Measuring Practicing Clinicians' Information Literacy. An Exploratory Analysis in the Context of Panel Management

Development and validation of the clinical information literacy questionnaire

BACKGROUND

Clinical Information Literacy (CIL) seems to be a prerequisite for physicians to implement Evidence-Based Medicine (EBM) effectively. This study endeavors to develop and validate a CIL questionnaire for medical residents of Isfahan University of Medical Sciences.

MATERIALS AND METHODS

This study employs sequential-exploratory mixed methods in 2019. The participants were 200 medical residents in different specialties; they are selected through the convenience sampling method. In the first (qualitative) phase, an early CIL questionnaire was designed by reviewing literature and performing complementary interviews with health professionals. In the second (validation) phase, the questionnaire's face validity and content validity were confirmed. In the third (quantitative) phase, the construct validity was examined via Item-Response Theory (IRT) model, and the factor loading was computed. The gathered data were analyzed using descriptive statistics, t-test, two-way ANOVA, as well as two-parameter IRT model in R software.

RESULTS

In the qualitative phase, the concept of CIL is initially described in seven main categories and 22 subcategories, and the items were formulated. An initial 125-item questionnaire was analyzed by the research team, leading to a 43-item. Through the content validity and face validity examination, we removed 11 and 4 items in the Content Validity Ratio (CVR) and Content Validity Index (CVI), respectively. Throughout the face validity analysis, none of the items were removed. According to the construct validity results, difficulty coefficient, discriminant coefficient, and factor loading were confirmed, most of the other questions achieved a proper factor loading value that is higher than 0.30, and a value of 0.66 was achieved for the reliability via the Kuder-Richardson method. Ultimately, the real-assessment 28-item CIL questionnaire was developed with four components.

CONCLUSIONS

The CIL questionnaire could be employed to examine the actual CIL basic knowledge. Because of using the real-assessment approach rather than self-assessment in the design, it can be claimed that this instrument can provide a more accurate assessment of the information literacy status of medical residents. This valid questionnaire is used to measure and train the skills needed by healthcare professionals in the effective implementation of EBM.

Interprofessional population health advocacy: Developing and implementing a panel management curriculum in five Veterans Administration primary care practices

Health care systems expect primary care clinicians to manage panels of patients and improve population health, yet few have been trained to do so. An interprofessional panel management (PM) curriculum is one possible strategy to address this training gap and supply future primary care practices with clinicians and teams prepared to work together to improve the health of individual patients and populations. This paper describes a Veterans Administration (VA) sponsored multi-site interprofessional PM curriculum development effort. Five VA Centers of Excellence in Primary Care Education collaborated to identify a common set of interprofessionally relevant desired learning outcomes (DLOs) for the PM and to develop assessment instruments for monitoring trainees' PM learning. Authors cataloged teaching and learning activities across sites. Results from pilot testing were systematically discussed leading to iterative revisions of curricular elements. Authors completed a retrospective self-assessment of curriculum implementation for the academic year 2015-16 using a 5-point scale: contemplation (score = 0), pilot (1), action (2), maintenance (3), and embedded (4). Implementation scores were analyzed using descriptive statistics. DLOs were organized into five categories (individual patients, populations, guidelines/measures, teamwork, and improvement) along with a developmental continuum and mapped to program competencies. Instruction and implementation varied across sites based on resources and priorities. Between 2015 and 2016, 159 trainees (internal medicine residents, nurse practitioner students and residents, pharmacy residents, and psychology post-doctoral fellows) participated in the PM curriculum. Curriculum implementation scores for guidelines/measures and improvement DLOs were similar for all trainees; scores for individual patients, populations, and teamwork DLOs were more advanced for nurse practitioner and physician trainees. In conclusion, collaboratively identified DLOs for PM guided development of assessment instruments and instructional approaches for panel management activities in interprofessional teams. This PM curriculum and associated tools provide resources for educators in other settings.

Empowerment for the Digital Transformation: Results of a Structured Blended-Learning On-the-Job Training for Practicing Physicians in Germany

(1) Background: Practicing physicians have not been in the focus of structured qualifications in basic digital competences so far. However, they are the current gatekeepers to implement digital technologies and need empowerment to proactively take part in the ongoing digital transformation process. The present study investigates if a structured blended-learning training for practicing physicians in Germany enhances both physicians' knowledge about central aspects of the digital transformation (including awareness of personal possibilities to act) and their attitudes towards a more digitally empowered mindset. (2) Methods: Participants (n = 32) self-assessed their knowledge (19 items, 10-point Likert-scale) and attitudes (6 items, 5-point Likert-scale) towards the digital transformation at the beginning and at the end of the training. MANCOVAs were conducted. (3) Results: Participants reported an increase in every knowledge domain, representing large effects (Hedges' g 1.06 to 2.82). Attitudes were partly shifted towards a more empowered mindset with decreased insecurity towards technological, legal, and ethical aspects of the digital transformation (Hedges' g -0.82 to -1.40). However, preparedness for the digital transformation remained low. (4) Conclusions: Generally, the hypotheses were confirmed. The presented on-the-job training had the desired effects on practicing physicians' knowledge and attitudes. Nevertheless, additional empowerment and support are essential.

Information literacy: a desideratum of the 21st century

Purpose

The research surveyed the competency of information literacy of senior high school students in Fiji. This is to evaluate the strong predictors of information literacy.

Design/methodology/approach

The study adopted a survey research design whereby a five-point Likert scale self-reporting questionnaire was administered to Year 12 and Year 13 secondary school students. The data were analysed using the Statistical Package for the Social Sciences (SPSS) software-descriptive statistics of calculating the mean and standard deviation, a correlation and linear regression analysis to deduce the strong predictors of information literacy.

Findings

The study showed that 81% of the students surveyed were average to above average information literate. The strong predictors of information literacy were the ability of an individual to collaborate and share safely online, the ability to share files securely and the ability to access the credibility of any resource assessed on the digital platform.

Research limitations/implications

The current study evaluates information literacy of a cohort – stating how information literate the participants are, comprehending the strong predicators of information literacy so that there is an appropriate and effective implementation of interventions for the desired improvements.

Practical implications

The results can be used to improve information literacy of students at all levels of education in the Fiji Islands.

Social implications

If the youths are information literate they will be able to effectively contribute towards the development of their economy. Since the work environment today is technology oriented and involves a lot of information, being information literate means knowing how to use the information and differentiate between good and bad information. Hence, contributing effectively towards whatever task is performed.

Originality/value

This research if the first ever research done on evaluating the information literacy of individuals in Fiji.

Susceptibility of falling behind current medical knowledge among health-care professionals: the extended parallel process model

Purpose

The purpose of this paper is to appraise the possible response outcomes (no response, fear control or danger control) of a fear-based message on falling behind current medical knowledge among health-care professionals (HCPs).

Design/methodology/approach

This study was conducted using a quantitative research design. A cross-sectional survey was carried out in 2,873 health-care facilities across 36 districts of Punjab. The Extended Parallel Process Model (EPPM) provided a theoretical framework for this study. The important components to EPPM such as threat, efficacy and outcomes were used to collect the data. The collected data was analyzed using Statistical Package for Social Sciences (SPSS) version 22.

Findings

HCPs perceived high susceptibility and threat of falling behind current medical knowledge. A majority of the HCPs were at the danger control process and engaged in a behavior that is recommended for adaptive behavioral changes. Clinical experience and enrollment in post-graduation programs (e.g. FCPS, MCPS) were significant factors as to HCPs’ perceived response efficacy.

Research limitations/implications

The responses were obtained using a structured questionnaire, which is always subject to respondents’ personal biases and ability to understand the question’s statement.

Practical implications

This study has important implications in terms of introducing promotional, educational and logistical interventions that could help in HCPs overcoming the fear of falling behind current medical knowledge and develop productive and adoptive information behavior thus improving patient care and outcome.

Originality/value

This is the first large-scale empirical study in Pakistan that measured the level of threat and efficacy among HCPs using the EPPM. It proposes a framework for developing long-lasting adaptive information behavioral changes that may result in informed patient care and better decision-making.

Routine Health Information System (RHIS) improvements for strengthened health system management

BACKGROUND

A well-functioning routine health information system (RHIS) can provide the information needed for health system management, for governance, accountability, planning, policy making, surveillance and quality improvement, but poor information support has been identified as a major obstacle for improving health system management.

OBJECTIVES

To assess the effects of interventions to improve routine health information systems in terms of RHIS performance, and also, in terms of improved health system management performance, and improved patient and population health outcomes.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE Ovid and Embase Ovid in May 2019. We searched Global Health, Ovid and PsycInfo in April 2016. In January 2020 we searched for grey literature in the Grey Literature Report and in OpenGrey, and for ongoing trials using the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov. In October 2019 we also did a cited reference search using Web of Science, and a 'similar articles' search in PubMed.

SELECTION CRITERIA

Randomised and non-randomised trials, controlled before-after studies and time-series studies comparing routine health information system interventions, with controls, in primary, hospital or community health care settings. Participants included clinical staff and management, district management and community health workers using routine information systems.

DATA COLLECTION AND ANALYSIS

Two authors independently reviewed records to identify studies for inclusion, extracted data from the included studies and assessed the risk of bias. Interventions and outcomes were too varied across studies to allow for pooled risk analysis. We present a 'Summary of findings' table for each intervention comparisons broadly categorised into Technical and Organisational (or a combination), and report outcomes on data quality and service quality. We used the GRADE approach to assess the certainty of the evidence.

MAIN RESULTS

We included six studies: four cluster randomised trials and two controlled before-after studies, from Africa and South America. Three studies evaluated technical interventions, one study evaluated an organisational intervention, and two studies evaluated a combination of technical and organisational interventions. Four studies reported on data quality and six studies reported on service quality. In terms of data quality, a web-based electronic TB laboratory information system probably reduces the length of time to reporting of TB test results, and probably reduces the overall rate of recording errors of TB test results, compared to a paper-based system (moderate certainty evidence). We are uncertain about the effect of the electronic laboratory information system on the recording rate of serious (misidentification) errors for TB test results compared to a paper-based system (very low certainty evidence). Misidentification errors are inaccuracies in transferring test results between an electronic register and patients' clinical charts. We are also uncertain about the effect of the intervention on service quality (timeliness of starting or changing a patient's TB treatment) (very low certainty evidence). A hand-held electronic device probably improves the length of time to report TB test results, and probably reduces the total frequency of recording errors in TB test results between the laboratory notebook and the electronic information record system, compared to a paper-based system (moderate-certainty evidence). We are, however, uncertain about the effect of the intervention on the frequency of serious (misidentification) errors in recording between the laboratory notebook and the electronic information record, compared to a paper-based system (very low certainty evidence). We are uncertain about the effect of a hospital electronic health information system on service quality (length of time outpatients spend at hospital, length of hospital stay, and hospital revenue collection), compared to a paper-based system (very low certainty evidence). High-intensity brief text messaging (SMS) may make little or no difference to data quality (in terms of completeness of documentation of pregnancy outcomes), compared to low-intensity brief text messaging (low-certainty evidence). We are uncertain about the effect of electronic drug stock notification (with either data management support or product transfer support) on service quality (in terms of transporting stock and stock levels), compared to paper-based stock notification (very low certainty evidence). We are uncertain about the effect of health information strengthening (where it is part of comprehensive service quality improvement intervention) on service quality (health worker motivation, receipt of training by health workers, health information index scores, quality of clinical observation of children and adults) (very low certainty evidence).

AUTHORS' CONCLUSIONS

The review indicates mixed effects of mainly technical interventions to improve data quality, with gaps in evidence on interventions aimed at enhancing data-informed health system management. There is a gap in interventions studying information support beyond clinical management, such as for human resources, finances, drug supply and governance. We need to have a better understanding of the causal mechanisms by which information support may affect change in management decision-making, to inform robust intervention design and evaluation methods.

Attitudes and Perceptions of General Practitioners towards the National Electronic Health Record (NEHR) in Singapore

Background: In Singapore, the National Electronic Health Record (NEHR) was launched in 2011. The central ethos of the initiative was that of “One Patient, One Health Record”, as NEHR allows registered doctors to review and upload patient data. However, uptake of the system has been slow in the private sector, with only 27% of doctors with private licenses, including general practitioners (GP) and specialists in the ambulatory care setting, accessing it. A questionnaire-based study was therefore conducted to find out the proportion of GP who used NEHR, and the barriers faced by those who do not. Methods: This study involved a self-administered questionnaire, randomly sampling private GP in Singapore. The questionnaire ascertained the number of GP who used NEHR and gathered their demographic information. A 5-point Likert scale was used to measure the perceived barriers to NEHR use. Results: Of the 315 responses, multinomial logistics regression showed that solo-practising GP who were >40 years old and who had practised for >15 years were less likely to review, or review and upload, data onto NEHR. Doctors who regarded themselves as computer users with lower levels of technical aptitude and those who perceived an inadequate level of support were less likely to use the NEHR. The majority of GP had a positive attitude towards NEHR. Conclusions: This study highlighted key demographics and perceived barriers affecting NEHR use. By raising awareness of these issues to policy makers and working to overcome these barriers, NEHR use may be increased.

Presenting models to policymakers: intention and perception

The Seifu et al. article is a start to a timely inquiry on policymakers' perceptions of mathematical modeling and simulations aimed to guide obesity prevention programs. These computational tools have the potential to transform the fields of public health policy. Yet, to be effective, a broad Data and Information Literacy Initiative is needed to instill policymakers with the willingness to become life-long learners, to adapt and accept new technologies, attitudes, information, and creative ways of thinking.