Risks and Benefits of Web-Based Patient Narratives: Systematic Review

Client Perspectives of Case Stories in Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Study

BACKGROUND

Internet-delivered cognitive behavioral therapy (ICBT) is an effective and convenient means of offering cognitive behavioral therapy to the general population. To increase access to ICBT among Canadian public safety personnel (PSP)-a group that experiences elevated rates of mental health concerns and barriers to mental health care-a clinical research unit called PSPNET has tailored ICBT to PSP, primarily through offering case stories and PSP-specific examples within an ICBT program. PSPNET's first and most frequently used ICBT program, called the PSP Wellbeing Course, has been found to reduce symptoms of mental disorders (eg, anxiety, depression, and posttraumatic stress) among PSP. Little research, however, has investigated clients' perceptions of the case stories in this course.

OBJECTIVE

This study was designed to expand the literature on the use and evaluation of case stories in ICBT among PSP. Specifically, this study investigated (1) PSP's perceptions of the case stories using the theoretical model provided by Shaffer and Zikmund-Fisher and (2) PSP feedback on the case stories in the PSP Wellbeing Course.

METHODS

This study included 41 clients who completed the PSP Wellbeing Course. Of these, 27 clients completed a bespoke questionnaire called the Stories Questionnaire, 10 of whom also participated in a semistructured interview.

RESULTS

Findings show that perceptions of the case stories in the PSP Wellbeing Course were largely positive and that the case stories were generally successful in achieving the 5 purposes of case stories (ie, informing, comforting, modeling, engaging, and persuading) proposed by Shaffer and Zikmund-Fisher. Client feedback also identified 3 tangible areas for story improvement: characters, content, and delivery. Each area highlights the need for and potential benefits of story development. Not all PSP engaged with the case stories, though, so results must be interpreted with caution.

CONCLUSIONS

Overall, this study adds to the growing body of research supporting the use of case stories in internet-delivered interventions among PSP.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032.

Exploring patient perspective: using narrative DIPEx interviews and the ICF model for interprofessional learning

Introduction

The International Classification of Functioning, Disability, and Health (ICF) has been widely adopted in academic health profession education and is part of bachelor curricula since its introduction by the WHO in 2001. In this context, interprofessional exchange among health professionals from a biopsychosocial perspective has become increasingly important and is now a key part of bachelor's program curricula to learn with, about, and from each other regarding students' curiosity about interprofessional collaboration (IPC). This pilot study describes initial teaching experiences within an interprofessional elective module for health professions focused on patient-centeredness. It uses the ICF model to exemplify interprofessional exchange based on real patient experiences from the "DIPEx" database, which stands for "Database of Individual Patients' Experiences."

Methods

Bachelor students from four healthcare professions learned in small interprofessional groups and selected case-related content from excerpts of real patient narratives from qualitative interviews in the DIPEx database. In a peer-to-peer process, students structured, analyzed, and reflected on selected patient experiences and presented their findings using the ICF model.

Outcome

Develop a shared understanding of the case from a biopsychosocial perspective using the ICF model to communicate and reflect on patient-centeredness in interprofessional groups for a common care strategy rooted in patient-centeredness.

Conclusion

This study illustrates how the shared analysis of a patient's experience of illness can lead to different perspectives on professional concepts for practice. The ICF model serves as a guiding structure and analysis tool. The core of the IPC, patient-centeredness, becomes the focus of the collaborative actions of the health professions.

Content and readability of patient educational materials about neuromodulation for childhood movement disorders

PURPOSE

To assess content and readability of online patient educational materials (PEMs) for paediatric deep brain stimulation (DBS) and intrathecal baclofen (ITB).

METHODS

A content analysis of PEMs identified from top children's hospitals, institutions affiliated with published neuromodulation research, and DBS and ITB device manufacturers was conducted. PEM content was analysed using a predetermined framework. Readability was assessed using the Simple Measure of Gobbledygook (SMOG).

RESULTS

Of 109 PEMs (72 DBS; 37 ITB) identified, most (77 (71%)) originated in the United States. More ITB PEMs (27 (73%)) contained specific paediatric information than DBS PEMs (16 (22%)). PEMS more frequently described benefits (DBS: 92%; ITB: 89%) than risks (DBS: 49%; ITB: 78%). Frequent content included pre- and post-operative care, procedural details, and device information. Less common content included long-term lifestyle considerations, alternatives, patient experiences, and financial details. Median readability of PEMs was 13.2 (interquartile range [IQR]: 11.4-14.45) for DBS and 11.8 (IQR: 11-12.9) for ITB.

CONCLUSIONS

Available ITB and DBS PEMs often miss important broader details of the treatments, and have additional shortcomings such as poor readability scores. Our findings highlight need for more holistic content within neuromodulation PEMs, improved accessibility, and more balanced representation of risks and benefits.

Correlates of Sleep Disturbance Experienced by Informal Caregivers of Persons Living with Dementia: A Systematic Review

OBJECTIVES

This study aims to comprehensively review and update the literature concerning the correlates of sleep disturbance among caregivers of persons living with Alzheimer's disease and related dementias to identify gaps in the literature and antecedent targets for interventions.

METHODS

We searched PubMed, CINAHL, PsycINFO, and Embase using terms related to "sleep," "caregiver," and "dementia."

RESULTS

Thirty-six articles were included in this review. Based on the antecedents within the 3P model of insomnia, predisposing factors associated with caregiver sleep included caregiver demographics, and physiological factors like genotype and biomarkers. Precipitating factors related to caregiver sleep included caregiving status and responsibilities, and person living with dementia factors.

CONCLUSIONS

Sleep disturbance is a significant issue for caregivers of persons living with dementia. However, this review has identified multiple precipitating factors that are modifiable targets for interventions to improve or enhance caregiver sleep.

CLINICAL IMPLICATIONS

Numerous predisposing and precipitating factors contribute to caregivers of persons living with dementia being susceptible to sleep disturbance. Healthcare providers should ask patients about their caregiving status during annual visits. Healthcare providers should also evaluate caregivers' sleep patterns, and the predisposing and precipitating factors of sleep disturbance, with a focus on the modifiable factors, to enable timely intervention.

Perceptions of client stories in internet-delivered cognitive behaviour therapy: A mixed-methods evaluation

Internet-delivered Cognitive-Behavioural Therapy (ICBT) aims to support people with mental health concerns using online treatment materials. Client stories (either real or a composite based on many clients) are often used in ICBT to facilitate learning. However, these stories remain understudied in terms of how they are perceived by clients, as well as their relationship to ICBT engagement, satisfaction, and outcomes. Among a sample of 324 clients enrolled in transdiagnostic ICBT targeting symptoms of depression and anxiety, we examined client perceptions of stories through mixed-method qualitative (open-ended) and quantitative (closed-ended) data collection. Specifically, 234 (72.22 %) clients responded to questions about stories at 4 weeks and 221 (68.21 %) responded to questions at 8 weeks. Most clients who responded to questions endorsed reviewing at least some stories (79.06 % at 4 weeks, 71.95 % at 8 weeks). Moreover, they rated stories positively in terms of being relatable, making clients feel less alone, increasing knowledge, providing ideas for how to use skills, and motivating clients to use skills. These perceptions of stories remained stable over the course of treatment. Stories were perceived more positively among those with lower symptom severity at 8 weeks as well as those who were more satisfied with ICBT at 8 weeks. Story perceptions at 4 weeks were predictive of decreased post-treatment anxiety symptom severity but not depression while controlling for baseline scores, age, and education. 26.49 % of clients at 4 weeks who reviewed stories and 33.33 % at 8 weeks provided suggestions about how to improve stories. In a qualitative analysis, we found 5 categories of suggestions including increasing the variety of issues and relatability of stories, ensuring the stories are realistic, refining the formatting, and making the stories shorter. Overall, this study provides insights into how client stories could be improved to play a more significant role in future ICBT programs.

Internet-Delivered Cognitive Behavioral Therapy Tailored to Spouses and Significant Others of Public Safety Personnel: Formative Evaluation Study

BACKGROUND

Spouses and significant others (SSOs) of public safety personnel (PSP) are affected by the risks and requirements of these occupations. Internet-delivered cognitive behavioral therapy (ICBT) provides a convenient and accessible treatment format that can be tailored to the needs of SSOs of PSP.

OBJECTIVE

This study aimed to assess the initial use and client perceptions (eg, likes, helpfulness, and areas for improvement) of a self-guided, transdiagnostic ICBT course designed for Canadian SSOs of PSP and identify opportunities to further tailor ICBT for this group.

METHODS

SSOs were invited to complete a 5-lesson, self-guided, transdiagnostic ICBT course. Descriptive statistics were used to analyze the demographic and clinical characteristics of participants. Content analysis was used to analyze the data from open-ended survey responses and interviews to understand their experiences with ICBT.

RESULTS

Clients (N=118) endorsed various mental health concerns (eg, depression, anxiety, posttraumatic stress symptoms, and relationship concerns) with a range of severity levels. Most clients identified as White (110/116, 94.8%) and women (108/116, 91.5%), with a mean age of 42.03 (SD 9.36) years. Of the 26 clients who were interviewed, 89% (23/26) reported believing that ICBT is helpful and 92% (24/26) reported finding at least 1 skill helpful. Clients provided suggestions for course improvements. On the basis of this feedback and quantitative data, changes were made to areas such as the delivery of materials, content, case stories, and timelines. Overall, the results indicated that many SSOs of PSP had positive perceptions of ICBT tailored to their needs and found several aspects of the course helpful, supporting the continued delivery of tailored ICBT to this population. However, there remains a need for continued promotion of the course and outreach to diverse groups of SSOs of PSP.

CONCLUSIONS

Findings from this formative evaluation provide insight into the unique experiences and needs of SSOs of PSP and provide preliminary evidence for the use of tailored ICBT to support the mental health of this group in Canada.

Cancer survival stories: Perception, creation, and potential use case

BACKGROUND

Cancer patients often search for information about their health conditions online. Cancer patient narratives have established themselves as a way of providing information and education but also as an effective approach to improving coping with the disease.

OBJECTIVE

We investigated how people affected by cancer perceive cancer patient narratives and whether such stories can potentially improve coping during their own cancer journeys. Additionally, we reflected on whether our co-creative citizen science approach can contribute to gaining knowledge about cancer survival stories and providing peer support.

DESIGN, SETTING AND STAKEHOLDERS

We applied a co-creative citizen science approach by using quantitative and qualitative research methods with stakeholders (i.e., cancer patients, their relatives, friends and health professionals).

MAIN OUTCOME MEASURES

Understandability and perceived benefits of cancer survival stories, coping, emotional reactions to the stories and helpful characteristics of the stories.

RESULTS

Cancer survival stories were considered intelligible and beneficial, and they potentially support positive emotions and coping in people affected by cancer. Together with the stakeholders, we identified four main characteristics that evoked positive emotions and that were considered especially helpful: (1) positive attitudes towards life, (2) encouraging cancer journeys, (3) individual coping strategies for everyday challenges and (4) openly shared vulnerabilities.

CONCLUSIONS

Cancer survival stories potentially support positive emotions and coping in people affected by cancer. A citizen science approach is suitable for identifying relevant characteristics of cancer survival stories and may become a helpful educational peer support resource for people coping with cancer.

PATIENT OR PUBLIC CONTRIBUTIONS

We adopted a co-creative citizen science approach, wherein citizens and researchers were equally involved throughout the entire project.

Evaluating the Amyloidosis Speakers Bureau: the influence of amyloidosis patients' narratives on medical students' knowledge, attitudes, and behavioral intent

Background:  Amyloidosis is a complex multi-systemic disease. Lack of knowledge about amyloidosis and subsequent mis- or under-diagnosis are major obstacles to treatment, which result in life-threatening organ damage, morbidity, and mortality. Hence, the purpose of this study is to explore the effectiveness of amyloidosis patients' narratives on medical students. Methods:  The Amyloidosis Speakers Bureau (ASB) arranges for amyloidosis patients to speak about their diagnostic and treatment experiences with medical students. Using a randomized post-test only experiment, we compared the effectiveness of patients' narratives between two groups (treatment and control). Outcome measures included medical students' intent to actively communicate with patients, acquire knowledge about amyloidosis, and reconsider diagnoses when warranted. Results:  The treatment group (those who listened to an ASB patient speaker) had higher mean differences on all measures, including the desire to improve communication with patients, acquire and apply knowledge of amyloidosis, and willingness to reconsider diagnoses when symptoms are puzzling. Conclusions:  ASB patient educators widened awareness of an under-diagnosed disease. Listening to a patient's narrative was associated with positive attitudes toward communication with patients, interest in acquiring and applying knowledge of amyloidosis, and humility about diagnosis. Narrative and persuasion theory are used to explain this quantitative evidence of the power of patient narratives.

Things I need you to know: a qualitative analysis of advice-giving statements in early-onset colorectal cancer patients' personal accounts published online

OBJECTIVE

People with early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) before the age of 50, now constitute a significant patient population. In empirical and grey literature EOCRC patients report unsatisfactory experiences of care, especially in relation to protracted intervals from first help-seeking to diagnosis. This study is the first to investigate EOCRC patients' perspectives on ways to improve experiences of care. The objective is to provide foundational knowledge for the development of EOCRC-specific patient-reported experience measures (PREMs).

DESIGN

The study was designed as qualitative Internet Mediated Research, involving a thematic analysis of unsolicited narratives recounting personal experiences of EOCRC care. We examined advice-giving statements in 120 online texts written by EOCRC patients and survivors.

SETTING

The Internet is the broad research setting. The host websites of three prominent charitable CRC support organisations were selected as specific research sites: Bowel Cancer Australia, Bowel Cancer UK and Bowel Cancer New Zealand.

RESULTS

We found that 90% of texts comprised statements of advice to new patients about the importance of self-advocacy in achieving quality care. Four key contexts for self-advocacy were identified: (1) accessing relevant diagnostic services; (2) driving diagnostic investigations when symptoms are not resolved; (3) involvement in treatment decision-making and (4) proactivity about preferred outcomes. Over 30% of advice-giving texts also directed statements of advice to healthcare providers, indicating that their youthfulness had been a barrier to timely diagnosis.

CONCLUSION

Healthcare barriers to, and facilitators of, patient self-advocacy may be indicators of quality EORC care. There is a need for greater awareness of the impact of age bias on the responsiveness of clinicians and healthcare services in EOCRC care. Our findings support the development of EOCRC-specific PREMs that can guide age-appropriate policy and practice for this newly identified patient population.

Patient narratives - a still undervalued resource for healthcare improvement

In recent years, patient narratives have attracted increasing attention as a valuable source of insights into the subjective experience of healthcare. This paper outlines a best-practice approach to the collection, analysis, and use of patient narratives, based on current literature and on the experience of developing the Swiss Database of Individual Patient Experiences (DIPEx). The DIPEx project aims to provide a systematic and methodologically rigorous collection of patient narratives on various health situations and topics. This paper presents and details the DIPEx approach as a current standard in the field, offering a comprehensive overview and discussing the potential uses and benefits of patient narratives: improve healthcare practice, empower patients and caregivers, help structure better communication in healthcare, and contribute to medical teaching and learning.

"Their Whole Lives Are Going To Change": A Photo-Elicitation Study of Rectal Cancer Survivorship

BACKGROUND

Rectal cancer survivors experience persistent symptoms, which may lead to unmet needs.

OBJECTIVE

This study aimed to explore the rectal cancer survivor experience and identify the impacts of treatment using photo-elicitation.

DESIGN

This was a novel study in which patients were instructed to take photographs that showed aspects of life that have been challenging to deal with since undergoing treatment. Participants underwent subsequent qualitative interviews using the photographs as prompts.

SETTING

The study was conducted in a cancer center in a tertiary medical center.

PATIENTS

Twenty patients were included who underwent curative-intent rectal cancer treatment.

MAIN OUTCOME MEASURES

Interviews were designed to explore the lived experiences of patients with rectal cancer after treatment.

RESULTS

Three major themes with regard to life after rectal cancer and its treatments emerged: physical symptoms, lifestyle changes, and changes over time. Physical symptoms encompassed GI issues, ostomy difficulties, and genitourinary symptoms. Lifestyle changes included those relating to diet, social life, and hobbies as well as major life changes and finances. Finally, patients spoke of improvement during the time of symptoms and impact on daily life.

LIMITATIONS

There may be bias because of the homogeneity of our study population, which may not represent the experiences of younger patients, those of lower socioeconomic status, or those who chose not to participate. Our sample was also overrepresented by patients with a complete pathologic response after neoadjuvant chemotherapy and excluded individuals with recurrence. Finally, single interviews with each individual at different points from their treatment may have resulted in recall bias.

CONCLUSIONS

This photo-elicitation study provided rectal cancer survivors with a unique opportunity to share how rectal cancer treatment has impacted their lives beyond traditional metrics such as postoperative complications and long-term survival. In addition to improving preoperative counseling and expectation setting, future efforts should focus on postoperative symptom surveillance and appropriate referral when needed. See Video Abstract at http://links.lww.com/DCR/C7.

SUS VIDAS ENTERAS VAN A CAMBIAR UN ESTUDIO DE OBTENCIN DE IMGENES SOBRE LA SUPERVIVENCIA AL CNCER DE RECTO

ANTECEDENTES:Los sobrevivientes de cáncer de recto experimentan síntomas persistentes, lo que puede dar lugar a necesidades no satisfechas.OBJETIVO:Explorar la experiencia de los sobrevivientes de cáncer de recto e identificar los impactos del tratamiento mediante el uso de fotoestimulación.DISEÑO:En este nuevo estudio, se instruyó a los pacientes para que tomaran fotografías que mostraran aspectos de la vida que han sido difíciles de manejar desde que se sometieron al tratamiento. Los participantes se sometieron posteriormente a entrevistas cualitativas utilizando las fotografías como estimuladores.ESCENARIO:Centro oncológico en un centro médico terciario.PARTICIPANTES:Veinte pacientes que se sometieron a tratamiento de cáncer de recto con intención curativa.PRINCIPALES MEDIDAS DE RESULTADO:Las entrevistas se diseñaron para explorar las experiencias vividas por los pacientes con cáncer de recto después del tratamiento.RESULTADOS:Surgieron tres temas principales con respecto a la vida después del cáncer de recto y sus tratamientos: síntomas físicos; cambios en el estilo de vida; y cambios en el tiempo. Los síntomas físicos abarcaron problemas gastrointestinales, dificultades de las ostomías y síntomas genitourinarios. Los cambios en el estilo de vida incluyeron aquellos relacionados con la dieta, la vida social y los pasatiempos, así como cambios importantes en la vida y las finanzas. Por último, los pacientes hablaron de una mejoría con el tiempo de los síntomas y el impacto en la vida diaria.LIMITACIONES:Puede haber sesgo debido a la homogeneidad de nuestra población de estudio, que puede no representar las experiencias de los pacientes más jóvenes, los de nivel socioeconómico más bajo o los que optaron por no participar. Nuestra muestra también estuvo sobrerrepresentada por pacientes con una respuesta patológica completa después de la quimioterapia neoadyuvante y excluyó a los individuos con recurrencia. Finalmente, las entrevistas individuales con cada paciente en diferentes puntos de su tratamiento pueden dar lugar a que los participantes experimenten un sesgo de recuerdo.CONCLUSIONES:Este estudio de obtención de fotografías brinda a los sobrevivientes de cáncer de recto una oportunidad única de compartir cómo el tratamiento del cáncer de recto ha impactado sus vidas más allá de las métricas tradicionales, como las complicaciones posoperatorias y la supervivencia a largo plazo. Además de mejorar el asesoramiento preoperatorio y el establecimiento de expectativas, los esfuerzos futuros deben centrarse en la vigilancia de los síntomas posoperatorios y la derivación adecuada cuando sea necesario. Consulte Video Resumen en http://links.lww.com/DCR/C7.

Evidence-based health information about pulmonary embolism: Assessing the quality, usability and readability of online and offline patient information

Objective

Pulmonary embolism (PE) is the third most common cardiovascular disease worldwide. However, public awareness is considerably lower than for myocardial infarction or stroke. Patients suffering from PE complain about the lack of (understandable) information and express high informational needs. To uncover if reliable information is indeed scarce, this study evaluates the quantity and quality of existing patient information for tertiary prevention using an evidence-based health information paradigm.

Methods

We conducted a quantitative content analysis (n = 21 patient information brochures; n = 67 websites) evaluating content categories addressed, methodical quality, usability, and readability.

Results

Results show that there is not enough patient information material focusing on PE as a main topic. Existing patient information material is mostly incomplete, difficult to understand, and low in actionability as well as readability.

Conclusion

Our systematic analysis reveals the need for more high-quality patient information on PE as part of effective tertiary prevention.

Innovation

This is the first review analyzing content, methodical quality, readability, and usability of patient information on PE. The findings of this analysis are guiding the development of an innovative, evidence-based patient information on PE aiming to support patients' informational needs and their self-care behavior.

Validation of the German eHealth impact questionnaire for online health information users affected by multiple sclerosis

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.

"What Do You Need? What Are You Experiencing?" Relationship Building and Power Dynamics in Participatory Research Projects: Critical Self-Reflections of Researchers

Participatory approaches create opportunities for cooperation, building relationships, gaining knowledge, rethinking, and eventually changing power structures. From an international perspective, the article looks at the historical development of different participatory approaches in which building relationships and managing the balance of power between persons engaged in participatory research are central. The authors present and critically reflect on four research projects to show how they understood and implemented participatory research in different ways and what they have learned from their respective experiences. The "PaSuMi" project worked in the context of addiction prevention with migrants and provides a glimpse into different contexts of participatory research. The initiator of the study "Back into life-with a power wheelchair" works with post-stroke individuals who use the assistive device in community mobility and reflects on the shifting and intertwining roles of participants. In the research project "Workshops for implementation of expanded community nursing", new professional roles for nurses in community nursing were developed; here limitations to participation and ways to deal with them are illustrated. Finally, the "DIPEx" project deals with challenges of enabling participation of persons with multiple sclerosis via narrative interviews on the experience of health and illness. All examples underline the necessity of a permanent reflection on relationships and power dynamics in participatory research processes.

Presenting scientifically-derived illness experiences online - Evaluation of the use of the DIPEx Germany website

OBJECTIVE

To evaluate the real-time usage of krankheitserfahrungen.de, a website providing scientifically collected and analyzed experiences of persons with various chronic illnesses.

METHODS

Web analytics of website use of www.krankheitserfahrungen.de in 2016. Qualitative content analysis of the 150 most and least opened video/audio clip titles in 2018-19.

RESULTS

In 2016, krankheitserfahrungen.de had 19,703 unique visits, of which 3925 were returning visits. Between new and returning visits, the latter were characterized by more actions and more time spent on the website. Thematic pages were clicked more often during new visits and person pages were more frequented during returning visits. In 2018-19, video/audio clip titles related to topics around uncertainties and/or decision making were most often clicked, whereas the least clicked clips dealt with topics like illness management, problem-solving, giving advice to others and emotionally difficult topics such as suffering, death and burden for the family.

CONCLUSION

A website with balanced, scientifically collected and analyzed patient experiences attracts a sufficient number of users and is used for further explorations.

PRACTICE IMPLICATIONS

Using multiple formats, broad topics and diverse personal experiences being accessible through themes or persons is necessary when a scientifically based website on patients' experiences is designed.

Positive impact of a co-designed digital resource for women with early menopause

OBJECTIVE

To evaluate a co-designed early menopause digital resource, including audio/video clips, question prompt list, and information links.

METHODS

Pre/post-test study. Women with early menopause, defined as menopause before age 45 years, were recruited from the community. Following online informed consent, participants were emailed links to the digital resource and online surveys to complete before (baseline) and, immediately and 1 month after viewing the resource. Main outcome measures: Health-related empowerment (Health Education Impact Questionnaire), illness perception (Brief Illness Perception Questionnaire), menopause symptoms (Greene Climacteric Scale), risk perception, and knowledge change.

RESULTS

One hundred fifty women participated. Compared to baseline, at 1-month health-related empowerment, 'health directed behavior' scores increased (mean change: +0.13; 95% CI: 0.01-0.24; and P = 0.03), 'emotional distress' decreased (mean change: -0.15; 95% CI: -0.25 to -0.05; and P = 0.003) and physical and emotional menopause symptom scores decreased (P = 0.001 and P  = 0.02, respectively). Illness perception scores increased at both immediate and 1-month follow-up versus baseline for 'personal control' (P < 0.001 and P  = 0.02) and 'coherence' (P = 0.003 and P  < 0.001). After viewing the digital resource, more women perceived that hormone therapy decreases heart disease risk, reduces hot flashes, and prevents fractures versus baseline (all P  < 0.05). More women correctly answered questions regarding early menopause prevalence (60% vs 35%), cause (46% vs 33%), risk (76% vs 55%), effect of phytoestrogens (60% vs 27%), and osteoporosis prevention (64% vs 44%) at immediate or 1-month follow-up versus baseline (all P  < 0.05).

CONCLUSIONS

A co-designed early menopause digital resource may improve women's health-related empowerment, illness perception, menopause symptoms, risk perception, and knowledge.

Spontaneously generated online patient experience data - how and why is it being used in health research: an umbrella scoping review

PURPOSE

Social media has led to fundamental changes in the way that people look for and share health related information. There is increasing interest in using this spontaneously generated patient experience data as a data source for health research. The aim was to summarise the state of the art regarding how and why SGOPE data has been used in health research. We determined the sites and platforms used as data sources, the purposes of the studies, the tools and methods being used, and any identified research gaps.

METHODS

A scoping umbrella review was conducted looking at review papers from 2015 to Jan 2021 that studied the use of SGOPE data for health research. Using keyword searches we identified 1759 papers from which we included 58 relevant studies in our review.

RESULTS

Data was used from many individual general or health specific platforms, although Twitter was the most widely used data source. The most frequent purposes were surveillance based, tracking infectious disease, adverse event identification and mental health triaging. Despite the developments in machine learning the reviews included lots of small qualitative studies. Most NLP used supervised methods for sentiment analysis and classification. Very early days, methods need development. Methods not being explained. Disciplinary differences - accuracy tweaks vs application. There is little evidence of any work that either compares the results in both methods on the same data set or brings the ideas together.

CONCLUSION

Tools, methods, and techniques are still at an early stage of development, but strong consensus exists that this data source will become very important to patient centred health research.

Development and evaluation of a website with patients experiences of multiple sclerosis: a mixed methods study

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.

Understanding and Addressing Occupational Stressors in Internet-Delivered Therapy for Public Safety Personnel: A Qualitative Analysis

Internet-delivered cognitive behavioral therapy (ICBT) is effective when tailored to meet the needs of public safety personnel (PSP). Nevertheless, there is limited research on the nature of the occupational stressors faced by PSP who seek ICBT and how PSP use ICBT to address occupational stressors. We provided tailored ICBT to PSP (N = 126; 54% women) and conducted a qualitative content analysis on clinicians’ eligibility screening notes, clients’ emails, and clients’ survey responses to understand the occupational stressors faced by PSP and their use of ICBT to address such stressors. Clients described several occupational stressors, including operational stressors (e.g., potentially psychologically traumatic events and sleep/shiftwork issues) and organizational stressors (e.g., issues with leadership, resources, and workload). More clients shared occupational concerns during the screening process (97%) than during treatment (58%). The most frequently cited occupational stressor was exposure to potentially psychologically traumatic events. Clients reported using course skills (e.g., controlled breathing and graduated exposure) to manage occupational stressors (e.g., responding to calls, workplace conflict, and work–family conflict). Thought challenging was the most frequently reported strategy used to manage occupational stressors. The current results provide insights into the occupational stressors PSP experience and endeavor to manage using ICBT, which can inform further efforts to tailor ICBT for PSP (e.g., adapting course materials and examples to take into account these operational and occupational stressors).

Moving forward: Implementing health psychology research to improve patient acceptance of biosimilars

As more biosimilars enter the pharmaceutical market, patient acceptance remains a significant barrier to their uptake. Psychological factors, such as negative expectations, are important causes of patient hesitancy. As a result, patients can develop nocebo responses following a transition, discontinue biosimilar treatment early, or have poor adherence. These negative outcomes may offset some of the cost-saving potential of biosimilars. Key healthcare professionals such as pharmacists, physicians, and nurses already play a noteworthy role in educating and transitioning patients. However, given the psychological aspect of biosimilar acceptance, it is logical for healthcare professionals and researchers to draw on research and theory from health psychology. This commentary outlines how a multidisciplinary approach can add to the understanding of the mechanisms behind patient resistance to biosimilars and help engage patients in the transitioning process. It also explores how health psychology strategies that have been successful in similar areas can be translated to help conduct more effective transitions. Future directions in research are discussed.

Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach

Background

The recent introduction of COVID-19 certificates in several countries, including the introduction of the European green pass, has been met with protests and concerns by a fraction of the population. In Italy, the green pass has been used as a nudging measure to incentivize vaccinations because a valid green pass is needed to enter restaurants, bars, museums, or stadiums. As of December 2021, a valid green pass can be obtained by being fully vaccinated with an approved vaccine, recovered from COVID-19, or tested. However, a green pass obtained with a test has a short validity (48 hours for the rapid test, 72 hours for the polymerase chain reaction test) and does not allow access to several indoor public places.

Objective

This study aims to understand and describe the concerns of individuals opposed to the green pass in Italy, the main arguments of their discussions, and their characterization.

Methods

We collected data from Telegram chats and analyzed the arguments and concerns that were raised by the users by using a mixed methods approach.

Results

Most individuals opposing the green pass share antivaccine views, but doubts and concerns about vaccines are generally not among the arguments raised to oppose the green pass. Instead, the discussion revolves around the legal aspects and the definition of personal freedom. We explain the differences and similarities between antivaccine and anti–green pass discourses, and we discuss the ethical ramifications of our research, focusing on the use of Telegram chats as a social listening tool for public health.

Conclusions

A large portion of individuals opposed to the green pass share antivaccine views. We suggest public health and political institutions to provide a legal explanation and a context for the use of the green pass, as well as to continue focusing on vaccine communication to inform vaccine-hesitant individuals. Further work is needed to define a consensual ethical framework for social listening for public health.

Examining Different Factors in Web-Based Patients' Decision-Making Process: Systematic Review on Digital Platforms for Clinical Decision Support System

(1) Background: The appearance of physician rating websites (PRWs) has raised researchers’ interest in the online healthcare field, particularly how users consume information available on PRWs in terms of online physician reviews and providers’ information in their decision-making process. The aim of this study is to consistently review the early scientific literature related to digital healthcare platforms, summarize key findings and study features, identify literature deficiencies, and suggest digital solutions for future research. (2) Methods: A systematic literature review using key databases was conducted to search published articles between 2010 and 2020 and identified 52 papers that focused on PRWs, different signals in the form of PRWs’ features, the findings of these studies, and peer-reviewed articles. The research features and main findings are reported in tables and figures. (3) Results: The review of 52 papers identified 22 articles for online reputation, 15 for service popularity, 16 for linguistic features, 15 for doctor–patient concordance, 7 for offline reputation, and 11 for trustworthiness signals. Out of 52 studies, 75% used quantitative techniques, 12% employed qualitative techniques, and 13% were mixed-methods investigations. The majority of studies retrieved larger datasets using machine learning techniques (44/52). These studies were mostly conducted in China (38), the United States (9), and Europe (3). The majority of signals were positively related to the clinical outcomes. Few studies used conventional surveys of patient treatment experience (5, 9.61%), and few used panel data (9, 17%). These studies found a high degree of correlation between these signals with clinical outcomes. (4) Conclusions: PRWs contain valuable signals that provide insights into the service quality and patient treatment choice, yet it has not been extensively used for evaluating the quality of care. This study offers implications for researchers to consider digital solutions such as advanced machine learning and data mining techniques to test hypotheses regarding a variety of signals on PRWs for clinical decision-making.

"I have to start learning how to live with becoming sick": A scoping review of the lived experiences of people with Huntington's disease

Person-centered care (PCC) is recognized as a key component of the delivery of quality healthcare and a model for healthcare systems worldwide. The experience of illness through a person's perspective is one domain defining PCC contributing to a growing interest in examining the lived experiences of illness. This scoping review sought to examine what is known from the existing literature about the lived experiences of persons gene-positive for or living with Huntington's disease (HD) as described in their own voices and to outline prominent psychosocial themes of those experiences. Five databases were systematically searched and analyzed resulting in 19 publications for inclusion. Using a thematic analysis, five prominent psychosocial themes were identified: grappling with control, avoidance as an escape from realities, adaptation to new realities, managing emotions, and appreciation for life. Variation in themes existed across HD life stage of being undiagnosed or diagnosed with HD. The findings of this review demonstrate that individuals who are gene-positive for or living with HD require support well beyond the disclosure of genetic testing and that it may be beneficial for healthcare providers to consider where along the life stage trajectory a person affected by HD may be to ensure the delivery of quality PCC.

Reasons for Discontinuing Active Participation on the Internet Forum Tinnitus Talk: Mixed Methods Citizen Science Study

Background

Tinnitus Talk is a nonprofit online self-help forum. Asking inactive users about their reasons for discontinued usage of health-related online platforms such as Tinnitus Talk is important for quality assurance.

Objective

The aim of this study was to explore reasons for discontinued use of Tinnitus Talk, and their associations to the perceptions of Tinnitus Talk and the age of users who ceased logging on to the platform.

Methods

Initially, 13,745 users that did not use Tinnitus Talk within the previous 2 months were contacted and the response rate was 20.47% (n=2814). After dataset filtering, a total of 2172 past members of Tinnitus Talk were included in the analyses. Nine predefined reasons for discontinued usage of Tinnitus Talk were included in the survey as well as one open question. Moreover, there were 14 predefined questions focusing on perception of Tinnitus Talk (usefulness, content, community, and quality of members’ posts). Mixed methods analyses were performed. Frequencies and correlation coefficients were calculated for quantitative data, and grounded theory methodology was utilized for exploration of the qualitative data.

Results

Quantitative analysis revealed reasons for discontinued use of Tinnitus Talk as well as associations of these reasons with perceptions of Tinnitus Talk and age. Among the eight predefined reasons for discontinued use of Tinnitus Talk, the most frequently reported was not finding the information they were looking for (451/2695, 16.7%). Overall, the highest rated perception of Tinnitus Talk was content-related ease of understanding (mean 3.9, SD 0.64). A high number (nearly 40%) of participants provided additional free text explaining why they discontinued use. Qualitative analyses identified a total of 1654 specific reasons, more than 93% of which (n=1544) could be inductively coded. The coding system consisted of 33 thematically labeled codes clustered into 10 categories. The most frequent additional reason for discontinuing use was thinking that there is no cure or help for tinnitus symptoms (375/1544, 24.3%). Significant correlations (P<.001) were observed between reasons for discontinued usage and perception of Tinnitus Talk. Several reasons for discontinued usage were associated with the examined dimensions of perception of Tinnitus Talk (usefulness, content, community, as well as quality of members’ posts). Moreover, significant correlations (P<.001) between age and reasons for discontinued use were found. Older age was associated with no longer using Tinnitus Talk because of not finding what they were looking for. In addition, older participants had a generally less positive perception of Tinnitus Talk than younger participants (P<.001).

Conclusions

This study contributes to understanding the reasons for discontinued usage of online self-help platforms, which are typically only reported according to the dropout rates. Furthermore, specific groups of users who did not benefit from Tinnitus Talk were identified, and several practical implications for improvement of the structure, content, and goals of Tinnitus Talk were suggested.

Personal Accounts of Young-Onset Colorectal Cancer Organized as Patient-Reported Data: Protocol for a Mixed Methods Study

BACKGROUND

Young-onset colorectal cancer is a contemporary issue in need of substantial research input. The incidence of colorectal cancer in adults younger than 50 years is rising in contrast to the decreasing incidence of this cancer in older adults. People with young-onset colorectal cancer may be at that stage of life in which they are establishing their careers, building relationships with long-term partners, raising children, and assembling a financial base for the future. A qualitative study designed to facilitate triangulation with extant quantitative patient-reported data would contribute the first comprehensive resource for understanding how this distinct patient population experiences health services and the outcomes of care throughout the patient pathway.

OBJECTIVE

The aim of this study was to undertake a mixed-methods study of qualitative patient-reported data on young-onset colorectal cancer experiences and outcomes.

METHODS

This is a study of web-based unsolicited patient stories recounting experiences of health services and clinical outcomes related to young-onset colorectal cancer. Personal Recollections Organized as Data (PROD) is a novel methodology for understanding patients' health experiences in order to improve care. PROD pivots qualitative data collection and analysis around the validated domains and dimensions measured in patient-reported outcome and patient-reported experience questionnaires. PROD involves 4 processes: (1) classifying attributes of the contributing patients, their disease states, their routes to diagnosis, and the clinical features of their treatment and posttreatment; (2) coding texts into the patient-reported experience and patient-reported outcome domains and dimensions, defined a priori, according to phases of the patient pathway; (3) thematic analysis of content within and across each domain; and (4) quantitative text analysis of the narrative content.

RESULTS

Relevant patient stories have been identified, and permission has been obtained for use of the texts in primary research. The approval for this study was granted by the Macquarie University Human Research Ethics Committee in June 2020. The analytical framework was established in September 2020, and data collection commenced in October 2020. We will complete the analysis in March 2021 and we aim to publish the results in mid-2021.

CONCLUSIONS

The findings of this study will identify areas for improvement in the PROD methodology and inform the development of a large-scale study of young-onset colorectal cancer patient narratives. We believe that this will be the first qualitative study to identify and describe the patient pathway from symptom self-identification to help-seeking through to diagnosis, treatment, and to survivorship or palliation for people with young-onset colorectal cancer.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/25056.

What do Australian health consumers believe about commercial advertisements and testimonials? a survey on health service advertising

Background

There has been little examination of consumer attitudes towards the commercial advertising of healthcare services in Australia and how marketing is used by consumers in their health decision-making. In this research, we examined how consumers reported commercial advertising helped them to understand the health services available to them and the influence that marketing had upon their choices.

Methods

A survey instrument using a Likert scale to indicate agreement or disagreement with 21 questions was developed using qualitative interviews before being distributed online within Australia. Sampling of participants was stratified by age, gender and location. The results were subjected to statistical analysis with Spearman Rank Correlation test being used for bivariate analysis.

Results

One thousand five hundred sixty-four complete surveys were collected. The results revealed certain consumer beliefs, for example; the title of ‘Dr’ was believed to indicate skill and high levels of training (81.0%), with 80.3% agreeing incorrectly that use of the title was strictly regulated. Participants reported to have a higher confidence in their own abilities (71.2%) than the public (52.8%) in assessing health advertising. The level of self-confidence increased with higher education level and decreased by age (p < 0.05). Testimonials were reported to be lacking in reliability (67.7%) and that they should not be used in healthcare in the same manner as they are used in other industries. Only 44.8% of participants reported that they felt confident to spot a review that was not written by a genuine user of a service.

Conclusions

The data demonstrated that many health consumers felt that while commercial health advertising was helpful, it was also confusing, with many participants also holding mistaken beliefs around other elements of commercial health advertising. While the advertising of healthcare services might have educational effects and be superficially empowering, advertising is primarily intended to sell, not educate. This research demonstrates that there is significant potential for healthcare advertising to mislead. Future developments in regulatory health advertising policy, and the related ethical frameworks developed by professional healthcare associations, need to consider how the consumers of healthcare services might be better protected from misleading and predatory advertising practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-10078-9.