessed because of their trustworthiness. CONCLUSIONS This study provided novel insights into the motivations of people living with MS for seeking web-based health information. Furthermore, their preferences for the content and format of the web-based information accessed and their experiences and reactions to this information were explored. These findings may guide educators, researchers, and clinicians involved in MS care to optimize the engagement and processing of web-based health information seeking by people living with MS.
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Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
- Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, United States
| | - Rebekah Davenport
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia
| | - Sandra Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Maggie Yu
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Pia Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - George Alexander Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Jeanette Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
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Newsome SD, Binns C, Kaunzner UW, Morgan S, Halper J. No Evidence of Disease Activity (NEDA) as a Clinical Assessment Tool for Multiple Sclerosis: Clinician and Patient Perspectives [Narrative Review]. Neurol Ther 2023; 12:1909-1935. [PMID: 37819598 PMCID: PMC10630288 DOI: 10.1007/s40120-023-00549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
The emergence of high-efficacy therapies for multiple sclerosis (MS), which target inflammation more effectively than traditional disease-modifying therapies, has led to a shift in MS management towards achieving the outcome assessment known as no evidence of disease activity (NEDA). The most common NEDA definition, termed NEDA-3, is a composite of three related measures of disease activity: no clinical relapses, no disability progression, and no radiological activity. NEDA has been frequently used as a composite endpoint in clinical trials, but there is growing interest in its use as an assessment tool to help patients and healthcare professionals navigate treatment decisions in the clinic. Raising awareness about NEDA may therefore help patients and clinicians make more informed decisions around MS management and improve overall MS care. This review aims to explore the potential utility of NEDA as a clinical decision-making tool and treatment target by summarizing the literature on its current use in the context of the expanding treatment landscape. We identify current challenges to the use of NEDA in clinical practice and detail the proposed amendments, such as the inclusion of alternative outcomes and biomarkers, to broaden the clinical information captured by NEDA. These themes are further illustrated with the real-life perspectives and experiences of our two patient authors with MS. This review is intended to be an educational resource to support discussions between clinicians and patients on this evolving approach to MS-specialized care.
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Affiliation(s)
- Scott D Newsome
- Johns Hopkins University School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD, 21287, USA.
| | - Cherie Binns
- Multiple Sclerosis Foundation, 6520 N Andrews Avenue, Fort Lauderdale, FL, 33309, USA
| | | | - Seth Morgan
- National Multiple Sclerosis Society, 1 M Street SE, Suite 510, Washington, DC, 20003, USA
| | - June Halper
- Consortium of Multiple Sclerosis Centers, 3 University Plaza Drive Suite A, Hackensack, NJ, 07601, USA
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Ahn J, Kahlor LA. When Experts Offer Conflicting Information: A Study of Perceived Ambiguity, Information Insufficiency, Trustworthiness and Risk Information Behaviors. HEALTH COMMUNICATION 2023; 38:3276-3286. [PMID: 36404712 DOI: 10.1080/10410236.2022.2146033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This study conducted an experiment to examine the impact of informational conflicts about COVID-19 transmission routes on cognitive and behavioral factors. We were guided by the risk information seeking and processing model and focused on relationships among perceived ambiguity, information insufficiency, trustworthiness, and seeking/avoidance across several conditions. Data from 304 participants indicated a higher level of perceived ambiguity in the conflicting information condition compared to the one-sided information condition. The serial mediations suggest conflicting information enhanced perceived ambiguity, which was negatively related with trustworthiness of experts, information seeking, and adherence intentions. These findings shed light on how conflicting information negatively affects the decision-making process and provide insight about what to consider when presenting dynamic information to the public.
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Affiliation(s)
- Jisoo Ahn
- Department of Media and Advertising, Dong-Eui University
| | - Lee Ann Kahlor
- Advertising and Public Relations School, Moody College of Communication, The University of Texas at Austin
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Stormacq C, Oulevey Bachmann A, Van den Broucke S, Bodenmann P. How socioeconomically disadvantaged people access, understand, appraise, and apply health information: A qualitative study exploring health literacy skills. PLoS One 2023; 18:e0288381. [PMID: 37556436 PMCID: PMC10411818 DOI: 10.1371/journal.pone.0288381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 06/26/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES Health literacy, or a person's competence to access, understand, appraise and apply health information, can be considered a mediating factor between socioeconomic characteristics and health disparities. Socioeconomically disadvantaged people in particular present with less health literacy skills. To develop targeted interventions tailored to their real needs, it is important to understand how they function and what difficulties they encounter when dealing with health information. The purpose of this study was to explore their experiences when accessing, understanding, appraising, and applying health information in their everyday lives. METHODS Semi-structured face-to-face interviews were conducted with 12 socioeconomically disadvantaged adults living in the community in Switzerland (age range: 44-60 years old). RESULTS Thematic analysis of the interviews yielded four themes, describing the health literacy processes of participants, related barriers, and compensatory strategies used: Financial insecurity triggers the need for health information; Pathway 1: Physicians as ideal (but expensive) interlocutors; Pathway 2: The internet as a suboptimal alternative; and Pathway 3: Relatives as a default resource. The progression of socioeconomically disadvantaged people in the health literacy process is like an 'obstacle course', with numerous steps taken backwards before they can develop compensatory strategies to overcome the barriers to obtaining health information. CONCLUSIONS Financial deprivation seems to be the most important factor contributing to health literacy barriers. Appraising health information is the health literacy skill with which socioeconomically disadvantaged people struggle the most. Physician-based, individual skills-based, organizational, and policy-based interventions are needed to help them overcome their health literacy challenges.
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Affiliation(s)
- Coraline Stormacq
- University Center for General Medicine and Public Health (Unisanté), Department of Vulnerabilities and Social Medicine, University of Lausanne, Lausanne, Switzerland
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Annie Oulevey Bachmann
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Stephan Van den Broucke
- Faculty of Psychology and Educational Sciences, Psychological Sciences Research Institute (IPSY), Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Patrick Bodenmann
- University Center for General Medicine and Public Health (Unisanté), Department of Vulnerabilities and Social Medicine, University of Lausanne, Lausanne, Switzerland
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Singh G, Sawatzky B, Nimmon L, Mortenson WB. Perceived eHealth literacy and health literacy among people with spinal cord injury: A cross-sectional study. J Spinal Cord Med 2023; 46:118-125. [PMID: 35254229 PMCID: PMC9897799 DOI: 10.1080/10790268.2021.1963140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This purpose of this research was to (1) to evaluate eHealth and general health literacy levels among individuals with spinal cord injury (SCI) and (2) to identify relationships between eHealth literacy, general health literacy, and various sociodemographic factors. DESIGN Cross-sectional. SETTING The study was conducted in the community setting. PARTICIPANTS As part of a larger study, a total of 50 community-dwelling individuals with SCI were recruited. INTERVENTIONS n/a. OUTCOME MEASURES Quantitative online survey data were collected on participants' sociodemographic characteristics, eHealth literacy (using the eHealth Literacy Scale), general health literacy (using the Brief Health Literacy Screening Tool). RESULTS The average age of participants was 49 years old; 25 participants were male and 25 were female. A total of 39 participants experienced traumatic SCI and 11 participants experienced non-traumatic SCI. Participants demonstrated moderate levels of eHealth literacy (31.6 out of 40) and general health literacy (17.6 out of 20). A significant, positive correlation was found between eHealth literacy and general health literacy. Significant, positive correlations were found between general health literacy and sociodemographic factors, including income and education. A significant, negative correlation was found between general health literacy and time since injury. CONCLUSION No previous studies we are aware of have evaluated perceived eHealth literacy and general health literacy among people with SCI. This study demonstrated the diverse range of eHealth literacy levels in SCI populations and how this, and other factors, may impact an individual's ability to self-manage and adopt to eHealth technologies.
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Affiliation(s)
- Gurkaran Singh
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada.,G.F. Strong Rehabilitation Centre, Vancouver, Canada
| | - Bonita Sawatzky
- International Collaboration on Repair Discoveries, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Laura Nimmon
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada.,Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - W Ben Mortenson
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada.,G.F. Strong Rehabilitation Centre, Vancouver, Canada
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Neate SL, Bevens W, Jelinek PL, Gray KM, Weiland TJ, Nag N, Simpson-Yap S, Jelinek GA, Yu M, Reece JC. A multiple sclerosis lifestyle behavior online course: Qualitative analysis of participants' motivations, expectations and experiences. Front Public Health 2022; 10:1022185. [PMID: 36568793 PMCID: PMC9768550 DOI: 10.3389/fpubh.2022.1022185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Background Modification of lifestyle-related risk factors for multiple sclerosis (MS) has been associated with improved health outcomes when compared with standard medical management alone. Based on an existing lifestyle modification program offered as a residential workshop, the MS Online Course (MSOC) was developed to translate the workshop into an online intervention. We performed a pilot randomized controlled trial (RCT), to assess the feasibility concepts of accessibility, learnability and desirability through quantitative and qualitative analyzes. In the present study, we performed additional qualitative analyzes to explore participants' motivations, expectations, and experiences of the MSOC. This study aims to complement prior feasibility analyzes and inform recruitment strategies and course content redevelopment so that its effectiveness may be assessed by examining behavior change and health outcomes in a future larger RCT. Methods Participants were recruited via online advertisements and randomized to either: the standard care course, containing material sourced from public facing MS websites; or the intervention course, based on an evidence-based lifestyle modification program for people with MS. Course completers were invited to participate in semi-structured interviews. Within a qualitative paradigm, reflexive thematic analysis of interviews was undertaken. Results Of 31 eligible participants, 17 completed the MSOC and 14 agreed to be interviewed. Four themes were identified in this analysis: (1) "Wanting to help others" (helping through volunteering, contributing to knowledge base, spreading the word; (2) "Seeking knowledge" (confirmation of existing knowledge; obtaining new knowledge, relevant, credible information); (3) "Doing what I can to help myself" (understanding lifestyle modification, changing my lifestyle, remaining well); and (4) "Changing attitudes" (finding positivity, feeling more confident and in control). Conclusions Participants were motivated to help others through research, help themselves by improving knowledge and to find ways to better manage their MS. Expectations included obtaining credible, reliable information, to substantiate existing knowledge, and to further understand lifestyle modification. Participants' experiences included confirmation of and obtaining new knowledge, and early implementation of modified lifestyle behaviors. These insights surrounding participants' motivations, expectations and experiences will assist in recruitment strategies, course redevelopment and outcome measures for the future RCT to examine the effectiveness of the MSOC.
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Affiliation(s)
- Sandra L. Neate
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia,*Correspondence: Sandra L. Neate
| | - William Bevens
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Pia L. Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kathleen M. Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, VIC, Australia
| | - T. J. Weiland
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nupur Nag
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Steve Simpson-Yap
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia,MS Flagship, Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - M. Yu
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jeanette C. Reece
- Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Sippel A, Riemann-Lorenz K, Pöttgen J, Wiedemann R, Drixler K, Bitzer EM, Holmberg C, Lezius S, Heesen C. Validation of the German eHealth impact questionnaire for online health information users affected by multiple sclerosis. BMC Med Inform Decis Mak 2022; 22:219. [PMID: 35974395 PMCID: PMC9380659 DOI: 10.1186/s12911-022-01968-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Persons with multiple sclerosis (MS) are confronted by an overwhelming amount of online health information, which can be valuable but also vary in quality and aim. Therefore, it is of great importance for developers and providers of eHealth information to understand its impact on the users. The eHealth Impact Questionnaire (eHIQ) has been developed in the United Kingdom to measure the potential effects of health and experimental information websites. This contains user’s general attitudes towards using the internet to gain health information and attitudes towards a specific health related website. The self-complete questionnaire is divided into two independently administered and scored parts: the 11-item eHIQ part 1 and the 26-item eHIQ part 2. This study aimed to validate the psychometric properties of the German version of the eHealth Impact Questionnaire (eHIQ-G). Methods 162 people with multiple sclerosis browsed one of two possible websites containing information on MS and completed an online survey. Internal consistency was assessed by Cronbach’s alpha and structural validity by Confirmatory Factor Analysis. Construct validity was examined by assessing correlations with the reference instruments eHealth Literacy Questionnaire and the General Self-Efficacy Scale measuring related, but dissimilar constructs. Moreover, we investigated the mean difference of the eHIQ-G score between the two websites. Data were analyzed using SPSS and AMOS software. Results The eHIQ-G subscales showed high internal consistency with Cronbach’s alpha from 0.833 to 0.885. The 2-factor model of eHIQ part 1 achieved acceptable levels of goodness-of-fit indices, whereas the fit for the 3-factor model of eHIQ part 2 was poor and likewise for the alternative modified models. The correlations with the reference instruments were 0.08–0.62 and as expected. Older age was related with lower eHIQ part 1 score, whereas no significant effect was found for education on eHIQ part 1. Although not significant, the website ‘AMSEL’ reached higher mean scores on eHIQ part 2. Conclusions The eHIQ-G has good internal consistency, and sufficient structural and construct validity. This instrument will facilitate the measurement of the potential impact of eHealth tools. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01968-6.
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Affiliation(s)
- Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jana Pöttgen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Long-term prognosis communication preferences in early-stage relapsing-remitting multiple sclerosis. Mult Scler Relat Disord 2022; 64:103969. [PMID: 35728432 DOI: 10.1016/j.msard.2022.103969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/23/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multiple sclerosis is one of the most common causes of neurological disability in young adults with major consequences for their future lives. Improving communication strategies on prognosis may help patients deal with the disease and adjust their long-term life goals. However, there is limited information on patients' preferences of long-term prognosis (LTP) communication and associated factors. OBJECTIVE The aim of this study was to describe patients' preferences and assess the factors associated with LTP communication preferences in early-stage relapsing-remitting multiple sclerosis (RRMS) patients. METHODS A multicenter, non-interventional study was conducted. Adult patients with a diagnosis of RRMS, a disease duration from first attack ≤ 3 years, and an Expanded Disability Status Scale (EDSS) score of 0-5.5 were included. The Prognosis in MS questionnaire was used to assess how much patients want to know about their LTP. Different patient-reported measures were administered to gather information on symptom severity, pain, fatigue, mood/anxiety, quality of life, stigma, illness perception, feeling of hopelessness, self-efficacy, information avoidance and coping strategies. Cognition was assessed using the Symbol Digit Modalities Test (SDMT). A multivariate logistic regression analysis was performed to assess the association between LTP information preference and demographic and clinical characteristics, as well as patients' perspectives. RESULTS A total of 189 patients were included (mean age: 36.1 ± 9.4 years, 71.4% female, mean disease duration: 1.2 ± 0.8 years). Median EDSS score was 1.0 (IQR = 0.0-2.0). A proportion of 68.5% (n = 126) of patients had never discussed LTP with their neurologists, whereas 69.2% (n = 126) reported interest in knowing it (73.5% at diagnosis). Bivariate analyses suggested that patients were significantly more likely to have higher LTP information preferences if they were male and had a lower SDMT score. Male gender and a lower SDMT score were predictors of LTP information preferences. CONCLUSIONS Patients with early-stage RRMS want to discuss their LTP shortly after diagnosis. Understanding the factors involved may be useful to design individualized communication strategies.
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13
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Frattaroli JM, Torto FL, Turriziani G, Bruno E, Marcasciano M, Ribuffo D. Quality of online information about migraine headache surgery. J Plast Reconstr Aesthet Surg 2022; 75:3603-3607. [DOI: 10.1016/j.bjps.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/24/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
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14
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Development and evaluation of a website with patients experiences of multiple sclerosis: a mixed methods study. BMC Neurol 2022; 22:146. [PMID: 35443631 PMCID: PMC9019288 DOI: 10.1186/s12883-022-02663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A variety of management options (e.g., disease-modifying therapy, lifestyle interventions, rehabilitation) are available for persons with relapsing-remitting multiple sclerosis (MS). Besides coping with the diagnosis, persons with MS have to make complex decisions, e.g., regarding disease-modifying therapies. In addition to factual information, reports of patient experiences may support other patients in their decision-making. Therefore, we developed a website presenting patient experiences illustrated by video, audio and text files. This study aimed to test the acceptability and usability of a website with patient experiences with MS. METHODS A mixed-methods approach was applied. A total of 69 participants visited the German "Patient Experiences with MS (PExMS)" website and among them, 50 persons with MS and 6 experts completed an online survey. In total, 18 participants took part in telephone interviews or focus groups. Data from the survey were analysed using descriptive statistics. Qualitative data were analysed using thematic analysis. RESULTS Both quantitative and qualitative responses suggest that the PExMS website was viewed positively by patients and experts. 94% of persons with MS agreed that the information was comprehensible and reliable. 54% felt encouraged to share their health problems with others after having studied the website. 74% claimed to use the website if they had to make a decision regarding their health. Qualitative responses deduced from the website fell into 5 key themes: (1) web design, appearance, and functionality, (2) content, (3) usability, (4) satisfaction, and (5) loyalty. The search for persons of similar age and with comparable experiences was a major driving force to navigate the website. The material on the website was perceived as diverse, covering both positive and negative experiences in daily living with MS. All participants greatly appreciated having access to other people's experiences online and judged the material on the website as particularly helpful in decision-making for disease-modifying therapies. CONCLUSIONS The findings suggest that the PExMS website might have the potential to be a useful source of audio-visual information for persons with MS. Given the lack of websites available to patients with experiential information, health care professionals may be encouraged to routinely inform patients about this website at regular appointments.
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15
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Singh G, Nimmon L, Sawatzky B, Ben Mortenson W. Barriers and Facilitators to eHealth Technology Use Among Community-Dwelling Individuals With Spinal Cord Injury: A Qualitative Study. Top Spinal Cord Inj Rehabil 2022; 28:196-204. [PMID: 35521060 PMCID: PMC9009201 DOI: 10.46292/sci21-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background As eHealth technologies become a more prevalent means to access care and self-manage health, it is important to identify the unique facilitators and barriers to their use. Few studies have evaluated the use or potential use of eHealth technologies in spinal cord injury (SCI) populations. Objectives The primary objective of this study was to explore and identify barriers and facilitators to engagement with eHealth technologies among individuals with SCI. Methods A qualitative descriptive study was conducted. Data were collected via one-on-one, semi-structured interviews with a subsample of 20 community-dwelling participants enrolled in a larger clinical trial. Analysis of the transcripts was undertaken using a four-phase process of content analysis. Results Our analysis identified three barriers to engagement with eHealth technologies, including (1) overcoming a digital divide to comprehending and utilizing eHealth technologies, (2) navigating internet resources that provide too much information, and (3) interacting with these technologies despite having limited hand function. Our analysis also identified three facilitators to using eHealth technologies, including (1) having previous successful experiences with eHealth technologies, (2) being able to use voice activation features, and (3) being able to interact in an online community network. Conclusion By exploring barriers and facilitators to eHealth technology use, these findings may have a short-term impact on informing researchers and clinicians on important factors affecting engagement of individuals with SCI with telemedicine, mobile, and web applications (apps) and a long-term impact on informing future development of eHealth interventions and tools among chronic disease populations.
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Affiliation(s)
- Gurkaran Singh
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
,International Collaboration on Repair Discoveries, Vancouver, Canada
,G.F. Strong Rehabilitation Centre, Vancouver, Canada
| | - Laura Nimmon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
,Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Bonita Sawatzky
- International Collaboration on Repair Discoveries, Vancouver, Canada
,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - W. Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
,International Collaboration on Repair Discoveries, Vancouver, Canada
,G.F. Strong Rehabilitation Centre, Vancouver, Canada
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16
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Bevens W, Reece J, Jelinek PL, Weiland TJ, Nag N, Simpson-Yap S, Gray K, Jelinek GA, Neate SL. The feasibility of an online educational lifestyle program for people with multiple sclerosis: A qualitative analysis of participant semi-structured interviews. Digit Health 2022; 8:20552076221123713. [PMID: 36081754 PMCID: PMC9445470 DOI: 10.1177/20552076221123713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the feasibility of a randomised controlled trial of a multiple sclerosis online course (MSOC) via qualitative analysis of participant semi-structured interviews. Methods The MSOC was developed in two arms: intervention arm which contained evidence-based lifestyle modification recommendations, and standard-care arm which delivered information from MS websites reflecting standard advice. Participants were recruited via online advertisements, completed a baseline questionnaire, and randomised. Seven modules were delivered over six weeks. Course completers were invited to participate in semi-structured interviews. Within a qualitative paradigm, interviews were analysed using reflexive thematic analysis. Results Fourteen of the 17 course completers were interviewed: 86% (12/14) female; mean age 50 years; residing in Australia, New Zealand, and the USA, predominantly had relapsing-remitting MS, mean time from diagnosis 9.5 years, and patient-determined disease steps disability assessment distributed evenly across all three categories. Four themes were identified: 1) “Hearing our stories” (hope for the future, feeling represented, exploring the journey of others with MS, learning from diversity, and wanting to connect with others); 2) “Taking the plunge” (not wanting to be first, feelings of nervousness or reluctance and feeling confronted); 3) “The accessibility and safety of being online” (ease of access, going at your own pace, making it work and not letting others down); and 4) “unpacking the course” (ease of navigation, visuals, understandability, and length and timing). Conclusion Participants felt represented, found the course accessible and content was easy to understand. These experiences provide important insights and considerations for this digital health intervention.
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Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - J Reece
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - PL Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - TJ Weiland
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - N Nag
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - S Simpson-Yap
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - K Gray
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - GA Jelinek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - SL Neate
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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17
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Sun W, Luo A, Bian Z, Zhao B, Liu P, Wang K, Liu Y, Xie W, Wang F. Assessing the Quality of Online Health Information About Breast Cancer from Chinese Language Websites: Quality Assessment Survey. JMIR Cancer 2021; 7:e25783. [PMID: 34792471 PMCID: PMC8663447 DOI: 10.2196/25783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/22/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022] Open
Abstract
Background In China, the internet has become one of the most important ways to obtain information about breast cancer. However, quantitative evaluations of the quality of Chinese health websites and the breast cancer treatment information they publish are lacking. Objective This study aimed to evaluate the quality of Chinese breast cancer websites and the value, suitability, and accuracy of the breast cancer treatment information they publish. Methods Chinese breast cancer health websites were searched and manually screened according to their Alexa and Baidu search engine rankings. For each website included in the survey, which was conducted on April 8, 2019, the three most recently published papers on the website that met the inclusion criteria were included for evaluation. Three raters assessed all materials using the LIDA, DISCERN, and Suitability Assessment of Materials (SAM) tools and the Michigan Checklist. Data analysis was completed with the Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results This survey included 20 Chinese breast cancer websites and 60 papers on breast cancer treatment. The LIDA tool was used to evaluate the quality of the 20 websites. The LIDA’s scores of the websites (mean=54.85, SD 3.498; total possible score=81) were low. In terms of the layout, color scheme, search facility, browsing facility, integration of nontextual media, submission of comments, declaration of objectives, content production method, and robust method, more than half of the websites scored 0 (never) or 1 (sometimes). For the online breast cancer treatment papers, the scores were generally low. Regarding suitability, 32 (53.33%) papers were evaluated as presenting unsuitable material. Regarding accuracy, the problems were that the papers were largely not original (44/60, 73%) and lacked references (46/60, 77%). Conclusions The quality of Chinese breast cancer websites is poor. The color schemes, text settings, user comment submission functions, and language designs should be improved. The quality of Chinese online breast cancer treatment information is poor; the information has little value to users, and pictorial information is scarcely used. The online breast cancer treatment information is accurate but lacks originality and references. Website developers, governments, and medical professionals should play a full role in the design of health websites, the regulation of online health information, and the use of online health information.
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Affiliation(s)
- Weiwei Sun
- School of Health Management, Bengbu Medical College, Bengbu, China
| | - Aijing Luo
- The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Medical Information Research, College of Hunan Province, Central South University, Changsha, China
| | - Zhiwei Bian
- School of Health Management, Bengbu Medical College, Bengbu, China
| | - Bin Zhao
- School of Health Management, Bengbu Medical College, Bengbu, China
| | - Peng Liu
- School of Health Management, Bengbu Medical College, Bengbu, China
| | - Kai Wang
- School of Health Management, Bengbu Medical College, Bengbu, China
| | - Yuwen Liu
- School of Health Management, Bengbu Medical College, Bengbu, China
| | - Wenzhao Xie
- Key Laboratory of Medical Information Research, College of Hunan Province, Central South University, Changsha, China.,The Third Xiangya Hospital, Central South University, Cahngsha, China
| | - Fuzhi Wang
- School of Health Management, Bengbu Medical College, Bengbu, China
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18
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McKay A. How access to online health information affects the dental hygiene client experience. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2021; 55:182-186. [PMID: 34925519 PMCID: PMC8641553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Due to the widespread availability of online information, oral care providers are no longer the main source of oral health information for clients. This shift in the balance of knowledge has the potential to alter clients' experiences and relationships with their oral care providers, including dental hygienists. This review explores how access to online health information has influenced clients' experiences with their dental hygienists. METHOD A narrative literature review of quantitative, qualitative, and mixed,method studies concerning clients' experiences with online health information and how it has influenced the client-health care professional relationship was completed. The electronic databases searched were Google ScholarTM, PubMed, and CINAHL. Twenty-three studies published between 2005 and 2020 were included. RESULTS AND DISCUSSION The majority of clients used the internet to access health information to be better informed about health issues. Both clients and health care providers had concerns about the legitimacy and accuracy of various online information sources. Clients faced various communication facilitators and barriers when discussing this information with their health care provider. A positive response by the health care provider led to an improved client-clinician relationship, whereas a negative response led to distrust among all parties. Clients would be open to e-health literacy training by their dental hygienists. CONCLUSION Clients' access to online health information can either improve or worsen their experiences and relationships with their dental hygienists, depending on the response by the dental hygienist when these topics are broached. Dental hygienists should consider taking time to provide e-health literacy training to clients during consultations.
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Affiliation(s)
- Amanda McKay
- Alumna, Dental Hygiene Degree Completion Program, University of British Columbia, Vancouver, BC, Canada
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19
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Bergien S, Petersen CM, Lynning M, Kristiansen M, Skovgaard L. "I need personal experiences or some sort of documentation": a qualitative study on where people with multiple sclerosis seek information on dietary and herbal supplements. BMC Complement Med Ther 2021; 21:213. [PMID: 34419015 PMCID: PMC8379853 DOI: 10.1186/s12906-021-03377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background The use of dietary and herbal supplements (DIHES) is widespread among people with multiple sclerosis (PwMS). PwMS are a highly informed patient group, and they use several types of sources to seek information on subjects related to their disease. However, it is still unknown where PwMS seek information about DIHES. It is important that PwMS make decisions about DIHES based on accurate, useful and accessible information. Therefore, the aim of this study was to explore where PwMS seek information on DIHES and how they experience and engage with this information. Methods Semi-structured interviews were conducted with eighteen PwMS using DIHES. Participants were selected from a cross-sectional survey. Diversity sampling was used, based on relevant characteristics such as gender and number of DIHES used during the past 12 months. The interviews were conducted face-to-face or over the telephone and lasted between 30 min and 1 hour. The interviews were recorded, transcribed verbatim, and analyzed using thematic network analysis in NVivo 12 Pro software. Results Three main themes emerged in the analysis: i) engaging with healthcare professionals (HCPs) regarding DIHES, ii) social networks as a source of information regarding DIHES, and iii) reliance on bodily sensations. Most participants navigated all three types of sources. All participants had at some point discussed DIHES with an HCP. Information from HCPs was considered reliable and valuable, but HCPs were viewed as uncommitted to the dialogue about DIHES. Recommendations from others were often the driver of decisions regarding use of DIHES. However, the information from PwMS’ networks could be overwhelming and difficult to navigate. Finally, PwMS relied on their own experiences regarding DIHES and let their bodily sensations guide their use of DIHES. Conclusions Participants often rely on all three types of information sources to create a nuanced and comprehensive information base. However, PwMS may feel overwhelmed or confused with all the information they have gathered. These findings indicate the need for better guidance for PwMS concerning DIHES and an openness among HCPs to engage in dialogue. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03377-0.
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Affiliation(s)
- Sofie Bergien
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, Denmark.
| | - Clara M Petersen
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, Denmark
| | - Marie Lynning
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, Denmark
| | - Maria Kristiansen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen K, Denmark
| | - Lasse Skovgaard
- The Danish Multiple Sclerosis Society, Poul Bundgaards Vej 1, Valby, Denmark
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20
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Wollmann K, der Keylen PV, Tomandl J, Meerpohl JJ, Sofroniou M, Maun A, Voigt-Radloff S. The information needs of internet users and their requirements for online health information-A scoping review of qualitative and quantitative studies. PATIENT EDUCATION AND COUNSELING 2021; 104:1904-1932. [PMID: 33563502 DOI: 10.1016/j.pec.2021.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/05/2021] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This scoping review has been conducted to summarise the information needs of internet users and their requirements for online health information. METHODS We searched MEDLINE, Web of Science and Scopus up to July 2019. Qualitative, quantitative and mixed-method studies were included and a thematic synthesis with category formation and exact description of the items was carried out. RESULTS 118 studies were included. To address all users' needs mentioned in the included studies, we grouped them into nine main categories: authority, comprehension, currency, evidence-based information, exchange with others, independence, purpose, services, user experience. The evaluation showed that website users wanted qualifications of authors to be cited. Users preferred health information that offered interactive elements and resources for relatives, whilst also providing an opportunity for online contact with others. The ease with which information was accessed and the intelligibility of texts were regarded as being very important to users. CONCLUSION Given the rapid evolvement and changes of online health information, it is crucial to provide up to date insights and a comprehensive overview of the range of criteria. PRACTICE IMPLICATIONS With the results obtained through this scoping review, the creators of online health information could be assisted in providing user-specific resources.
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Affiliation(s)
- Katharina Wollmann
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
| | - Piet van der Keylen
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany.
| | - Johanna Tomandl
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of General Practice, Erlangen, Germany.
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
| | - Mario Sofroniou
- Institute for General Practice/Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Andy Maun
- Institute for General Practice/Primary Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center - University of Freiburg, Germany.
| | - Sebastian Voigt-Radloff
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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21
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Chen AT. Interactions between affect, cognition, and information behavior in the context of fibromyalgia. J Assoc Inf Sci Technol 2021. [DOI: 10.1002/asi.24538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Annie T. Chen
- Biomedical Informatics and Medical Education UW Medicine South Lake Union Seattle Washington USA
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22
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Zimmermann BM, Fanderl J, Koné I, Rabaglio M, Bürki N, Shaw D, Elger B. Examining information-seeking behavior in genetic testing for cancer predisposition: A qualitative interview study. PATIENT EDUCATION AND COUNSELING 2021; 104:257-264. [PMID: 32988685 DOI: 10.1016/j.pec.2020.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/12/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aims to assess information needs and information sources and seeks to illustrate what at-risk individuals consider motivators of and barriers to information-seeking before and after genetic testing for cancer predisposition. METHODS Semi-structured interviews with people seeking genetic counseling in Switzerland were analyzed qualitatively using thematic analysis. Wilson's model of information behavior was the theoretical framework. RESULTS We identified four themes that illustrate motivators of and barriers to information-seeking: attitudes and emotions; knowledge; social environment; and demographic factors. We also elucidated information needs and collected participants' information sources. CONCLUSION This study£s empirical approach helps healthcare professionals to understand their patients' behaviors and wishes concerning information-seeking more concretely than theoretical models alone. The study also identifies information gaps, especially outside the genetic counseling setting. PRACTICE IMPLICATIONS Genetic counselors and other healthcare professionals need to purposefully assist patients in finding trustworthy and accessible information. Healthcare professionals in all disciplines need to be educated about predictive genetic testing.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland; Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany.
| | - Julia Fanderl
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Bürki
- Women's Clinic and Gynecological Oncology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland; Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland; Center for Legal Medicine, University of Geneva, Geneva, Switzerland
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Rahn AC, Solari A, Beckerman H, Nicholas R, Wilkie D, Heesen C, Giordano A. "I Will Respect the Autonomy of My Patient": A Scoping Review of Shared Decision Making in Multiple Sclerosis. Int J MS Care 2021; 22:285-293. [PMID: 33424485 DOI: 10.7224/1537-2073.2020-027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Patient autonomy is a bioethical principle that was strengthened in the revised Declaration of Geneva. Shared decision making (SDM) is particularly relevant in the management of multiple sclerosis (MS) because many preference-sensitive decisions have to be made during the disease course. We aimed to summarize the available evidence on SDM in the MS field and to inform future research and practice. Methods We performed a scoping review by searching MEDLINE (past 5 years). Studies were included if they reported primary/secondary research and focused on SDM related to people with MS. Data were grouped into topics, with results presented in narrative form. Results From 865 references, we included 55 studies conducted mostly in Europe. Half of the studies were observational, followed by qualitative (20%), mixed-methods (17%), randomized controlled trials (RCTs, 5%), quasi-experimental (5%), and reviews (4%). Most studies addressed people with relapsing-remitting MS (85%); the remaining addressed health care professionals, patients' significant others, or a combination. We identified five main topics: decisions on disease-modifying drugs, decisions on chronic cerebrospinal venous insufficiency treatment, information provision and patient education, health literacy, and risk knowledge. Conclusions The high proportion of included studies on SDM in MS in Europe suggests an earlier adoption of these concepts in this area. Decisions on disease-modifying drugs was the prevalent topic. Only 5% of studies were RCTs, indicating that more research is needed to study the effectiveness of SDM interventions. Studies addressing people with primary and secondary progressive MS are also needed.
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Barabasch A, Riemann-Lorenz K, Kofahl C, Scheiderbauer J, Eklund D, Kleiter I, Kasper J, Köpke S, Lezius S, Zapf A, Rahn AC, Heesen C. Impact of a multimedia website with patient experiences of multiple sclerosis (PExMS) on immunotherapy decision-making: study protocol for a pilot randomised controlled trial in a mixed-methods design. Pilot Feasibility Stud 2021; 7:16. [PMID: 33413658 PMCID: PMC7788927 DOI: 10.1186/s40814-020-00749-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background A variety of management options (e.g. immunotherapies, lifestyle interventions, and rehabilitation) are available for people with relapsing-remitting multiple sclerosis (RRMS). Besides coping with the diagnosis, people with MS (pwMS) have to make complex decisions such as deciding about immunotherapies. In addition to factual information, reports of patient experiences (PEx) may support patients in decision-making. The added value of PEx in decision-making is not clear, and controlled studies are rare. Therefore, systematic methods are necessary to develop and analyse PEx. As there are no evaluated PEx for MS in Germany, we are currently creating a website presenting PEx structured according to topics and illustrated by video, audio, and text files. We aim to determine the feasibility of an intervention using PEx and evaluate whether PEx may help pwMS in their immunotherapy decision-making processes as a supplement to evidence-based information. Methods This project will follow the Medical Research Council framework for development and evaluation of complex interventions. After the development of a website with PEx, a randomised controlled pilot trial (pilot RCT) will be conducted in 2–3 MS centres, clinics, or rehabilitation centres including 55 pwMS and accompanied by a process evaluation. Patients with a RRMS diagnosis considering immunotherapy are eligible. The primary outcome is decision self-efficacy. Secondary outcomes include preparation for decision-making, decisional conflict, risk knowledge, confidence in active participation, affective forecasting, social support, and self-reported impact of eHealth on its users. Participants will be randomly assigned either to (i) an intervention group with 4 weeks access to an evidence-based patient information resource and the PExMS-website as an adjunct or to (ii) the control group with access to evidence-based information alone. A 6-member advisory panel involving representatives of pwMS, researchers, and neurologists, who accompany the whole project, will mentor this pilot RCT. Discussion The intervention was developed with systematic methods, created with active patient involvement and in critical appraisal by an expert advisory panel. The study is innovative as it contributes to the controversial evidence on the use of PEx in the context of evidence-based patient information. Trial registration ClinicalTrials.gov, NCT04236544 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-020-00749-0.
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Affiliation(s)
- Anna Barabasch
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Patient representative, Hamburg, Trier, Germany
| | | | | | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Jürgen Kasper
- Department of Nursing and Health Promotion, OsloMET, Oslo Metropolitan University, Oslo, Norway
| | - Sascha Köpke
- Institute for Clinical Nursing Science, University of Cologne, Cologne, Germany
| | - Susanne Lezius
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Christin Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Celius EG, Thompson H, Pontaga M, Langdon D, Laroni A, Potra S, Bharadia T, Yeandle D, Shanahan J, van Galen P, Alexandri N, Kesselring J. Disease Progression in Multiple Sclerosis: A Literature Review Exploring Patient Perspectives. Patient Prefer Adherence 2021; 15:15-27. [PMID: 33447018 PMCID: PMC7802794 DOI: 10.2147/ppa.s268829] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/20/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Multiple sclerosis (MS) prognosis is often uncertain. This literature review considers patients' understanding of, and perspectives on, MS progression to better comprehend the unmet needs of people with MS (PwMS), in order to improve treatment adherence and quality of life (QoL). METHODS Literature searches for peer-reviewed papers concerning patient perspectives on the progression of MS and comparable conditions, published between January 2000 and January 2020, were conducted. RESULTS Little qualitative evidence exists that examines PwMS' perspectives on MS progression. The understanding and meaning ascribed to terms such as "disease progression" vary. Some PwMS find disease labels stigmatizing, confusing, and disconnected from reality. The lack of a clear definition of progression and discrepancies between PwMS and healthcare professional (HCP) perspectives may contribute to misunderstanding and poor communication. Patient descriptions of progression and relapses include symptoms in addition to those evaluated by standard severity and disability measures. Compared with HCPs, PwMS are still focused on relapse prevention but place higher priority on QoL and ascribe different relative importance to the causes of poor adherence to treatment plans. PwMS want to discuss progression and likely prognosis. Such communication needs to be personalized and delivered with sensitivity, at an appropriate time. Poor treatment adherence may arise from a lack of understanding and poor communication, particularly around treatment goals. The few studies that directly considered patient perspectives on the progression of comparable conditions supported and extended the perspectives of PwMS. Lack of adequate communication by HCPs was the most common theme. CONCLUSION Patient perspectives on disease progression in MS and other chronic progressive conditions are under-investigated and under-reported. The limited evidence available highlights the importance of providing adequate information and effective HCP communication. While further studies are needed, the current evidence base offers information and insights that may help HCPs to enhance patient care, well-being, and treatment adherence.
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Affiliation(s)
- Elisabeth G Celius
- Deparment of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Correspondence: Elisabeth G Celius Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, Oslo0424, NorwayTel +47 91 50 27 70 Email
| | - Heidi Thompson
- The Neurology Centre, Craigavon Area Hospital, Portadown, UK
| | | | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stanca Potra
- Patient Member of the MS in the 21st Century Steering Group, Bucharest, Romania
| | - Trishna Bharadia
- Patient Member of the MS in the 21st Century Steering Group, Buckinghamshire, UK
| | - David Yeandle
- Patient Member of the MS in the 21st Century Steering Group, Southampton, UK
| | - Jane Shanahan
- Patient Member of the MS in the 21st Century Steering Group, Ascot, UK
| | - Pieter van Galen
- Patient Member of the MS in the 21st Century Steering Group, Overijse, Belgium
| | - Nektaria Alexandri
- Global Medical Affairs, Neurology and Immunology, Merck KGaA, Darmstadt, Germany
| | - Jürg Kesselring
- Department of Neurology & Neurorehabilitation, Kliniken Valens, Valens, Switzerland
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26
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Guo C, Zhang Z, Zhou J, Deng Z. Seeking or contributing? Evidence of knowledge sharing behaviours in promoting patients' perceived value of online health communities. Health Expect 2020; 23:1614-1626. [PMID: 33047428 PMCID: PMC7752205 DOI: 10.1111/hex.13146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/07/2020] [Accepted: 09/19/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Health knowledge, as an important resource of online health communities (OHCs), attracts users to engage in OHCs and improve the traffics within OHCs, thereby promoting the development of OHCs. Seeking and contributing health knowledge are basic activities in OHCs and are helpful for users to solve their health-related problems, improve their health conditions and thus influence their evaluation of OHCs (ie perceived value of OHCs). However, how do patients' health knowledge seeking and health knowledge contributing behaviours together with other factors influence their perceived value of OHCs? We still have little knowledge. OBJECTIVE In order to address the above gap, we root the current study in social cognitive theory and prior related literature on health knowledge sharing in OHCs and patients' perceived value. We treat health knowledge seeking and health knowledge contributing behaviours as behavioural factors and structural social capital as an environmental factor and explore their impacts on patients' perceived value of OHCs. DESIGN We have built a theoretical model composed of five hypotheses. We have designed a questionnaire composed of four key constructs and then collected data via an online survey. SETTING AND PARTICIPANTS We have distributed the questionnaire in two Chinese OHCs. We obtained a sample of 352 valid responses that were completed by patients having a variety of conditions. RESULTS The empirical results indicate that health knowledge seeking and health knowledge contributing have positive impacts on patients' perceived value of OHCs. The impact of health knowledge seeking on patients' perceived value of OHCs is greater than the impact of health knowledge contributing. In addition, structural social capital moderates the effects of health knowledge seeking and health knowledge contributing on patients' perceived value of OHCs. It weakens the effect of health knowledge seeking but enhances the effect of health knowledge contributing on patients' perceived value of OHCs. CONCLUSIONS These findings contribute to the literature on patients' perceived value of OHCs and on the role of structural social capital in OHCs. For OHC managers, they should provide their users more opportunities to seek or contribute health knowledge in their communities.
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Affiliation(s)
- Cui Guo
- Shantou University Business SchoolShantouChina
| | - Zhen Zhang
- Shantou University Business SchoolShantouChina
| | - Junjie Zhou
- Shantou University Business SchoolShantouChina
| | - Zhaohua Deng
- Huazhong University of Science & TechnologyWuhanChina
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27
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French-Lawyer J, Siano S, Ioerger M, Young V, Turk MA. Health information seeking and people with disability: A systematic search and scoping review. Disabil Health J 2020; 14:100983. [PMID: 33046431 DOI: 10.1016/j.dhjo.2020.100983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Health information and access to it are important aspects of maintaining health. There are 61 million people with disability in the U.S., many of whom experience health disparities. However, it may not be clear to health professionals how people with disability seek health information. OBJECTIVE Assess the breadth, examine the characteristics, and evaluate the risk of bias in the existing literature related to health information seeking and people with disability. METHODS The authors conducted a systematic search across five databases (Pubmed, Scopus, PsycINFO, HealthSTAR, and CINAHL) to identify empirical journal articles related to health information seeking among people with disability. Analysis of data items and a quality assessment were completed. RESULTS Forty-two articles met the criteria for inclusion and were assessed. The articles primarily used survey methodology (50%), and primarily focused on ten disability types, including MS (19%), CP (17%) and general disability (17%). The articles primarily investigated the internet (88%), and healthcare providers (71%) as sources of health information. Trustworthiness (31%), accuracy (29%), and accessibility (29%) were also commonly assessed. The overall quality was high, with room for improvement in minimizing bias. CONCLUSIONS The literature addressing health information seeking among people with disability is heterogeneous, but generally of high quality. Future research may benefit from an inclusive definition of disability and a more consistent definition of health information. Focused research on best practices and interactions among sources of health information would be valuable additions.
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Affiliation(s)
- Jeremy French-Lawyer
- Department of Physical Medicine & Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, 13244, USA.
| | - Steven Siano
- UNC School of Medicine, Chapel Hill, NC 27516, USA
| | - Michael Ioerger
- Ohio State University College of Medicine, Columbus, OH 43210, USA
| | | | - Margaret A Turk
- Department of Physical Medicine & Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, 13244, USA
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28
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Desborough J, Brunoro C, Parkinson A, Chisholm K, Elisha M, Drew J, Fanning V, Lueck C, Bruestle A, Cook M, Suominen H, Tricoli A, Henschke A, Phillips C. 'It struck at the heart of who I thought I was': A meta-synthesis of the qualitative literature examining the experiences of people with multiple sclerosis. Health Expect 2020; 23:1007-1027. [PMID: 32578287 PMCID: PMC7696124 DOI: 10.1111/hex.13093] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 02/03/2023] Open
Abstract
Background People with multiple sclerosis (MS) have varied experiences and approaches to self‐management. This review aimed to explore the experiences of people with MS, and consider the implications of these experiences for clinical practice and research. Methods A meta‐synthesis of the qualitative literature examining experiences of people with MS was conducted using systematic searches of ProQuest, PubMed, CINAHL and PsycINFO. We incorporated feedback from team members with MS as expert patient knowledge‐users to capture the complex subjectivities of persons with lived experience responding to research on lived experience of the same disease. Results Of 1680 unique articles, 77 met the inclusion criteria. We identified five experiential themes: (a) the quest for knowledge, expertise and understanding, (b) uncertain trajectories (c) loss of valued roles and activities, and the threat of a changing identity, (d) managing fatigue and its impacts on life and relationships, and (f) adapting to life with MS. These themes were distributed across three domains related to disease (symptoms; diagnosis; progression and relapse) and two contexts (the health‐care sector; and work, social and family life). Conclusion The majority of people in the studies included in this review expressed a determination to adapt to MS, indicating a strong motivation for people with MS and clinicians to collaborate in the quest for knowledge. Clinicians caring for people with MS need to consider the experiential and social outcomes of this disease such as fatigue and the preservation of valued social roles, and incorporate this into case management and clinical planning.
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Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Crystal Brunoro
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Parkinson
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Katrina Chisholm
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Mark Elisha
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Janet Drew
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Vanessa Fanning
- Department of Health Services Research and Policy, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Christian Lueck
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Anne Bruestle
- John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Matthew Cook
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia.,John Curtin School of Medical Research, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Hanna Suominen
- School of Computer Science, College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia
| | - Antonio Tricoli
- Research School of Electrical Energy & Materials Engineering, College of Engineering and Computer Science, Australian National University, Canberra, ACT, Australia
| | - Adam Henschke
- National Security College, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Christine Phillips
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
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29
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Russell RD, Black LJ, Begley A. The unresolved role of the neurologist in providing dietary advice to people with multiple sclerosis. Mult Scler Relat Disord 2020; 44:102304. [PMID: 32570182 DOI: 10.1016/j.msard.2020.102304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND People with MS often make dietary changes after diagnosis with the aim of slowing disease progression. Although people with MS commonly use the internet for information on diet and MS, neurologists are their preferred source of information. However, little is known about what dietary advice is provided by neurologists. OBJECTIVES To explore the perceptions of neurologists about diet and MS, and to identify the type of dietary advice they provide to their patients with MS. METHODS In this exploratory qualitative study, 11 semi-structured interviews were conducted with neurologists in Western Australia. Audio files were transcribed verbatim, and transcripts were thematically analysed using a general inductive approach. RESULTS Four themes emerged: 1) juggling the evidence on the role of diet in MS; 2) acknowledging the risks and benefits of specific diets; 3) distancing from the diet 'gurus'; and 4) the unresolved role of the neurologist in providing dietary advice. CONCLUSION Neurologists could meet their patients' expectations by providing evidence-based dietary advice, such as promoting the benefits of diets that adhere to national dietary guidelines, and being prepared to explain potential risks of restrictive diets. Information about healthy eating needs to be targeted to people with MS.
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Affiliation(s)
| | | | - A Begley
- Kent Street, Perth, WA 6102, SA.
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30
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Health information–seeking behaviors and adherence to urgent care discharge instructions. J Am Assoc Nurse Pract 2020; 32:438-446. [DOI: 10.1097/jxx.0000000000000262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Vermersch P, Shanahan J, Langdon D, Yeandle D, Alexandri N, Schippling S. Knowledge Is Power, but Is Ignorance Bliss? Optimising Conversations About Disease Progression in Multiple Sclerosis. Neurol Ther 2020; 9:1-10. [PMID: 31748873 PMCID: PMC7229099 DOI: 10.1007/s40120-019-00170-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 02/07/2023] Open
Abstract
Communication about multiple sclerosis (MS) disease progression between healthcare professionals (HCPs) and people with MS (PwMS) has historically been considered difficult, and attention to improving it has been neglected. However, a growing number of studies have shown that this is a key area to get right, since negative experiences can affect patient satisfaction, treatment adherence, and clinical outcomes. This article reports on a symposium at the European Charcot Foundation, 2018, led by a panel of leading clinicians and patient experts from MS in the 21st Century, who debated the benefits, drawbacks, and challenges of communicating about disease progression, for both HCPs and PwMS, and potential ways to optimise these discussions. PwMS' preferences and priorities regarding conversations about disease progression vary widely. While the majority want to have these conversations, some will be reluctant and/or emotionally unready. Communication therefore needs to be personalised, and HCPs should always be prepared to have such conversations in an appropriate and sensitive manner. Clinical information can be opaque for PwMS, so HCPs also need to use language that is clear, easily understandable, and patient-friendly. MS in the 21st Century is in the process of developing several resources and programmes to help improve disease progression communication between HCPs and PwMS. FUNDING: Merck KGaA, Darmstadt, Germany. Plain language summary available for this article.
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Affiliation(s)
- Patrick Vermersch
- University of Lille, INSERM U995, CHU Lille, FHU Imminent, 59000, Lille, France.
| | | | - Dawn Langdon
- Royal Holloway, University of London, London, UK
| | - David Yeandle
- MS in the 21st Century Steering Group, Southampton, UK
| | - Nektaria Alexandri
- Global Medical Affairs, Neurology and Immunology, Merck KGaA, Darmstadt, Germany
| | - Sven Schippling
- Universitätsspital Zürich and Neuroimmunology and Multiple Sclerosis Research, University Hospital Zurich, Zurich, Switzerland
- Center for Neuroscience and Federal Institute of Technology (ETH) Zurich, University of Zurich, Zurich, Switzerland
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32
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Russo A, Lavorgna L, Silvestro M, Abbadessa G, Bisecco A, Trojsi F, Tessitore A, Tedeschi G, Bonavita S. Readability Analysis of Online Headache and Migraine Information. Headache 2020; 60:1317-1324. [PMID: 32463516 DOI: 10.1111/head.13818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although migraine is recognized as one of the most common and disabling diseases in the world, it is nonetheless still underestimated, underdiagnosed, and undertreated. The fact that migraine patients often tend to access the Web to search for headache-related information hinders patient-doctor relationships and one should also bear in mind that, unfortunately, text readability and medical literacy in the overall population may be the reason why patients' understanding of health information is compromised. AIM We aimed to assess the readability of the home page of the top 10 patient - oriented migraine-related websites and the educational level required to be in a position to broach them. METHODS On April 15, 2018, we conducted a descriptive study on the international version of Google by entering the words "headache" and "migraine." We then analyzed the overall level of readability of texts of the home pages of the top 10 patient-oriented websites, by means of the Simple Measure of Gobbledygook Readability Calculator. RESULTS Entering "headache" on the home pages of the top 10 patient-oriented websites on Google we found that to understand these particular websites with ease, an average grade level of 12.4 (±1.5 standard deviation, SD) and an average 13.3 years of formal education (±1.7 SD) were required. Similarly, typing "migraine" on Google we found an average grade level of 10.8 (±1.2 SD) and an average of 12.5 years of formal education (±1.9 SD) were required. The most frequently viewed websites all failed to meet the USA National Institutes of Health guidelines, which recommend a range between 6th and 7th grade level readability. DISCUSSION The present study shows the low readability level resulting from the top 10 patient-oriented headache/migraine websites and the consequent barrier this creates in the dissemination of headache/migraine-related medical information. Although the actual physicians, both primary care physicians and headache specialists are the principal source of understandable headache-related information, only a minority of people consult these professionals. Given the foregoing, the majority of migraine patients is, therefore, unable to obtain adequate comprehensible health information on the Web. Furthermore, the existing gap between migraine-related website content readability and the unmet need for migraine patients to obtain pertinent and correct information might well contribute to the worldwide neglect of migraine as a major public health problem. CONCLUSION Physician experts in headache and migraine should actively cooperate in planning informative material to establish what information patients need to know, how they should use it, and how readable that material actually is. Readability ought to be established before the final website publication. Plain language ought to be used and written messages should be supplemented with visual content such as simple drawings. We recommend the setting up of a new dynamic, modern, plain-talking, and efficient approach in communication aimed at catching the public's attention with its readability and thus satisfying a migraine and headache web scenario.
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Affiliation(s)
- Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Università degli Studi della Campania Luigi Vanvitelli Scuola di Medicina e Chirurgia, Naples, Italy
| | - Luigi Lavorgna
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marcello Silvestro
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Università degli Studi della Campania Luigi Vanvitelli Scuola di Medicina e Chirurgia, Naples, Italy
| | - Gianmarco Abbadessa
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alvino Bisecco
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Trojsi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessandro Tessitore
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Università degli Studi della Campania Luigi Vanvitelli Scuola di Medicina e Chirurgia, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Università degli Studi della Campania Luigi Vanvitelli Scuola di Medicina e Chirurgia, Naples, Italy
| | - Simona Bonavita
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
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Colombo C, Confalonieri P, Rovaris M, La Mantia L, Galeazzi P, Silena Trevisan, Pariani A, Gerevini S, De Stefano N, Guglielmino R, Caserta C, Mosconi P, Filippini G. The IN-DEEP project "INtegrating and Deriving Evidence, Experiences, Preferences": a web information model on magnetic resonance imaging for people with multiple sclerosis. J Neurol 2020; 267:2421-2431. [PMID: 32361839 DOI: 10.1007/s00415-020-09864-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The IN-DEEP project aims to provide people with multiple sclerosis (PwMS) with evidence-based information on magnetic resonance imaging (MRI) in diagnosis and monitoring the disease through a website, and to collect their opinions on the clarity of the website's contents and its usefulness. METHODS AND ANALYSIS A multidisciplinary advisory board committee was set up. We investigated the experience, attitude and information needs on MRI through three meetings with 24 PwMS, facilitated by an expert researcher and an observer. We developed the website on the basis of input from PwMS and systematic reviews and guidelines, assessed with AMSTAR and AGREE II. We sought feedback from nine PwMS who pilot-tested the beta-version of the website, during a meeting and through phone interviews and judged whether the contents were clear, understandable and useful, and the website was easily navigable. The website is in Italian. RESULTS The website ( https://www.istituto-besta.it/in-deep-risonanza-magnetica2 ) provides two levels of information, different layouts and visualization of data covering MRI diagnostic accuracy, sensitivity and specificity, contents on how MRI can monitor PwMS over time to determine changes in the condition and evaluate treatment effects, practical information on how to prepare for the exam, educational tools and a glossary. The website was judged clear and useful by a sample of PwMS. CONCLUSIONS The website is a tool to address PwMS information needs on the role of MRI. It could be used by neurologists to facilitate communication with PwMS.
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Affiliation(s)
- Cinzia Colombo
- Laboratory of Research and Consumer Involvement, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
| | - Paolo Confalonieri
- Multiple Sclerosis Centre, Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS, Istituto Neurologico Carlo Besta, via Celoria 11, 20133, Milan, Italy
| | - Marco Rovaris
- IRCCS Don C. Gnocchi Foundation ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - Loredana La Mantia
- IRCCS Don C. Gnocchi Foundation ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | | | | | | | - Simonetta Gerevini
- Unit of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - Roberta Guglielmino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
| | - Cinzia Caserta
- Multiple Sclerosis Center, Policlinico G. Rodolico, University of Catania, Catania, Italy
| | - Paola Mosconi
- Laboratory of Research and Consumer Involvement, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | - Graziella Filippini
- Scientific Direction, Carlo Besta Foundation and Neurological Institute, via Celoria 11, 20133, Milan, Italy
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Jindal G. Assessing the Value of an Online Repository of Local Resources for People Who Have Chronic Health Conditions. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2019. [DOI: 10.1080/15398285.2019.1611171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Gagan Jindal
- College of Information Studies, University of Maryland, College Park, MD, USA
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Development and Validation of Online Textual Pediatrician-Parent Communication Instrument Based on the SEGUE Framework. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8638174. [PMID: 31183376 PMCID: PMC6512034 DOI: 10.1155/2019/8638174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/01/2019] [Accepted: 04/16/2019] [Indexed: 01/22/2023]
Abstract
The prevalence and feature of online textual pediatrician-parent communication (OPPC) have been recognized, but evidence on OPPC assessment remains insufficient. This study aimed to develop and validate an OPPC instrument to provide measurement and quality characteristics for quality assessment and management. 490 OPPC exchanges of 61 tertiary hospitals from 9 Chinese provinces were obtained from the Spring Rain Doctor website. The SEGUE framework, OPPC feature, and a pilot study were considered to establish the instrument. An empirical study was conducted to validate it and the incidence of OPPC items was also analyzed. As a result, a four-dimensional, 15-item OPPC instrument was developed. The empirical results are as follows. Cronbach's α values of dimensions were 0.80, 0.62, 0.64, and 0.60; the mean interrater reliability was 0.93; the correlation coefficients between items and their corresponding dimensions' scores ranged from 0.51 to 0.89 (P<0.001). The goodness-of-fit indices were acceptable. The overall incidence rate of parent-dominated/cooperative items (46.9%) was higher than that of pediatrician-dominated items (39.6%). Thus, the instrument is acceptable and OPPC quality is characterized by more parent-dominated and cooperative behaviors.
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Synnot AJ, Cherry CL, Summers MP, Stuckey R, Milne CA, Lowe DB, Hill SJ. Consumer engagement critical to success in an Australian research project: reflections from those involved. Aust J Prim Health 2019; 24:197-203. [PMID: 29875031 DOI: 10.1071/py17107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/08/2018] [Indexed: 11/23/2022]
Abstract
This paper describes the people, activities and methods of consumer engagement in a complex research project, and reflects on the influence this had on the research and people involved, and enablers and challenges of engagement. The 2.5-year Integrating and Deriving Evidence Experiences and Preferences (IN-DEEP) study was conducted to develop online consumer summaries of multiple sclerosis (MS) treatment evidence in partnership with a three-member consumer advisory group. Engagement methods included 6-monthly face-to-face meetings and email contact. Advisory group members were active in planning, conduct and dissemination and translational phases of the research. Engaging consumers in this way improved the quality of the research process and outputs by: being more responsive to, and reflective of, the experiences of Australians with MS; expanding the research reach and depth; and improving the researchers' capacity to manage study challenges. Advisory group members found contributing their expertise to MS research satisfying and empowering, whereas researchers gained confidence in the research direction. Managing the unpredictability of MS was a substantive challenge; the key enabler was the 'brokering role' of the researcher based at an MS organisation. Meaningfully engaging consumers with a range of skills, experiences and networks can make important and unforeseen contributions to research success.
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Affiliation(s)
- Anneliese J Synnot
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3068, Australia
| | - Catherine L Cherry
- Centre for Biomedical Research, Burnet Institute 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Michael P Summers
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3068, Australia
| | - Rwth Stuckey
- Centre for Ergonomics and Human Factors, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Melbourne, Vic. 3086, Australia
| | - Catherine A Milne
- Sydney Health Ethics, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Dianne B Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3068, Australia
| | - Sophie J Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Kingsbury Drive, Bundoora, Vic. 3068, Australia
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Furaijat G, Kleinert E, Simmenroth A, Müller F. Implementing a digital communication assistance tool to collect the medical history of refugee patients: DICTUM Friedland - an action-oriented mixed methods study protocol. BMC Health Serv Res 2019; 19:103. [PMID: 30728030 PMCID: PMC6366114 DOI: 10.1186/s12913-019-3928-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background Language barriers play a decisive role in determining the outcomes of medical consultations between healthcare providers and their foreign patients. This issue is a significant challenge to the German healthcare system, especially with the rising number of refugees in recent years. The communication gap between healthcare professionals and their non-German speaking patients sometimes leads to unnecessary medical re-admission, insufficient medical history, incorrect diagnosis, and treatment plans. In this study, we aim to assess the usability and accuracy of a novel digital translation tool in collecting medical history from patients in their native language and to check its effects on healthcare outcomes. Methods The study aims to monitor the implementation of a new digital communication assistance tool (DCAT) and to investigate its impact on the mutual understanding between refugee patients and their German general practitioners (GPs). In the first study phase, an action-oriented approach is used to implement DCAT. In the second study phase, DCAT use will be evaluated with a mixed methods design. The main outcome assesses the re-consultation rates of patients before and after using DCAT. Secondary outcomes include the usability of the tool, its acceptance and perceived quality by patients, the accuracy of the information collected as determined from analysing the reasons for the consultation (ICPC-2 codes), and diagnosis (ICD-10 codes). The acceptance by patients, socio-demographic factors and native language are also taken into account. The research designs for both study phases include questionnaires, semi-structured interviews, non-participant observation and analysis of collected patients’ data. All the collected data is pseudonymised. Discussion The DCAT study is one of the new research projects in primary healthcare investigating the usability, accuracy, and acceptance of digital translation tools during medical encounters. We aim to eliminate significant communication errors and misunderstandings in medical consultations, thereby improving the quality of healthcare outcomes. By applying an action research design, we will attain a more comprehensive evaluation of DCAT scopes and limits. The results of this study are expected to give an in-depth understanding of possible applications and benefits of digital translation tools for patient care. Trial registration German Clinical Trials Register DRKS00013076, 29/09/2017. Electronic supplementary material The online version of this article (10.1186/s12913-019-3928-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ghefar Furaijat
- Department of General Practice, University Medical Centre Göttingen/Georg-August-University, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Evelyn Kleinert
- Department of General Practice, University Medical Centre Göttingen/Georg-August-University, Humboldtallee 38, 37073, Göttingen, Germany
| | - Anne Simmenroth
- Department of General Practice, University Medical Centre Göttingen/Georg-August-University, Humboldtallee 38, 37073, Göttingen, Germany.,Department of General Practice, University Medical Centre Würzburg/Julius-Maximilian-University, Josef-Schneider-Straße 2, 97080, Würzburg, Germany
| | - Frank Müller
- Department of General Practice, University Medical Centre Göttingen/Georg-August-University, Humboldtallee 38, 37073, Göttingen, Germany
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Mazanderani F, Hughes N, Hardy C, Sillence E, Powell J. Health information work and the enactment of care in couples and families affected by Multiple Sclerosis. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:395-410. [PMID: 30677163 DOI: 10.1111/1467-9566.12842] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Given the considerable emphasis placed on informed choice, the management of health information has become an increasingly important part of living with chronic illness. This paper explores the intra-familial dynamics of managing health information in the context of chronic illness. Drawing on 77 interviews with people affected by Multiple Sclerosis in the UK (patients, partners, family members and close friends), we show how families develop their own idiosyncratic information practices, including the careful, at times strategic, seeking, sharing and withholding of information. We describe how one individual, most commonly either the patient or their partner, often takes primary responsibility for managing growing quantities of health information. Doing this is a complex task, yet its dynamics within the family unit remain invisible and unacknowledged. In this paper we: (a) stress the importance of understanding information management in chronic illness as a collective process across all those affected, patients as well as carers; (b) conceptualise the process of managing health information in this context as 'health information work'; and (c) analyse it as part of the wider care practices families engage in and as a form of care in its own right.
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Affiliation(s)
| | | | - Claire Hardy
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - John Powell
- Department of Primary Health Care, University of Oxford, UK
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Stern BZ, Goverover Y. Everyday technology use for men with multiple sclerosis: An occupational perspective. Br J Occup Ther 2018. [DOI: 10.1177/0308022618777985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brocha Z Stern
- PhD Candidate, Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, USA
| | - Yael Goverover
- Associate Professor, Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, USA
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Understanding treatment decisions from the perspective of people with relapsing remitting multiple Sclerosis: A critical interpretive synthesis. Mult Scler Relat Disord 2018; 27:370-377. [PMID: 30476873 DOI: 10.1016/j.msard.2018.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 10/31/2018] [Accepted: 11/16/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system that mainly affects young adults. While there is no cure for MS, disease modifying treatments (DMTs) reduce the relapse rate and partial accrual of disability. More effective DMTs may have higher risks including life-threatening infections or secondary autoimmunity. The complexity and novelty of available treatments cause challenges for clinicians when prescribing treatments and for people with MS (PwMS) when deciding what trade-offs they are willing and ready to make. OBJECTIVE To explore the experience of people with relapsing remitting MS (PwRRMS) and their perspectives in choosing treatments. METHODS Critical interpretive synthesis was employed to review and synthesis the published literature. Eighty-three publications were selected in a multi-step systematic process. RESULTS Findings are presented in four interrelated areas: the influence of the clinical evidence-base in decision making; the meaning of DMT efficacy for PwRRMS; the influence of models of decision-making and information acquisition practices in PwRRMS; and the importance of psychosocial dimensions in DMT decision making. Synthesis of the findings revealed that alongside medical and individual reasoning, contextual circumstances play an important role in making treatment decisions. CONCLUSION This review identifies and explains the importance of diverse contextual circumstances (clinical, social, psychological) that are important for PwRRMS when making treatment decisions. The findings demonstrate the importance of eliciting, understanding and addressing such contextual factors.
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Impact of early diagnosis on clinical characteristics of an Italian sample of people with multiple sclerosis recruited online. Mult Scler Relat Disord 2018; 27:239-246. [PMID: 30419509 DOI: 10.1016/j.msard.2018.10.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 10/19/2018] [Accepted: 10/28/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND In order to anticipate the diagnosis of Multiple Sclerosis (MS), the diagnostic criteria had been reviewed several times in the last years. OBJECTIVE We wanted to understand whether earlier diagnoses of MS have impacted on therapeutic management of the disease. METHODS We designed a 22-item survey posted on SMsocialnetwork, a webplatform with a medical supervision, dedicated to Italian MS patients. We collected socio-demographic data, disease and treatment-related information of 1000 patients. RESULTS The median age at diagnosis significantly decreased over years. In the last decades the time delay between disease onset and diagnosis reduced, the disease phenotypes at diagnosis shifted from progressive form to relapsing ones and clinically isolated syndrome, the number of early treated patients increased over time. CONCLUSION We showed, verifying a large sample of patients in a reallife setting, that the improvement of the diagnostic process allowed the anticipation of MS diagnosis over years and had a huge impact in terms of treatment approach.
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Synnot AJ, Hawkins M, Merner BA, Summers MP, Filippini G, Osborne RH, Shapland SD, Cherry CL, Stuckey R, Milne CA, Mosconi P, Colombo C, Hill SJ. Producing an evidence-based treatment information website in partnership with people affected by multiple sclerosis. Health Sci Rep 2018; 1:e24. [PMID: 30623063 PMCID: PMC6266475 DOI: 10.1002/hsr2.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND AIMS In earlier work, we identified that people affected by multiple sclerosis (MS) can have difficulty finding online treatment information that is up to date, trustworthy, understandable, and applicable to personal circumstances, but does not provoke confusion or negative emotional consequences. The objective was to develop online consumer summaries of MS treatment evidence (derived from Cochrane Reviews) that respond to identified treatment information needs of people affected by MS. METHODS A 2-phase mixed-methods project, conducted in partnership with consumers and an MS organisation. Phase 1 included review panels with consumers (Australians affected by MS) and health professionals to test paper-based treatment summaries before development, and pilot testing of the website. Phase 2 involved an online survey after website launch. RESULTS Eighty-three participants (85% affected by MS) took part. Phase 1 participants strongly endorsed key review summary components, including layering information, and additional sections to aid personal applicability. Participants additionally suggested questions for health professionals. Participants across both phases were receptive to the idea of being provided with Cochrane Review summaries online but were seeking other types of evidence and information, such as personal experiences and the latest experimental treatments, which could not be provided. While the small survey sample size (n = 58) limits application of the results to a broader population, the website was viewed favourably, as a useful, understandable, and trustworthy information source. CONCLUSION We describe a partnership approach to developing online evidence-based treatment information, underpinned by an in-depth understanding of consumers' information needs.
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Affiliation(s)
- Anneliese J. Synnot
- Centre for Health Communication and Participation, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
- Cochrane Australia, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Melanie Hawkins
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social DevelopmentDeakin UniversityGeelongAustralia
| | - Bronwen A. Merner
- Centre for Health Communication and Participation, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
| | - Michael P. Summers
- Centre for Health Communication and Participation, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
| | - Graziella Filippini
- Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Review Group, Scientific DirectionIRCCS Foundation Neurological Institute Carlo BestaMilanItaly
| | - Richard H. Osborne
- Health Systems Improvement Unit, Centre for Population Health Research, School of Health and Social DevelopmentDeakin UniversityGeelongAustralia
| | | | - Catherine L. Cherry
- Burnet Institute, Department of Infectious DiseasesThe Alfred Hospital and Monash UniversityMelbourneAustralia
- Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Rwth Stuckey
- Centre for Ergonomics and Human Factors, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
| | - Catherine A. Milne
- Centre for Values, Ethics and Law in MedicineUniversity of SydneySydneyNew South WalesAustralia
| | - Paola Mosconi
- Laboratory for Medical Research and Consumer Involvement, Department of Public HealthIRCCS Istituto di Ricerche Farmacologiche Mario NegriMilanItaly
| | - Cinzia Colombo
- Laboratory for Medical Research and Consumer Involvement, Department of Public HealthIRCCS Istituto di Ricerche Farmacologiche Mario NegriMilanItaly
| | - Sophie J. Hill
- Centre for Health Communication and Participation, School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia
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Dennison L, Brown M, Kirby S, Galea I. Do people with multiple sclerosis want to know their prognosis? A UK nationwide study. PLoS One 2018; 13:e0193407. [PMID: 29489869 PMCID: PMC5831099 DOI: 10.1371/journal.pone.0193407] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Multiple sclerosis (MS) has a varied and uncertain trajectory. The recent development of analytical processing tools that draw on large longitudinal patient databases facilitates personalised long-term prognosis estimates. This has the potential to improve both shared treatment decision-making and psychological adjustment. However, there is limited research on how people with MS feel about prognosis communication and forecasting. This study investigated the prognosis communication experiences and preferences of people with MS and explored whether clinical, demographic and psychological factors are associated with prognosis information preferences. Methods 3175 UK MS Register members (59% of those with active accounts) completed an online survey containing 17 questions about prognosis communication experiences, attitudes and preferences. Participants also completed validated questionnaires measuring coping strategies, tendencies to seek out (‘monitor’) or avoid (‘blunt’) information in threatening situations, and MS risk perceptions and reported their clinical and sociodemographic characteristics. Data already held on the MS Register about participants’ quality of life, anxiety and depression symptoms and MS impact were obtained and linked to the survey data. Results 53.1% of participants had never discussed long-term prognosis with healthcare professionals. 54.2% lacked clarity about their long-term prognosis. 76% had strong preferences for receiving long-term prognosis information. 92.8% were interested in using tools that generate personalised predictions. Most participants considered prognostication useful for decision-making. Participants were more receptive to receiving prognosis information at later time-points, versus at diagnosis. A comprehensive set of sociodemographic, clinical and psychological variables predicted only 7.9% variance in prognosis information preferences. Conclusions People with MS have an appetite for individualised long-term prognosis forecasting and their need for information is frequently unmet. Clinical studies deploying and evaluating interventions to support prognostication in MS are now needed. This study indicates suitable contexts and patient preferences for initial trials of long-term prognosis tools in clinical settings.
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Affiliation(s)
- Laura Dennison
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Martina Brown
- Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Sarah Kirby
- Centre for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- * E-mail:
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Lavorgna L, Lanzillo R, Brescia Morra V, Abbadessa G, Tedeschi G, Bonavita S. Social Media and Multiple Sclerosis in the Posttruth Age. Interact J Med Res 2017; 6:e18. [PMID: 28954717 PMCID: PMC5637067 DOI: 10.2196/ijmr.7879] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 12/13/2022] Open
Abstract
Over the last few decades, patients have increasingly been searching for health information on the Internet. This aspect of information seeking is really important, especially for people affected by chronic pathologies and require lifelong treatment and management. These people are usually very well informed about the disease, but are nonetheless vulnerable to hopes of being cured or saved, often amplified by misinformation, myths, legends, and therapies that are not always scientifically proven. Many studies suggest that some individuals prefer to rely on the Internet as their main source of information, often hindering the patient-doctor relationship. This is why a professional approach is imperative in this posttruth age, in order to maintain confidentiality, honesty, and trust in the medical profession.
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Affiliation(s)
- Luigi Lavorgna
- 1st Clinic of Neurology, University of Campania, Naples, Italy
| | - Roberta Lanzillo
- Clinic of Neurology, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | - Vincenzo Brescia Morra
- Clinic of Neurology, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University, Naples, Italy
| | | | | | - Simona Bonavita
- 1st Clinic of Neurology, University of Campania, Naples, Italy
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Brady E, Segar J, Sanders C. Accessing support and empowerment online: The experiences of individuals with diabetes. Health Expect 2017; 20:1088-1095. [PMID: 28718928 PMCID: PMC5600220 DOI: 10.1111/hex.12552] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/28/2022] Open
Abstract
CONTEXT The use of the internet for health information by those with long-term conditions is growing. It has been argued that this represents a form of empowerment by patients, as it enables them to control the content and flow of the information available to them. To explore this, the use of online discussion groups by those with diabetes was examined. METHOD Semi-structured interviews were conducted with 21 participants with type 1 and 2 diabetes and analysed using thematic analysis. Participants were recruited via online and offline routes, namely discussion boards, newsletters, and research networks related to diabetes. RESULTS By drawing on the advice, information, and support shared online, participants were empowered to position themselves as active participants in their own health care and to further engage with health-care professionals. CONCLUSION The findings indicate that forums can play a valuable role in aiding and motivating individuals in the daily management diabetes and highlight how this support is used to complement formal health services. However, more work needs to be carried out to determine to explore when and under what circumstances online support may be particularly beneficial to those with long-term conditions.
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Affiliation(s)
- Ellen Brady
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Julia Segar
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Caroline Sanders
- NIHR School for Primary Care Research, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Lavorgna L, Russo A, De Stefano M, Lanzillo R, Esposito S, Moshtari F, Rullani F, Piscopo K, Buonanno D, Brescia Morra V, Gallo A, Tedeschi G, Bonavita S. Health-Related Coping and Social Interaction in People with Multiple Sclerosis Supported by a Social Network: Pilot Study With a New Methodological Approach. Interact J Med Res 2017; 6:e10. [PMID: 28710056 PMCID: PMC5533941 DOI: 10.2196/ijmr.7402] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/07/2017] [Accepted: 05/29/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Social media are a vital link for people with health concerns who find in Web communities a valid and comforting source for information exchange, debate, and knowledge enrichment. This aspect is important for people affected by chronic diseases like multiple sclerosis (MS), who are very well informed about the disease but are vulnerable to hopes of being cured or saved by therapies whose efficacy is not always scientifically proven. To improve health-related coping and social interaction for people with MS, we created an MS social network (SMsocialnetwork.com) with a medical team constantly online to intervene promptly when false or inappropriate medical information are shared. OBJECTIVE The goal of this study was to assess the impact of SMsocialnetwork.com on the health-related coping and social interaction of people with MS by analyzing areas of interest through a Web-based survey. METHODS Referring to previous marketing studies analyzing the online platform's role in targeted health care, we conducted a 39-item Web-based survey. We then performed a construct validation procedure using a factorial analysis, gathering together like items of the survey related to different areas of interest such as utility, proximity, sharing, interaction, solving uncertainty, suggestion attitude, and exploration. RESULTS We collected 130 Web-based surveys. The areas of interest analysis demonstrated that the users positively evaluated SMsocialnetwork.com to obtain information, approach and solve problems, and to make decisions (utility: median 4.2); improve feeling of closeness (proximity: median 5); catalyze relationships and text general personal opinions (sharing: median 5.6); get in touch with other users to receive innovative, effective, and practical solutions (interaction, solving uncertainty, and suggestion attitude medians were respectively: 4.1, 3, and 3); and share information about innovative therapeutic approaches and treatment options (suggestion attitude: median: 3.3). CONCLUSIONS SMsocialnetwork.com was perceived by users to be a useful tool to support health-related coping and social interaction, and may suggest a new kind of therapeutic alliance between physicians and people with MS.
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Affiliation(s)
- Luigi Lavorgna
- University of Campania Luigi Vanvitelli, 1st Clinic of Neurology, Naples, Italy
| | - Antonio Russo
- University of Campania Luigi Vanvitelli, 1st Clinic of Neurology, Naples, Italy
| | - Manuela De Stefano
- University of Campania Luigi Vanvitelli, 1st Clinic of Neurology, Naples, Italy
| | - Roberta Lanzillo
- University Federico II, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Naples, Italy
| | - Sabrina Esposito
- University of Campania Luigi Vanvitelli, 1st Clinic of Neurology, Naples, Italy
| | - Fatemeh Moshtari
- Free International University for Social Studies Guido Carli, Department of Business and Management, Rome, Italy
| | - Francesco Rullani
- Free International University for Social Studies Guido Carli, Department of Business and Management, Rome, Italy
| | - Kyrie Piscopo
- University Federico II, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Naples, Italy
| | - Daniela Buonanno
- University of Campania Luigi Vanvitelli, 1st Clinic of Neurology, Naples, Italy
| | - Vincenzo Brescia Morra
- University Federico II, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Naples, Italy
| | - Antonio Gallo
- University of Campania Luigi Vanvitelli, 1st Clinic of Neurology, Naples, Italy
| | - Gioacchino Tedeschi
- University of Campania Luigi Vanvitelli, 1st Clinic of Neurology, Naples, Italy
| | - Simona Bonavita
- University of Campania Luigi Vanvitelli, 1st Clinic of Neurology, Naples, Italy
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Filippini G, Del Giovane C, Clerico M, Beiki O, Mattoscio M, Piazza F, Fredrikson S, Tramacere I, Scalfari A, Salanti G. Treatment with disease-modifying drugs for people with a first clinical attack suggestive of multiple sclerosis. Cochrane Database Syst Rev 2017; 4:CD012200. [PMID: 28440858 PMCID: PMC6478290 DOI: 10.1002/14651858.cd012200.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The treatment of multiple sclerosis has changed over the last 20 years. The advent of disease-modifying drugs in the mid-1990s heralded a period of rapid progress in the understanding and management of multiple sclerosis. With the support of magnetic resonance imaging early diagnosis is possible, enabling treatment initiation at the time of the first clinical attack. As most of the disease-modifying drugs are associated with adverse events, patients and clinicians need to weigh the benefit and safety of the various early treatment options before taking informed decisions. OBJECTIVES 1. to estimate the benefit and safety of disease-modifying drugs that have been evaluated in all studies (randomised or non-randomised) for the treatment of a first clinical attack suggestive of MS compared either with placebo or no treatment;2. to assess the relative efficacy and safety of disease-modifying drugs according to their benefit and safety;3. to estimate the benefit and safety of disease-modifying drugs that have been evaluated in all studies (randomised or non-randomised) for treatment started after a first attack ('early treatment') compared with treatment started after a second attack or at another later time point ('delayed treatment'). SEARCH METHODS We searched the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group Trials Register, MEDLINE, Embase, CINAHL, LILACS, clinicaltrials.gov, the WHO trials registry, and US Food and Drug Administration (FDA) reports, and searched for unpublished studies (until December 2016). SELECTION CRITERIA We included randomised and observational studies that evaluated one or more drugs as monotherapy in adult participants with a first clinical attack suggestive of MS. We considered evidence on alemtuzumab, azathioprine, cladribine, daclizumab, dimethyl fumarate, fingolimod, glatiramer acetate, immunoglobulins, interferon beta-1b, interferon beta-1a (Rebif®, Avonex®), laquinimod, mitoxantrone, natalizumab, ocrelizumab, pegylated interferon beta-1a, rituximab and teriflunomide. DATA COLLECTION AND ANALYSIS Two teams of three authors each independently selected studies and extracted data. The primary outcomes were disability-worsening, relapses, occurrence of at least one serious adverse event (AE) and withdrawing from the study or discontinuing the drug because of AEs. Time to conversion to clinically definite MS (CDMS) defined by Poser diagnostic criteria, and probability to discontinue the treatment or dropout for any reason were recorded as secondary outcomes. We synthesized study data using random-effects meta-analyses and performed indirect comparisons between drugs. We calculated odds ratios (OR) and hazard ratios (HR) along with relative 95% confidence intervals (CI) for all outcomes. We estimated the absolute effects only for primary outcomes. We evaluated the credibility of the evidence using the GRADE system. MAIN RESULTS We included 10 randomised trials, eight open-label extension studies (OLEs) and four cohort studies published between 2010 and 2016. The overall risk of bias was high and the reporting of AEs was scarce. The quality of the evidence associated with the results ranges from low to very low. Early treatment versus placebo during the first 24 months' follow-upThere was a small, non-significant advantage of early treatment compared with placebo in disability-worsening (6.4% fewer (13.9 fewer to 3 more) participants with disability-worsening with interferon beta-1a (Rebif®) or teriflunomide) and in relapses (10% fewer (20.3 fewer to 2.8 more) participants with relapses with teriflunomide). Early treatment was associated with 1.6% fewer participants with at least one serious AE (3 fewer to 0.2 more). Participants on early treatment were on average 4.6% times (0.3 fewer to 15.4 more) more likely to withdraw from the study due to AEs. This result was mostly driven by studies on interferon beta 1-b, glatiramer acetate and cladribine that were associated with significantly more withdrawals for AEs. Early treatment decreased the hazard of conversion to CDMS (HR 0.53, 95% CI 0.47 to 0.60). Comparing active interventions during the first 24 months' follow-upIndirect comparison of interferon beta-1a (Rebif®) with teriflunomide did not show any difference on reducing disability-worsening (OR 0.84, 95% CI 0.43 to 1.66). We found no differences between the included drugs with respect to the hazard of conversion to CDMS. Interferon beta-1a (Rebif®) and teriflunomide were associated with fewer dropouts because of AEs compared with interferon beta-1b, cladribine and glatiramer acetate (ORs range between 0.03 and 0.29, with substantial uncertainty). Early versus delayed treatmentWe did not find evidence of differences between early and delayed treatments for disability-worsening at a maximum of five years' follow-up (3% fewer participants with early treatment (15 fewer to 11.1 more)). There was important variability across interventions; early treatment with interferon beta-1b considerably reduced the odds of participants with disability-worsening during three and five years' follow-up (OR 0.52, 95% CI 0.32 to 0.84 and OR 0.57, 95% CI 0.36 to 0.89). The early treatment group had 19.6% fewer participants with relapses (26.7 fewer to 12.7 fewer) compared to late treatment at a maximum of five years' follow-up and early treatment decreased the hazard of conversion to CDMS at any follow-up up to 10 years (i.e. over five years' follow-up HR 0.62, 95% CI 0.53 to 0.73). We did not draw any conclusions on long-term serious AEs or discontinuation due to AEs because of inadequacies in the available data both in the included OLEs and cohort studies. AUTHORS' CONCLUSIONS Very low-quality evidence suggests a small and uncertain benefit with early treatment compared with placebo in reducing disability-worsening and relapses. The advantage of early treatment compared with delayed on disability-worsening was heterogeneous depending on the actual drug used and based on very low-quality evidence. Low-quality evidence suggests that the chances of relapse are less with early treatment compared with delayed. Early treatment reduced the hazard of conversion to CDMS compared either with placebo, no treatment or delayed treatment, both in short- and long-term follow-up. Low-quality evidence suggests that early treatment is associated with fewer participants with at least one serious AE compared with placebo. Very low-quality evidence suggests that, compared with placebo, early treatment leads to more withdrawals or treatment discontinuation due to AEs. Difference between drugs on short-term benefit and safety was uncertain because few studies and only indirect comparisons were available. Long-term safety of early treatment is uncertain because of inadequately reported or unavailable data.
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Affiliation(s)
- Graziella Filippini
- Fondazione IRCCS, Istituto Neurologico Carlo BestaScientific Directionvia Celoria, 11MilanItaly20133
| | - Cinzia Del Giovane
- University of Modena and Reggio EmiliaCochrane Italy, Department of Diagnostic, Clinical and Public Health MedicineVia del Pozzo 71ModenaItaly41124
| | - Marinella Clerico
- AOU San Luigi GonzagaUniversity of Turin, Division of NeurologyRegione Gonzole, 13OrbassanoItaly10043
| | | | - Miriam Mattoscio
- Imperial College LondonDepartment of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience LaboratoriesDu Cane RoadLondonUKW12 0NN
| | - Federico Piazza
- AOU San Luigi GonzagaUniversity of Turin, Division of NeurologyRegione Gonzole, 13OrbassanoItaly10043
| | - Sten Fredrikson
- Karolinska InstitutetDepartment of Clinical NeuroscienceStockholmSweden17177
| | - Irene Tramacere
- Fondazione IRCCS, Istituto Neurologico Carlo BestaScientific Directionvia Celoria, 11MilanItaly20133
| | - Antonio Scalfari
- Imperial College LondonDepartment of Medicine, Division of Brain Sciences, Centre for Neuroscience, Wolfson Neuroscience LaboratoriesDu Cane RoadLondonUKW12 0NN
| | - Georgia Salanti
- University of BernInstitute of Social and Preventive Medicine (ISPM)Finkenhubelweg 11BernSwitzerland3005
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Pateman K, Cockburn N, Campbell J, Ford PJ. How do Australians living with MS experience oral health and accessing dental care? A focus group study. Community Dent Oral Epidemiol 2016; 45:84-91. [PMID: 27681479 DOI: 10.1111/cdoe.12263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 09/08/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The symptoms of multiple sclerosis (MS) can affect oral care and access to dental services, but there is limited literature describing the oral health and perceived oral healthcare needs of people with MS. This study aimed to explore the oral health experiences, oral health behaviours and barriers to accessing dental care perceived by people living with MS in Australia. METHODS Six focus groups were held across two metropolitan areas (Brisbane, Queensland and Melbourne, Victoria) and one regional area (Toowoomba, Queensland). Focus group data were analysed using thematic analysis. RESULTS Living with MS was a highly individual experience due to the range of symptoms that may be experienced. In addition to having different symptom experiences to others with MS, individual symptoms also differed on a daily basis as the disease relapsed and remitted. The physical expressions of MS directly and indirectly affected the oral health of participants. Additionally, oral health was affected by the side effects of medications and orofacial pain symptoms. Depending on the symptoms experienced by the individual, personal oral hygiene was affected and professional dental appointments were difficult. Participants also experienced structural barriers to accessing professional dental care including difficulty accessing transport to-and-from dental appointments, space limitations in the dental surgery and financial barriers to care. DISCUSSION Dental care was perceived to be inflexible and was not tailored to individual experiences of MS, which contributed to perceptions of poor quality and appropriateness of care. It is important for dental professionals to offer tailored and individualized dental care when treating people with MS. Our findings suggest that there needs to be greater interprofessional communication and referral to manage atypical dental pain symptoms. Oral health education for people with MS should include altered strategies to performing daily oral hygiene, the management of xerostomia and advice regarding low cariogenic diets suitable for dysphagia. Additionally, policy and strategies to improve the oral health of people with MS should focus on enhancing access through transport, reducing the cost of dental services to the individual and providing domiciliary oral health care.
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Affiliation(s)
- K Pateman
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Brisbane, QLD, Australia
| | - N Cockburn
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Brisbane, QLD, Australia
| | - J Campbell
- Multiple Sclerosis Limited, The Nerve Centre, Blackburn, Vic., Australia
| | - P J Ford
- The University of Queensland, School of Dentistry, UQ Oral Health Centre, Brisbane, QLD, Australia
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Coffey NT, Weinstein AA, Cai C, Cassese J, Jones R, Shaewitz D, Garfinkel S. Identifying and Understanding the Health Information Experiences and Preferences of Individuals With TBI, SCI, and Burn Injuries. J Patient Exp 2016; 3:88-95. [PMID: 28725843 PMCID: PMC5513647 DOI: 10.1177/2374373516667007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction: Traumatic brain injury, spinal cord injury, and burn injury can cause lifelong disability and changes in quality of life. In order to meet the challenges of postinjury life, various types of health information are needed. We sought to identify preferred sources of health information and services for persons with these injuries and discover how accessibility could be improved. Methods: Thirty-three persons with injury participated in semistructured interviews. Responses to interview questions were coded using NVivo. Results: Participants’ difficulties accessing health information varied by injury type and individually. The majority of respondents found information via the Internet and advocated its use when asked to describe their ideal health information system. Nearly all participants supported the development of a comprehensive care website. When searching for health information, participants sought doctor and support group networks, long-term health outcomes, and treatments specific to their injury. Conclusion: To optimize the quality of health information resources, Internet-based health-care platforms should add or highlight access points to connect patients to medical professionals and support networks while aggregating specialized, injury-specific research and treatment information.
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Affiliation(s)
- Nathan T Coffey
- Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Ali A Weinstein
- Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Cindy Cai
- American Institutes for Research, Washington, DC, USA
| | - Jimmy Cassese
- Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Rebecca Jones
- Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA, USA
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