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Shuldiner J, Green ME, Kiran T, Khan S, Frymire E, Moineddin R, Kerr M, Tadrous M, Nowak DA, Kwong JC, Hu J, Witteman HO, Hamilton B, Bogoch I, Marshall LJ, Ikura S, Bar-Ziv S, Kaplan D, Ivers N. Characteristics of primary care practices by proportion of patients unvaccinated against SARS-CoV-2: a cross-sectional cohort study. CMAJ 2024; 196:E432-E440. [PMID: 38589026 PMCID: PMC11001391 DOI: 10.1503/cmaj.230816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Variations in primary care practices may explain some differences in health outcomes during the COVID-19 pandemic. We sought to evaluate the characteristics of primary care practices by the proportion of patients unvaccinated against SARS-CoV-2. METHODS We conducted a population-based, cross-sectional cohort study using linked administrative data sets in Ontario, Canada. We calculated the percentage of patients unvaccinated against SARS-CoV-2 enrolled with each comprehensive-care family physician, ranked physicians according to the proportion of patients unvaccinated, and identified physicians in the top 10% (v. the other 90%). We compared characteristics of family physicians and their patients in these 2 groups using standardized differences. RESULTS We analyzed 9060 family physicians with 10 837 909 enrolled patients. Family physicians with the largest proportion (top 10%) of unvaccinated patients (n = 906) were more likely to be male, to have trained outside of Canada, to be older, and to work in an enhanced fee-for-service model than those in the remaining 90%. Vaccine coverage (≥ 2 doses of SARS-CoV-2 vaccine) was 74% among patients of physicians with the largest proportion of unvaccinated patients, compared with 87% in the remaining patient population. Patients in the top 10% group tended to be younger and live in areas with higher levels of ethnic diversity and immigration and lower incomes. INTERPRETATION Primary care practices with the largest proportion of patients unvaccinated against SARS-CoV-2 served marginalized communities and were less likely to use team-based care models. These findings can guide resource planning and help tailor interventions to integrate public health priorities within primary care practices.
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Affiliation(s)
- Jennifer Shuldiner
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont.
| | - Michael E Green
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Tara Kiran
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Shahriar Khan
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Eliot Frymire
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Rahim Moineddin
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Meghan Kerr
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Mina Tadrous
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Dominik Alex Nowak
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Jeffrey C Kwong
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Jia Hu
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Holly O Witteman
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Bryn Hamilton
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Isaac Bogoch
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Lydia-Joy Marshall
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Sophia Ikura
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Stacey Bar-Ziv
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - David Kaplan
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
| | - Noah Ivers
- Women's College Hospital Institute of Virtual Care and Systems Solutions (Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Departments of Family Medicine and Public Health Sciences (Green, Kerr), Queen's University, Kingston, Ont.; ICES (Green, Khan, Moineddin, Tadrous, Kwong, Ivers); Department of Family and Community Medicine (Kiran, Nowak, Kwong), University of Toronto; St. Michael's Hospital (Kiran), Unity Health Toronto; MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Centre for Health Services and Policy Research (Frymire), Queen's University, Kingston, Ont.; Leslie Dan School of Pharmacy (Tadrous), and Dalla Lana School of Public Health (Nowak), University of Toronto; Women's College Hospital Academic Family Health Team (Nowak), Women's College Hospital; Public Health Ontario (Kwong); University Health Network (Kwong), Toronto, Ont.; Department of Community Health Sciences (Hu), University of Calgary, Calgary, Alta.; VITAM Research Centre for Sustainable Health (Witteman); Department of Family and Emergency Medicine (Witteman), Université Laval, Québec, Que.; Association of Family Health Teams of Ontario (Hamilton); Department of Medicine (Bogoch), University of Toronto; Health Commons Solutions Labs Ontario (Marshall, Ikura); Ontario Health (Bar-Ziv, Kaplan); Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto, Toronto, Ont
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Tricco AC, Parker A, Khan PA, Nincic V, Robson R, MacDonald H, Warren R, Cleary O, Zibrowski E, Baxter N, Burns KEA, Coyle D, Ndjaboue R, Clark JP, Langlois EV, Ahmed SB, Witteman HO, Graham ID, El-Adhami W, Skidmore B, Légaré F, Curran J, Hawker G, Watt J, Bourgeault IL, Leigh JP, Lawford K, Aiken A, McCabe C, Shepperd S, Pattani R, Leon N, Lundine J, Adisso ÉL, Ono S, Rabeneck L, Straus SE. Interventions on gender equity in the workplace: a scoping review. BMC Med 2024; 22:149. [PMID: 38581003 PMCID: PMC10998304 DOI: 10.1186/s12916-024-03346-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/07/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interventions examining gender equity in workplace or volunteer settings. An additional aim was to determine whether interventions considered intersection of gender and other variables, including PROGRESS-Plus equity variables (e.g., race/ethnicity). METHODS Scoping review conducted using the JBI guide. Literature was searched in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ERIC, Index to Legal Periodicals and Books, PAIS Index, Policy Index File, and the Canadian Business & Current Affairs Database from inception to May 9, 2022, with an updated search on October 17, 2022. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to scoping reviews (PRISMA-ScR), Sex and Gender Equity in Research (SAGER) guidance, Strengthening the Integration of Intersectionality Theory in Health Inequality Analysis (SIITHIA) checklist, and Guidance for Reporting Involvement of Patients and the Public (GRIPP) version 2 checklist. All employment or volunteer sectors settings were included. Included interventions were designed to promote workplace gender equity that targeted: (a) individuals, (b) organizations, or (c) systems. Any comparator was eligible. Outcomes measures included any gender equity related outcome, whether it was measuring intervention effectiveness (as defined by included studies) or implementation. Data analyses were descriptive in nature. As recommended in the JBI guide to scoping reviews, only high-level content analysis was conducted to categorize the interventions, which were reported using a previously published framework. RESULTS We screened 8855 citations, 803 grey literature sources, and 663 full-text articles, resulting in 24 unique RCTs and one companion report that met inclusion criteria. Most studies (91.7%) failed to report how they established sex or gender. Twenty-three of 24 (95.8%) studies reported at least one PROGRESS-Plus variable: typically sex or gender or occupation. Two RCTs (8.3%) identified a non-binary gender identity. None of the RCTs reported on relationships between gender and other characteristics (e.g., disability, age, etc.). We identified 24 gender equity promoting interventions in the workplace that were evaluated and categorized into one or more of the following themes: (i) quantifying gender impacts; (ii) behavioural or systemic changes; (iii) career flexibility; (iv) increased visibility, recognition, and representation; (v) creating opportunities for development, mentorship, and sponsorship; and (vi) financial support. Of these interventions, 20/24 (83.3%) had positive conclusion statements for their primary outcomes (e.g., improved academic productivity, increased self-esteem) across heterogeneous outcomes. CONCLUSIONS There is a paucity of literature on interventions to promote workplace gender equity. While some interventions elicited positive conclusions across a variety of outcomes, standardized outcome measures considering specific contexts and cultures are required. Few PROGRESS-Plus items were reported. Non-binary gender identities and issues related to intersectionality were not adequately considered. Future research should provide consistent and contemporary definitions of gender and sex. TRIAL REGISTRATION Open Science Framework https://osf.io/x8yae .
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada.
| | - Amanda Parker
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Paul A Khan
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Reid Robson
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Heather MacDonald
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Rachel Warren
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | - Olga Cleary
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Nancy Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ruth Ndjaboue
- École de Travail Social, Université de Sherbrooke, Québec, (Québec), Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization (WHO), Geneva, Switzerland
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Wafa El-Adhami
- Science in Australia Gender Equity Limited, Greenway, Australia
| | | | - France Légaré
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Janet Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Gillian Hawker
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer Watt
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
| | | | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Canada
| | - Karen Lawford
- Department of Gender Studies, Haudenosaunee and Anishinaabek Territories, Queen's University, Settlement of Kingston, Canada
| | - Alice Aiken
- Research and Innovation, Dalhousie University, Halifax, Canada
| | | | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - Reena Pattani
- Department of Medicine, Division of Internal Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Évèhouénou Lionel Adisso
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
| | - Santa Ono
- Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USA
| | - Linda Rabeneck
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON, M5B 1T8, Canada
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Hakim H, Driedger SM, Gagnon D, Chevrier J, Roch G, Dubé E, Witteman HO. Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review. JMIR Serious Games 2024; 12:e47257. [PMID: 38421688 PMCID: PMC10906656 DOI: 10.2196/47257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. OBJECTIVE In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. METHODS We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. RESULTS Of 1402 records, we included 28 (2%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25%) explained the development of the tool, 16 (57%) described evaluation, and 2 (7%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44%) were web-based tools, 8 (32%) mobile (native mobile or mobile-enabled web) apps, and 6 (24%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. CONCLUSIONS Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dominique Gagnon
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Julien Chevrier
- Bibliothèque Louise-Lalonde-Lamarre, Polytechnique Montréal, Montréal, QC, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
| | - Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
- Département d'anthropologie, Université Laval, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
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Couture V, Germain N, Côté É, Lavoie L, Robitaille J, Morin M, Chouinard J, Couturier Y, Légaré F, Hardy MS, Chartier LB, Brousseau AA, Sourial N, Mercier É, Dallaire C, Fleet R, Leblanc A, Melady D, Roy D, Sinha S, Sirois MJ, Witteman HO, Émond M, Rivard J, Pelletier I, Turcotte S, Samb R, Giguère R, Abrougui L, Smith PY, Archambault PM. Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments. BMC Geriatr 2024; 24:8. [PMID: 38172725 PMCID: PMC10763115 DOI: 10.1186/s12877-023-04482-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Improving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions. METHODS The LEARNING WISDOM prospective longitudinal observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19. Their comments on this transition were collected via phone interview and transcribed. We conducted an inductive qualitative content analysis with randomly selected comments until saturation. Themes that arose from comments were coded and organized into frequencies and proportions. We followed the Standards for Reporting Qualitative Research (SRQR). RESULTS Comments from 690 patients (339 pre-COVID, 351 during COVID) composed of 351 women (50.9%) and 339 men (49.1%) were analyzed. Patients were satisfied with acute emergency care, and the proportion of patients with positive acute care experiences increased with the COVID-19 pandemic. Negative patient comments were most often related to communication between health providers across the care continuum and the professionalism of personnel in the ED. Comments concerning home care became more neutral with the COVID-19 pandemic. CONCLUSION Patients were satisfied overall with acute care but reported gaps in professionalism and follow-up communication between providers. Comments may have changed in tone from positive to neutral regarding home care over the COVID-19 pandemic due to service slowdowns. Addressing these concerns may improve the quality of care transitions and provide future pandemic mitigation strategies.
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Affiliation(s)
- Vanessa Couture
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Nathalie Germain
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
| | - Émilie Côté
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Lise Lavoie
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Joanie Robitaille
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Michèle Morin
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
| | - Josée Chouinard
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Yves Couturier
- Department of Social Work, Université de Sherbrooke, Sherbrooke, Québec Canada
| | - France Légaré
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Université Laval, Québec, Québec Canada
| | - Marie-Soleil Hardy
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Lucas B. Chartier
- Department of Emergency Medicine, University Health Network, Toronto, ON Canada
| | | | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, Montréal, Québec Canada
| | - Éric Mercier
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- Centre de recherche du CHU de Québec - Université Laval, Axe santé des populations et pratiques optimales en santé, Université Laval, Québec, Québec Canada
| | - Clémence Dallaire
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Nursing Science, Université Laval, Québec, Québec Canada
| | - Richard Fleet
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Annie Leblanc
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Don Melady
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON Canada
| | - Denis Roy
- Commissaire à la santé et au bien-être (CSBE), Québec, Québec Canada
| | - Samir Sinha
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, ON Canada
| | - Marie-Josée Sirois
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Québec Canada
| | - Holly O. Witteman
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
| | - Marcel Émond
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
| | - Josée Rivard
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Isabelle Pelletier
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Stéphane Turcotte
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Rawane Samb
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Raphaëlle Giguère
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Science and Engineering, Université Laval, Québec, Québec Canada
| | - Lyna Abrougui
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Science and Engineering, Université Laval, Québec, Québec Canada
| | - Pascal Y. Smith
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
| | - Patrick M. Archambault
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec Canada
- Faculty of Medicine, Université Laval, Québec, Québec Canada
- VITAM - Centre de recherche en santé durable, Québec, Québec Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Québec Canada
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Chen R, Guay M, Gilbert NL, Dubé E, Witteman HO, Hakim H. Determinants of parental vaccine hesitancy in Canada: results from the 2017 Childhood National Immunization Coverage Survey. BMC Public Health 2023; 23:2327. [PMID: 38001412 PMCID: PMC10668395 DOI: 10.1186/s12889-023-17079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In 2019, the World Health Organization (WHO) designated vaccine hesitancy as one of the ten leading threats to global health. Vaccine hesitancy exists when vaccination services are available and accessible, but vaccine uptake is lower than anticipated. It is often attributed to lack of trust in vaccine safety and effectiveness, or low level of concern about the risk of many vaccine-preventable diseases. This study aimed to examine the sociodemographic factors associated with parental vaccine hesitancy and vaccine refusal in Canada using data from the 2017 Childhood National Immunization Coverage Survey (CNICS). METHOD The 2017 CNICS was a cross-sectional and nationally representative survey to estimate national vaccine uptake and to collect information about parents' Knowledge, Attitudes and Beliefs (KAB) regarding vaccination. Using the KAB questions, parental vaccine hesitancy (i.e., parental hesitation, delay or refusal of at least one recommended vaccination) and refusal (i.e., unvaccinated children) by sociodemographic factors was estimated using weighted prevalence proportions. A multinomial logistic regression model was fitted to examine associations between parental vaccine hesitancy or refusal and sociodemographic factors among parents of two-year-old children in Canada. Adjusted odds ratios (aOR) of being vaccine-hesitant or vaccine-refusing versus being non-vaccine-hesitant were generated. RESULTS Both unadjusted and adjusted logistic regressions models showed that parents with lower household income (aOR 1.7, 95% CI 1.2-2.5), and those with a higher number of children in the household (aOR 2.2, 95% CI 1.4-3.5) had higher vaccine hesitancy. Conversely, lower vaccine hesitancy was observed among non-immigrant parents (aOR 0.4, 95% CI 0.3-0.6). In addition, lower household income (aOR 4.0, 95% CI 1.3-12.9), and higher number of children in the household (aOR 6.9, 95% CI 2.1-22.9) were significantly associated with parental vaccine refusal. Regional variations were also observed. CONCLUSION Several sociodemographic determinants are associated with parental vaccine hesitancy and refusal. The findings of the study could help public health officials and policymakers to develop and implement targeted interventions to improve childhood vaccination programs.
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Affiliation(s)
- Ruoke Chen
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada.
| | - Mireille Guay
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Nicolas L Gilbert
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, ON, Canada
- University of Montreal School of Public Health, Quebec, Canada
| | - Eve Dubé
- Institut National de Santé Publique du Québec, Quebec, Canada
- Department of Anthropology, Laval University, Quebec, Canada
| | | | - Hina Hakim
- Faculty of Medicine, Laval University, Quebec, Canada
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Umaefulam V, Wilson M, Boucher MC, Brent MH, Dogba MJ, Drescher O, Grimshaw JM, Ivers NM, Lawrenson JG, Lorencatto F, Maberley D, McCleary N, McHugh S, Sutakovic O, Thavorn K, Witteman HO, Yu C, Cheng H, Han W, Hong Y, Idrissa B, Leech T, Malette J, Mongeon I, Mugisho Z, Nguebou MM, Pabla S, Rahman S, Samandoulougou A, Visram H, You R, Zhao J, Presseau J. Assessing the feasibility, acceptability, and fidelity of a tele-retinopathy-based intervention to encourage greater attendance to diabetic retinopathy screening in immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada: a protocol. Pilot Feasibility Stud 2023; 9:158. [PMID: 37689724 PMCID: PMC10492373 DOI: 10.1186/s40814-023-01372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is a leading cause of preventable blindness in Canada. Clinical guidelines recommend annual diabetic retinopathy screening for people living with diabetes to reduce the risk and progression of vision loss. However, many Canadians with diabetes do not attend screening. Screening rates are even lower in immigrants to Canada including people from China, Africa, and the Caribbean, and these groups are also at higher risk of developing diabetes complications. We aim to assess the feasibility, acceptability, and fidelity of a co-developed, linguistically and culturally tailored tele-retinopathy screening intervention for Mandarin-speaking immigrants from China and French-speaking immigrants from African-Caribbean countries living with diabetes in Ottawa, Canada, and identify how many from each population group attend screening during the pilot period. METHODS We will work with our health system and patient partners to conduct a 6-month feasibility pilot of a tele-retinopathy screening intervention in a Community Health Centre in Ottawa. We anticipate recruiting 50-150 patients and 5-10 health care providers involved in delivering the intervention for the pilot. Acceptability will be assessed via a Theoretical Framework of Acceptability-informed survey with patients and health care providers. To assess feasibility, we will use a Theoretical Domains Framework-informed interview guide and to assess fidelity, and we will use a survey informed by the National Institutes of Health framework from the perspective of health care providers. We will also collect patient demographics (i.e., age, gender, ethnicity, health insurance status, and immigration information), screening outcomes (i.e., patients with retinopathy identified, patients requiring specialist care), patient costs, and other intervention-related variables such as preferred language. Survey data will be descriptively analyzed and qualitative data will undergo content analysis. DISCUSSION This feasibility pilot study will capture how many people living with diabetes from each group attend the diabetic retinopathy screening, costs, and implementation processes for the tele-retinopathy screening intervention. The study will indicate the practicability and suitability of the intervention in increasing screening attendance in the target population groups. The study results will inform a patient-randomized trial, provide evidence to conduct an economic evaluation of the intervention, and optimize the community-based intervention.
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Affiliation(s)
- Valerie Umaefulam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie Carole Boucher
- Department of Ophthalmology, Maisonneuve-Rosemont Ophthalmology University Center, Université de Montréal, Montreal, QC, Canada
| | - Michael H Brent
- Department of Ophthalmology and Vision Sciences, Donald K Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
- VITAM, Centre for Research On Sustainable Health, Université Laval, Québec City, QC, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John G Lawrenson
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | - David Maberley
- Department of Ophthalmology, The Ottawa Hospital, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Olivera Sutakovic
- Department of Ophthalmology and Vision Sciences, Donald K Johnson Eye Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, Canada
| | - Catherine Yu
- Division of Endocrinology & Metabolism, St. Michael's Hospital, Faculty of Medicine, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hao Cheng
- Patient Local Advisory Group, Ottawa, Canada
| | - Wei Han
- Patient Local Advisory Group, Ottawa, Canada
| | - Yu Hong
- Patient Local Advisory Group, Ottawa, Canada
| | | | - Tina Leech
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | | | - Sara Pabla
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | - Richard You
- Patient Local Advisory Group, Ottawa, Canada
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- School of Psychology, University of Ottawa, Ottawa, Canada.
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7
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Dubé E, Trottier ME, Gagnon D, Bettinger JA, Greyson D, Graham J, MacDonald NE, MacDonald SE, Meyer SB, Witteman HO, Driedger SM. Exploring parents' views of the use of narratives to promote childhood vaccination online. PLoS One 2023; 18:e0284107. [PMID: 37467300 DOI: 10.1371/journal.pone.0284107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/23/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Negative information about vaccines that spreads online may contribute to parents' vaccine hesitancy or refusal. Studies have shown that false claims about vaccines that use emotive personal narratives are more likely to be shared and engaged with on social media than factual evidence-based public health messages. The aim of this study was to explore parents' views regarding the use of positive narratives to promote childhood vaccination. METHODS We identified three ∼4-minute video narratives from social media that counter frequent parental concerns about childhood vaccination: parents and informed decision-making (online misinformation about vaccines); a paediatrician's clinical experience with vaccine-preventable diseases (prevention of still existing diseases); and a mother's experience with vaccine-preventable disease (risks of the disease). Focus group discussions were held with parents of children aged 0 to 5 years to assess their views on these three narratives and their general opinion on the use of narratives as a vaccine promotion intervention. RESULTS Four focus groups discussions were virtually held with 15 parents in December 2021. In general, parents trusted both health care provider's and parent's narratives, but participants identified more with stories having a parent as the main character. Both narratives featuring personal stories with vaccine-preventable diseases were preferred by parents, while the story about informed decision-making was perceived as less influential. Parents expressed the need for reliable and nuanced information about vaccines and diseases and felt that a short video format featuring a story was an efficient vaccine promotion intervention. However, many mentioned that they generally are not watching such videos while navigating the Web. CONCLUSION While vaccine-critical stories are widely shared online, evidence on how best public health could counter these messages remains scarce. The use of narratives to promote vaccination was well-perceived by parents. Future studies are needed to assess reach and impact of such an intervention.
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Affiliation(s)
- Eve Dubé
- Department of Anthropology, Laval University, Quebec, Quebec, Canada
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Marie-Eve Trottier
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Dominique Gagnon
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Julie A Bettinger
- Department of Pediatrics, Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Devon Greyson
- Department of Pediatrics, Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University, University of Alberta, Edmonton, Alberta, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Holly O Witteman
- Department of Family Medicine, Laval University, Quebec, Quebec, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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8
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Chambers A, McKay D, Farnsworth K, Morrison AE, Witteman HO, Senior P, Halperin IJ, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Kim J, Lewis J, MacDonald B, Mackay D, Mansell K, Senior P, Rabi D, Sherifali D. Do-It-Yourself Automated Insulin Delivery: A Health-care Practitioner User's Guide. Can J Diabetes 2023; 47:389-397.e8. [PMID: 37532366 DOI: 10.1016/j.jcjd.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
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9
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Halperin IJ, Chambers A, Covello L, Farnsworth K, Morrison AE, Schuklenk U, Witteman HO, Senior P, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Kim J, Lewis J, MacDonald B, Mackay D, Mansell K, Rabi D, Senior P, Sherifali D. Do-It-Yourself Automated Insulin Delivery: A Position Statement. Can J Diabetes 2023; 47:381-388. [PMID: 37532365 DOI: 10.1016/j.jcjd.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
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10
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McCleary N, Desveaux L, Presseau J, Reis C, Witteman HO, Taljaard M, Linklater S, Thavorn K, Dobell G, Mulhall CL, Lam JMC, Grimshaw JM, Ivers NM. Engagement is a necessary condition to test audit and feedback design features: results of a pragmatic, factorial, cluster-randomized trial with an embedded process evaluation. Implement Sci 2023; 18:13. [PMID: 37165413 PMCID: PMC10173488 DOI: 10.1186/s13012-023-01271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/06/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND While audit & feedback (A&F) is an effective implementation intervention, the design elements which maximize effectiveness are unclear. Partnering with a healthcare quality advisory organization already delivering feedback, we conducted a pragmatic, 2 × 2 factorial, cluster-randomized trial to test the impact of variations in two factors: (A) the benchmark used for comparison and (B) information framing. An embedded process evaluation explored hypothesized mechanisms of effect. METHODS Eligible physicians worked in nursing homes in Ontario, Canada, and had voluntarily signed up to receive the report. Groups of nursing homes sharing physicians were randomized to (A) physicians' individual prescribing rates compared to top-performing peers (the top quartile) or the provincial median and (B) risk-framed information (reporting the number of patients prescribed high-risk medication) or benefit-framed information (reporting the number of patients not prescribed). We hypothesized that the top quartile comparator and risk-framing would lead to greater practice improvements. The primary outcome was the mean number of central nervous system-active medications per resident per month. Primary analyses compared the four arms at 6 months post-intervention. Factorial analyses were secondary. The process evaluation comprised a follow-up questionnaire and semi-structured interviews. RESULTS Two hundred sixty-seven physicians (152 clusters) were randomized: 67 to arm 1 (median benchmark, benefit framing), 65 to arm 2 (top quartile benchmark, benefit framing), 75 to arm 3 (median benchmark, risk framing), and 60 to arm 4 (top quartile benchmark, risk framing). There were no significant differences in the primary outcome across arms or for each factor. However, engagement was low (27-31% of physicians across arms downloaded the report). The process evaluation indicated that both factors minimally impacted the proposed mechanisms. However, risk-framed feedback was perceived as more actionable and more compatible with current workflows, whilst a higher target might encourage behaviour change when physicians identified with the comparator. CONCLUSIONS Risk framing and a top quartile comparator have the potential to achieve change. Further work to establish the strategies most likely to enhance A&F engagement, particularly with physicians who may be most likely to benefit from feedback, is required to support meaningfully addressing intricate research questions concerning the design of A&F. TRIAL REGISTRATION ClinicalTrials.gov, NCT02979964 . Registered 29 November 2016.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
| | - Laura Desveaux
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Catherine Reis
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- Department of Family and Emergency Medicine, Laval University, Québec City, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Stefanie Linklater
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
| | - Kednapa Thavorn
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Gail Dobell
- Health System Performance, Ontario Health, Toronto, Canada
| | - Cara L Mulhall
- Health System Performance, Ontario Health, Toronto, Canada
| | | | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
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11
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Mousavi S, Tannenbaum Greenberg D, Ndjaboué R, Greiver M, Drescher O, Chipenda Dansokho S, Boutin D, Chouinard JM, Dostie S, Fenton R, Greenberg M, McGavock J, Najam A, Rekik M, Weisz T, Willison DJ, Durand A, Witteman HO. The Influence of Age, Sex, and Socioeconomic Status on Glycemic Control Among People With Type 1 and Type 2 Diabetes in Canada: Patient-Led Longitudinal Retrospective Cross-sectional Study With Multiple Time Points of Measurement. JMIR Diabetes 2023; 8:e35682. [PMID: 37104030 PMCID: PMC10176138 DOI: 10.2196/35682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Clinical guidelines for most adults with diabetes recommend maintaining hemoglobin A1c (HbA1c) levels ≤7% (≤53 mmol/mol) to avoid microvascular and macrovascular complications. People with diabetes of different ages, sexes, and socioeconomic statuses may differ in their ease of attaining this goal. OBJECTIVE As a team of people with diabetes, researchers, and health professionals, we aimed to explore patterns in HbA1c results among people with type 1 or type 2 diabetes in Canada. Our research question was identified by people living with diabetes. METHODS In this patient-led retrospective cross-sectional study with multiple time points of measurement, we used generalized estimating equations to analyze the associations of age, sex, and socioeconomic status with 947,543 HbA1c results collected from 2010 to 2019 among 90,770 people living with type 1 or type 2 diabetes in Canada and housed in the Canadian National Diabetes Repository. People living with diabetes reviewed and interpreted the results. RESULTS HbA1c results ≤7.0% represented 30.5% (male people living with type 1 diabetes), 21% (female people living with type 1 diabetes), 55% (male people living with type 2 diabetes) and 59% (female people living with type 2 diabetes) of results in each subcategory. We observed higher HbA1c values during adolescence, and for people living with type 2 diabetes, among people living in lower income areas. Among those with type 1 diabetes, female people tended to have lower HbA1c levels than male people during childbearing years but higher HbA1c levels than male people during menopausal years. Team members living with diabetes confirmed that the patterns we observed reflected their own life courses and suggested that these results be communicated to health professionals and other stakeholders to improve the treatment for people living with diabetes. CONCLUSIONS A substantial proportion of people with diabetes in Canada may need additional support to reach or maintain the guideline-recommended glycemic control goals. Blood sugar management goals may be particularly challenging for people going through adolescence or menopause or those living with fewer financial resources. Health professionals should be aware of the challenging nature of glycemic management, and policy makers in Canada should provide more support for people with diabetes to live healthy lives.
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Affiliation(s)
- Seyedmostafa Mousavi
- Diabetes Action Canada, Toronto, ON, Canada
- VITAM Research Centre in Sustainable Health, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
| | | | - Ruth Ndjaboué
- Diabetes Action Canada, Toronto, ON, Canada
- Centre de recherche sur le Vieillissement, Sherbrooke, QC, Canada
- School of Social Work, Faculty of Letters and Human Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Michelle Greiver
- Diabetes Action Canada, Toronto, ON, Canada
- Department of Family and Community Medicine, North York General Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Selma Chipenda Dansokho
- Diabetes Action Canada, Toronto, ON, Canada
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Denis Boutin
- Diabetes Action Canada, Toronto, ON, Canada
- Centre de recherche du CHUS, Sherbrooke, QC, Canada
| | | | | | - Robert Fenton
- Diabetes Action Canada, Toronto, ON, Canada
- National Indigenous Diabetes Association, Winnipeg, MB, Canada
| | | | - Jonathan McGavock
- Diabetes Action Canada, Toronto, ON, Canada
- Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | - Monia Rekik
- Diabetes Action Canada, Toronto, ON, Canada
- Department of Operations and Decision Systems, Faculty of Business Administration, Université Laval, Québec, QC, Canada
- Cardiometabolic Health, Diabetes and Obesity Research Network (CMDO), Sherbrooke, QC, Canada
- Interuniversity Research Centre of Enterprise Networks (CIRRELT), Montréal, QC, Canada
| | - Tom Weisz
- Diabetes Action Canada, Toronto, ON, Canada
- Wounds Canada, North York, ON, Canada
- Diabetes Canada, Toronto, ON, Canada
| | - Donald J Willison
- Diabetes Action Canada, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Audrey Durand
- Canada CIFAR AI Chair, Québec, QC, Canada
- Institute Intelligence and Data, Université Laval, Québec, QC, Canada
- Department of Computer Science and Software Engineering, Faculty of Science and Engineering, Université Laval, Québec, QC, Canada
- Department of Electrical Engineering and Computer Engineering, Faculty of Science and Engineering, Faculty of Science and Engineering, Québec, QC, Canada
| | - Holly O Witteman
- Diabetes Action Canada, Toronto, ON, Canada
- VITAM Research Centre in Sustainable Health, Québec, QC, Canada
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
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12
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Umaefulam V, Wilson M, Boucher MC, Brent MH, Dogba MJ, Drescher O, Grimshaw JM, Ivers NM, Lawrenson JG, Lorencatto F, Maberley D, McCleary N, McHugh S, Sutakovic O, Thavorn K, Witteman HO, Yu C, Cheng H, Han W, Hong Y, Idrissa B, Leech T, Malette J, Mongeon I, Mugisho Z, Nguebou MM, Pabla S, Rahman S, Samandoulougou A, Visram H, You R, Zhao J, Presseau J. The co-development of a linguistic and culturally tailored tele-retinopathy screening intervention for immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada. BMC Health Serv Res 2023; 23:302. [PMID: 36991464 PMCID: PMC10054218 DOI: 10.1186/s12913-023-09329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is a sight-threatening ocular complication of diabetes. Screening is an effective way to reduce severe complications, but screening attendance rates are often low, particularly for newcomers and immigrants to Canada and people from cultural and linguistic minority groups. Building on previous work, in partnership with patient and health system stakeholders, we co-developed a linguistically and culturally tailored tele-retinopathy screening intervention for people living with diabetes who recently immigrated to Canada from either China or African-Caribbean countries. METHODS Following an environmental scan of diabetes eye care pathways in Ottawa, we conducted co-development workshops using a nominal group technique to create and prioritize personas of individuals requiring screening and identify barriers to screening that each persona may face. Next, we used the Theoretical Domains Framework to categorize the barriers/enablers and then mapped these categories to potential evidence-informed behaviour change techniques. Finally with these techniques in mind, participants prioritized strategies and channels of delivery, developed intervention content, and clarified actions required by different actors to overcome anticipated intervention delivery barriers. RESULTS We carried out iterative co-development workshops with Mandarin and French-speaking individuals living with diabetes (i.e., patients in the community) who immigrated to Canada from China and African-Caribbean countries (n = 13), patient partners (n = 7), and health system partners (n = 6) recruited from community health centres in Ottawa. Patients in the community co-development workshops were conducted in Mandarin or French. Together, we prioritized five barriers to attending diabetic retinopathy screening: language (TDF Domains: skills, social influences), retinopathy familiarity (knowledge, beliefs about consequences), physician barriers regarding communication for screening (social influences), lack of publicity about screening (knowledge, environmental context and resources), and fitting screening around other activities (environmental context and resources). The resulting intervention included the following behaviour change techniques to address prioritized local barriers: information about health consequence, providing instructions on how to attend screening, prompts/cues, adding objects to the environment, social support, and restructuring the social environment. Operationalized delivery channels incorporated language support, pre-booking screening and sending reminders, social support via social media and community champions, and providing using flyers and videos as delivery channels. CONCLUSION Working with intervention users and stakeholders, we co-developed a culturally and linguistically relevant tele-retinopathy intervention to address barriers to attending diabetic retinopathy screening and increase uptake among two under-served groups.
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Affiliation(s)
- Valerie Umaefulam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie Carole Boucher
- Department of Ophthalmology, Maisonneuve-Rosemont Ophthalmology University Center, Université de Montréal, Montreal, QC, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research On Sustainable Health, VITAM, Université Laval, Québec City, QC, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John G Lawrenson
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | - David Maberley
- Department of Ophthalmology, The Ottawa Hospital, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Catherine Yu
- Division of Endocrinology & Metabolism, Faculty of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hao Cheng
- Patient Local Advisory Group, Ottawa, Canada
| | - Wei Han
- Patient Local Advisory Group, Ottawa, Canada
| | - Yu Hong
- Patient Local Advisory Group, Ottawa, Canada
| | | | - Tina Leech
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | | | - Sara Pabla
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | - Richard You
- Patient Local Advisory Group, Ottawa, Canada
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
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13
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Etienne D, Archambault PM, Aziaka D, Chipenda Dansokho S, Dubé E, Fallon CS, Hakim H, Kindrachuk J, Krecoum D, MacDonald SE, Ndjaboué R, Noubi M, Paquette JS, Parent E, Witteman HO. A personalized avatar-based web application to help people understand how social distancing can reduce the spread of COVID-19: a cross-sectional observational pre-post study. JMIR Form Res 2023; 7:e38430. [PMID: 36961787 PMCID: PMC10170367 DOI: 10.2196/38430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND To reduce the transmission of SARS-CoV-2 and the associated spread of COVID-19, many jurisdictions around the world imposed mandatory or recommended social or physical distancing. As a result, at the beginning of the pandemic, various communication materials appeared online to promote distancing. Explanations of the science underlying these mandates or recommendations were either highly technical or highly simplified. OBJECTIVE This study aimed to understand the effects of a dynamic visualization on distancing. Our overall aim was to help people understand the dynamics of the spread of COVID-19 in their community and the implications of their own behavior for themselves, those around them, the healthcare system, and society. METHODS We used Scrum, an agile framework, JavaScript (Vue.js framework), and code already developed for risk communication in another context of infectious disease transmission, we rapidly developed a new personalized web application. In our application, people make avatars that represent themselves and the people around them. These avatars are integrated into a 3-minute animation illustrating an epidemiological model for COVID-19 transmission, showing the differences in transmission with and without distancing. During the animation, the narration explains the science of how distancing reduces transmission of COVID-19 in plain language in English or French. The application offers full captions to complement the narration and a descriptive transcript for people using screen readers. We used Google Analytics to collect standard usage statistics. A brief, anonymous, optional survey also collected self-reported distancing behaviors and intentions in the previous and coming weeks, respectively. We launched and disseminated the application on Twitter and Facebook on April 8-9, 2020. RESULTS After 26 days, the application received >3600 unique hits from 82 countries. The optional survey at the end of the application collected 182 responses. Among this small subsample of users, survey respondents were nearly all (96.0%) already practicing distancing and (97.2%) indicated that they intended to practice distancing in the coming week. Among the small minority of people (n=7) who indicated that they had not been previously practicing distancing, 2 (29%) reported that they would practice distancing in the week to come. CONCLUSIONS We developed a web application to help people understand the relationship between individual-level behavior and population-level effects in the context of an infectious disease spread. This study also demonstrates how agile development can be used to quickly create personalized risk messages for public health issues like a pandemic. The non-randomized design of this rapid study prevents us from concluding the application's effectiveness; however, results thus far suggest that avatar-based visualizations may help people understand their role in infectious disease transmission. CLINICALTRIAL
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Affiliation(s)
- Doriane Etienne
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, CA
| | - Patrick M Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Québec, CA
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, CA
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, CA
| | - Donovan Aziaka
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
| | - Selma Chipenda Dansokho
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
| | - Eve Dubé
- Department of Anthropology, Université Laval, Québec, CA
| | - Catherine S Fallon
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Québec, CA
| | - Hina Hakim
- Maladies infectieuses et immunitaires, CHU de Quebec, Université Laval, Québec, CA
| | - Jason Kindrachuk
- Laboratory of Emerging Viruses, Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, CA
| | - Dan Krecoum
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
| | - Shannon E MacDonald
- Faculty of Nursing & School of Public Health, University of Alberta, Edmonton, CA
| | - Ruth Ndjaboué
- Centre de recherche sur le Vieillissement, Sherbrooke, CA
| | - Magniol Noubi
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, CA
| | | | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, CA
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry 2881-E1050, avenue de la Médecine, Québec, CA
- Research Centre of the CHU de Québec, Québec, CA
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Tricco AC, Nincic V, Darvesh N, Rios P, Khan PA, Ghassemi MM, MacDonald H, Yazdi F, Lai Y, Warren R, Austin A, Cleary O, Baxter NN, Burns KEA, Coyle D, Curran JA, Graham ID, Hawker G, Légaré F, Watt J, Witteman HO, Clark JP, Bourgeault IL, Parsons Leigh J, Ahmed SB, Lawford K, Aiken AB, Langlois EV, McCabe C, Shepperd S, Skidmore B, Pattani R, Leon N, Lundine J, Adisso ÉL, El-Adhami W, Straus SE. Global evidence of gender equity in academic health research: a scoping review. BMJ Open 2023; 13:e067771. [PMID: 36792322 PMCID: PMC9933760 DOI: 10.1136/bmjopen-2022-067771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To chart the global literature on gender equity in academic health research. DESIGN Scoping review. PARTICIPANTS Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support. RESULTS Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%). CONCLUSIONS Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity. TRIAL REGISTRATION NUMBER Open Science Framework: https://osf.io/8wk7e/.
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Affiliation(s)
- Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nazia Darvesh
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Paul A Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marco M Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Heather MacDonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fatemeh Yazdi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rachel Warren
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alyssa Austin
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Olga Cleary
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Nancy N Baxter
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Melbourne, Australia
| | - Karen E A Burns
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- HEI, McMaster University, Hamilton, Ontario, Canada
| | - Douglas Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Janet A Curran
- Department of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gillian Hawker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - France Légaré
- Vitam Research Centre in Sustainable Health, Quebec City, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
| | - Jennifer Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Holly O Witteman
- Vitam Research Centre in Sustainable Health, Quebec City, Quebec, Canada
- Department of Family and Emergency Medicine, Faculty of Medicine, Universite Laval, Quebec, Quebec, Canada
- Office of Education and Professional Development, Université Laval, Quebec City, Québec, Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- The Lancet Ltd, London, London, UK
| | | | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen Lawford
- Department of Gender Studies, Queen's University, Haudenosaunee and Anishinaabek Territories, Settlement of Kingston, Ontario, Canada
| | - Alice B Aiken
- Department of Research and Innovation, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), WHO, Geneve, Switzerland
| | - Christopher McCabe
- Institute of Health Economics, Edmonton, Alberta, Canada
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Reena Pattani
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Internal Medicine, Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Évèhouénou Lionel Adisso
- Department of Social and Preventive Medicine, Faculty of Medicine, Universite Laval, Quebec City, Quebec, Canada
| | - Wafa El-Adhami
- Science in Australia Gender Equity Limited, Canberra, ACT, Australia
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Division of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
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Morrison AE, Senior PA, Bubela T, Farnsworth K, Witteman HO, Lam A. Do-It-Yourself and Commercial Automated Insulin Delivery Systems in Type 1 Diabetes: An Uncertain Area for Canadian Health-care Providers. Can J Diabetes 2022; 46:863-870. [PMID: 35945126 DOI: 10.1016/j.jcjd.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 01/15/2023]
Abstract
In the past century, since the discovery of insulin, methods of insulin delivery and glucose monitoring have advanced technologically. In particular, the introduction of insulin pumps, providing continuous subcutaneous insulin infusion (CSII), and continuous glucose monitors (CGMs) have been revolutionary for people living with type 1 diabetes. In this review, we have focussed on automated insulin delivery (AID) systems and discuss the implications of both approved and off-label options for the user and health-care providers. By pairing insulin pumps with CGM, AID systems facilitate automated adjustment in insulin delivery based on CGM readings. A subset of these have been developed commercially and were granted regulatory approval. In contrast, unregulated do-it-yourself AID systems, designed and set up by people living with type 1 diabetes and their families, have advanced rapidly and are gaining popularity worldwide. These patient-driven technologies have demonstrated impressive user self-reported improvements in glycemic control and quality of life, but have not been evaluated in any formal randomized controlled trials or by regulators. This presents challenging uncertainty for health-care providers, in addition to ethical and legal implications in supporting people with diabetes who wish to use these technologies. The current knowledge, opinions and practices relating to the use of AID systems across Canada are unknown. Gathering this information will highlight current practice and areas of knowledge gaps and concern and will assist in focussed education. This understanding is crucial to ensure people with type 1 diabetes using these systems have access to optimal, consistent and safe patient-centred care.
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Affiliation(s)
- Amy E Morrison
- Division of Endocrinology and Metabolism, Department of Medicine, Walter C. MacKenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada.
| | - Peter A Senior
- Division of Endocrinology and Metabolism, Department of Medicine, Walter C. MacKenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada; Diabetes Action Canada, Toronto, Ontario, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Holly O Witteman
- Department of Family and Emergency Medicine and Office of Education and Professional Development, Université Laval, Québec City, Québec, Canada
| | - Anna Lam
- Division of Endocrinology and Metabolism, Department of Medicine, Walter C. MacKenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
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Ndjaboue R, Ngueta G, Rochefort-Brihay C, Delorme S, Guay D, Ivers N, Shah BR, Straus SE, Yu C, Comeau S, Farhat I, Racine C, Drescher O, Witteman HO. Prediction models of diabetes complications: a scoping review. J Epidemiol Community Health 2022; 76:jech-2021-217793. [PMID: 35772935 DOI: 10.1136/jech-2021-217793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Diabetes often places a large burden on people with diabetes (hereafter 'patients') and the society, that is, in part attributable to its complications. However, evidence from models predicting diabetes complications in patients remains unclear. With the collaboration of patient partners, we aimed to describe existing prediction models of physical and mental health complications of diabetes. METHODS Building on existing frameworks, we systematically searched for studies in Ovid-Medline and Embase. We included studies describing prognostic prediction models that used data from patients with pre-diabetes or any type of diabetes, published between 2000 and 2020. Independent reviewers screened articles, extracted data and narratively synthesised findings using established reporting standards. RESULTS Overall, 78 studies reported 260 risk prediction models of cardiovascular complications (n=42 studies), mortality (n=16), kidney complications (n=14), eye complications (n=10), hypoglycaemia (n=8), nerve complications (n=3), cancer (n=2), fracture (n=2) and dementia (n=1). Prevalent complications deemed important by patients such as amputation and mental health were poorly or not at all represented. Studies primarily analysed data from older people with type 2 diabetes (n=54), with little focus on pre-diabetes (n=0), type 1 diabetes (n=8), younger (n=1) and racialised people (n=10). Per complication, predictors vary substantially between models. Studies with details of calibration and discrimination mostly exhibited good model performance. CONCLUSION This rigorous knowledge synthesis provides evidence of gaps in the landscape of diabetes complication prediction models. Future studies should address unmet needs for analyses of complications n> and among patient groups currently under-represented in the literature and should consistently report relevant statistics. SCOPING REVIEW REGISTRATION: https://osf.io/fjubt/.
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Affiliation(s)
- Ruth Ndjaboue
- Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
- School of social work, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- CIUSSS de l'Estrie, Research Centre on Aging, Sherbrooke, Quebec, Canada
| | - Gérard Ngueta
- Université de Sherbrooke Faculté des Sciences, Sherbrooke, Quebec, Canada
| | | | | | - Daniel Guay
- Diabetes Action Canada, Toronto, Ontario, Canada
| | - Noah Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family Medicine and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catherine Yu
- Knowledge Translation, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Sandrine Comeau
- Université Laval Faculté de médecine, Quebec, Quebec, Canada
| | - Imen Farhat
- Université Laval Faculté de médecine, Quebec, Quebec, Canada
| | - Charles Racine
- Université Laval Faculté de médecine, Quebec, Quebec, Canada
| | - Olivia Drescher
- Université Laval Faculté de médecine, Quebec, Quebec, Canada
| | - Holly O Witteman
- Family and Emergency Medicine, Laval University, Quebec City, Quebec, Canada
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Légaré F, Stacey D, Forest PG, Archambault P, Boland L, Coutu MF, Giguère AMC, LeBlanc A, Lewis KB, Witteman HO. Shared decision-making in Canada: Update on integration of evidence in health decisions and patient-centred care government mandates. Z Evid Fortbild Qual Gesundhwes 2022; 171:22-29. [PMID: 35606312 DOI: 10.1016/j.zefq.2022.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
In Canada, government mandates for patient-centred care (PCC) vary across the 10 provinces and three territories. Although basic medical and hospital services are provided for all, health care options for patients also depend on having private insurance. Thus, the current design of the Canadian healthcare system has several implications for PCC and shared decision-making (SDM). Since 2007, this is our fourth update on SDM in Canada. The aim of this paper is to provide an update on the current state of SDM and patient and public involvement in Canada. Overall, we still observed the difficulty of implementing any sort of national strategy partly because of the decentralized nature of the healthcare system. Second, national professional education programs are complicated by licensure and scope of practice variations across jurisdictions. Third, there are variations in the availability of different options covered by universal healthcare. Canada has experienced some favorable development as PCC is now explicitly articulated in the policies of most provinces and territories and there are increased efforts to give patients more access to their electronic health records. However, patient and public engagement (PPE) reform in health programs and governance remains an exception, and continuing centralization of governance structures may reduce their responsiveness to patient priorities. In a 2018 survey, 47.2% of respondents reported that they were not told by their health professional that they had a choice about treatment. Nonetheless, decision aids and decision coaching are increasingly available for health-related decisions and the Ottawa Hospital Research Institute's decision aid inventory has ensured continued leadership in this area. Diverse jurisdictions are starting to embed decision aids into care pathways, with some decision aids being included in clinical practice guidelines. The COVID-19 pandemic may have had a negative impact on SDM by removing decision choices due to emergency public health mandates, but stimulated new research and decision aids. Canada continues to assign health research funding to SDM and PCC, and a program dedicated to patient-oriented research is central to this effort. Guides and frameworks are increasingly available for planning and evaluating PPE. Finally, various initiatives are attempting to involve and empower Indigenous peoples through PPE and SDM.
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Affiliation(s)
- France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada.
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Patrick Archambault
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada; Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Canada; Department of Anesthesiology and Intensive Care Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Laura Boland
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie-France Coutu
- Centre for Action in Work Disability Prevention and Rehabilitation affiliated with Hôpital Charles-Lemoyne Research Center, Rehabilitation School, Longueuil Campus - Université de Sherbrooke, Longueuil, Canada
| | - Anik M C Giguère
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Office of Education and Continuing Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Annie LeBlanc
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Krystina B Lewis
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; University of Ottawa Heart Institute, Ottawa, Canada
| | - Holly O Witteman
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada; Ottawa Hospital Research Institute, Ottawa, Canada; Office of Education and Continuing Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
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McCleary N, Ivers NM, Schwalm JD, Witteman HO, Taljaard M, Desveaux L, Bouck Z, Grace SL, Grimshaw JM, Presseau J. Impacts of two behavior change interventions on determinants of medication adherence: process evaluation applying the health action process approach and habit theory alongside a randomized controlled trial. J Behav Med 2022; 45:659-673. [PMID: 35596020 DOI: 10.1007/s10865-022-00327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Abstract
Investigating the mechanisms of behavior change interventions provides a more fulsome understanding of how and why interventions work (or don't work). We assessed mechanisms of two interventions (mailouts alone, and mailouts plus telephone support, informed by the Health Action Process Approach (HAPA) and Habit Theory), designed to increase medication adherence after myocardial infarction. We conducted a process evaluation alongside a pragmatic trial. Medication adherence was assessed via self-report at 12-months in the trial, and participants in all trial groups were invited to contemporaneously complete an additional questionnaire assessing targeted mechanisms (HAPA constructs and automaticity). We used multiple regression-based mediation models to investigate indirect effects. Of 589 respondents, 497 were analyzed (92 excluded due to missing data). Mailouts plus telephone support had statistically significant but small effects on intention, social support, action planning, coping planning, and automaticity. There were no indirect effects of interventions on medication adherence via these constructs. Therefore, while this intervention led to changes in proposed mechanisms, these changes were not great enough to lead to behavior change. Refinements (and subsequent evaluation) of the interventions are warranted, and our findings indicate that this could involve offering more intensive support to form plans and identify cues for taking medications, in addition to providing physical supports to encourage self-monitoring, feedback, and habit formation. Trial registration: ClinicalTrials.gov: NCT02382731.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada.,Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - J-D Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Division of Cardiology, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,Department of Family and Emergency Medicine, Laval University, Québec City, QC, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Laura Desveaux
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada.,KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, K1H 8L6, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
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19
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Gautier WC, Abaye M, Dev S, Seaman JB, Butler RA, Norman MK, Arnold RM, Witteman HO, Cook TE, Mohan D, White DB. An Online Training Program to Improve Clinicians' Skills in Communicating About Serious Illness. Am J Crit Care 2022; 31:189-201. [PMID: 35466353 DOI: 10.4037/ajcc2022105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Large-scale efforts to train clinicians in serious-illness communication skills are needed, but 2 important gaps in knowledge remain. (1) No proven training method exists that can be readily scaled to train thousands of clinicians. (2) Though the value of interprofessional collaboration to support incapacitated patients' surrogates is increasingly recognized, few interventions for training intensive care unit (ICU) nurses in important communication skills can be leveraged to provide interprofessional family support. OBJECTIVE To develop and test a web/videoconference-based platform to train nurses to communicate about serious illness. METHODS A user-centered process was used to develop the intervention, including (1) iteratively engaging a stakeholder panel, (2) developing prototype and beta versions of the platform, and (3) 3 rounds of user testing with 13 ICU nurses. Participants' ratings of usability, acceptability, and perceived effectiveness were assessed quantitatively and qualitatively. RESULTS Stakeholders stressed that the intervention should leverage interactive learning and a streamlined digital interface. A training platform was developed consisting of 6 interactive online training lessons and 3 group-based video-conference practice sessions. Participants rated the program as usable (mean summary score 84 [96th percentile]), acceptable (mean, 4.5/5; SD, 0.7), and effective (mean, 4.8/5; SD, 0.6). Ten of 13 nurses would recommend the intervention over 2-day in-person training. CONCLUSIONS Nurses testing this web-based training program judged it usable, acceptable, and effective. These data support proceeding with an appropriately powered efficacy trial.
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Affiliation(s)
- William C. Gautier
- William C. Gautier is a medical student, School of Medicine; Department of Critical Care Medicine; Clinical Research, Investigation, and Systems Modeling of Acute Illness Center; Program on Ethics and Decision Making in Critical Illness, University of Pittsburgh, Pennsylvania
| | - Menna Abaye
- Menna Abaye is a research project manager, School of Medicine; Department of Critical Care Medicine; Clinical Research, Investigation, and Systems Modeling of Acute Illness Center; Program on Ethics and Decision Making in Critical Illness, University of Pittsburgh, Pennsylvania
| | - Shelly Dev
- Shelly Dev is an assistant professor, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Jennifer B. Seaman
- Jennifer B. Seaman is an assistant professor, School of Nursing, Department of Acute and Tertiary Care, University of Pittsburgh, Pennsylvania
| | - Rachel A. Butler
- Rachel A. Butler is a research program manager, School of Medicine; Department of Critical Care Medicine; Clinical Research, Investigation, and Systems Modeling of Acute Illness Center; Program on Ethics and Decision Making in Critical Illness, University of Pittsburgh, Pennsylvania
| | - Marie K. Norman
- Marie K. Norman is an associate professor, School of Medicine, General Internal Medicine, Medicine and Clinical and Translational Science, Innovation Design for Education and Assessment (IDEA) Lab, University of Pittsburgh, Pennsylvania
| | - Robert M. Arnold
- Robert M. Arnold is a professor, School of Medicine, Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, and University of Pittsburgh Medical Center Palliative and Supportive Institute, Pennsylvania
| | - Holly O. Witteman
- Holly O. Witteman is a professor, Department of Family and Emergency Medicine & Office of Education and Professional Development, Faculty of Medicine, Laval University, Québec, Canada
| | - Tara E. Cook
- Tara E. Cook was an assistant professor, School of Medicine, Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pennsylvania
| | - Deepika Mohan
- Deepika Mohan is an associate professor, School of Medicine; Department of Critical Care Medicine; Clinical Research, Investigation, and Systems Modeling of Acute Illness Center; Program on Ethics and Decision Making in Critical Illness, University of Pittsburgh, Pennsylvania
| | - Douglas B. White
- Douglas B. White is a professor, School of Medicine; Department of Critical Care Medicine; Clinical Research, Investigation, and Systems Modeling of Acute Illness Center; Program on Ethics and Decision Making in Critical Illness, University of Pittsburgh, Pennsylvania
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20
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Shuldiner J, Schwartz KL, Langford BJ, Ivers NM, Taljaard M, Grimshaw JM, Lacroix M, Tadrous M, Leung V, Brown K, Morris AM, Garber G, Presseau J, Thavorn K, Leis JA, Witteman HO, Brehaut J, Daneman N, Silverman M, Greiver M, Gomes T, Kidd MR, Francis JJ, Zwarenstein M, Lam J, Mulhall C, Gushue S, Uppal S, Wong A. Optimizing responsiveness to feedback about antibiotic prescribing in primary care: protocol for two interrelated randomized implementation trials with embedded process evaluations. Implement Sci 2022; 17:17. [PMID: 35164805 PMCID: PMC8842929 DOI: 10.1186/s13012-022-01194-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Audit and feedback (A&F) that shows how health professionals compare to those of their peers, can be an effective intervention to reduce unnecessary antibiotic prescribing among family physicians. However, the most impactful design approach to A&F to achieve this aim is uncertain. We will test three design modifications of antibiotic A&F that could be readily scaled and sustained if shown to be effective: (1) inclusion of case-mix-adjusted peer comparator versus a crude comparator, (2) emphasizing harms, rather than lack of benefits, and (3) providing a viral prescription pad. Methods We will conduct two interrelated pragmatic randomized trials in January 2021. One trial will include family physicians in Ontario who have signed up to receive their MyPractice: Primary Care report from Ontario Health (“OH Trial”). These physicians will be cluster-randomized by practice, 1:1 to intervention or control. The intervention group will also receive a Viral Prescription Pad mailed to their office as well as added emphasis in their report on use of the pad. Ontario family physicians who have not signed up to receive their MyPractice: Primary Care report will be included in the other trial administered by Public Health Ontario (“PHO Trial”). These physicians will be allocated 4:1 to intervention or control. The intervention group will be further randomized by two factors: case-mix adjusted versus unadjusted comparator and emphasis or not on harms of antibiotics. Physicians in the intervention arm of this trial will receive one of four versions of a personalized antibiotic A&F letter from PHO. For both trials, the primary outcome is the antibiotic prescribing rate per 1000 patient visits, measured at 6 months post-randomization, the primary analysis will use Poisson regression and we will follow the intention to treat principle. A mixed-methods process evaluation will use surveys and interviews with family physicians to explore potential mechanisms underlying the observed effects, exploring targeted constructs including intention, self-efficacy, outcome expectancies, descriptive norms, and goal prioritization. Discussion This protocol describes the rationale and methodology of two interrelated pragmatic trials testing variations of theory-informed components of an audit and feedback intervention to determine how to optimize A&F interventions for antibiotic prescribing in primary care. Trial registration NCT04594200, NCT05044052. CIHR Grant ID: 398514 Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01194-8.
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21
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Fallon C, Lemire M, Dumont D, Parent E, Figueroa E, Cummings I, Brousseau J, Marquis M, Paquet N, Plante S, Witteman HO. Toward Food Sovereignty for Coastal Communities of Eastern Québec: Co-designing A Website to Support Consumption of Edible Resources from the St. Lawrence River, Estuary, and Gulf. MDM Policy Pract 2022; 7:23814683221094477. [PMID: 35479298 PMCID: PMC9036343 DOI: 10.1177/23814683221094477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background. Despite the abundance and proximity of edible marine resources, coastal communities along the St. Lawrence in Eastern Québec rarely consume these resources. Within a community-based food sovereignty project, Manger notre Saint-Laurent (“Sustenance from our St. Lawrence”), members of participating communities (3 non-Indigenous, 1 Indigenous) identified a need for a web-based decision tool to help make informed consumption choices. Methods. We thus aimed to co-design a prototype website that facilitates informed choices about consuming local edible marine resources based on seasonal and regional availability, food safety, nutrition, and sustainability, with community members, regional stakeholders, and experts in user experience design and web development. We conducted 48 interviews with a variety of people over 3 iterative cycles, assessing the prototype’s ease of use with a validated measure, the System Usability Scale. Results. Community members, regional stakeholders, and other experts identified problematic elements in initial versions of the website (e.g., confusing symbols). We resolved issues and added features people identified as useful. Usability scores reached “best imaginable” for both the second and the third versions and did not differ significantly between sociodemographic groups. The final prototype includes a tool to explore each species and index cards to regroup accurate evidence relevant to each species. Conclusions. Engaging co-designers with different sociodemographic characteristics brought together a variety of perspectives. Several components would not have been included without co-designers’ input; other components were greatly improved thanks to their feedback. Co-design approaches in research and intervention development are preferable to foster the inclusion of a variety of people. Once the prototype is programmed and available online, we hope to evaluate the website to determine its effects on food choices.
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Affiliation(s)
| | - Mélanie Lemire
- Faculty of Medicine, Laval University, Québec City, Qc, Canada
- Research Center of CHU de Québec, Institut de biologie intégrative et des systèmes, Laval University, Québec City, Québec, Canada
| | - Dany Dumont
- Institut des sciences de la mer de Rimouski, Université du Québec à Rimouski, Rimouski, Qc, Canada
| | | | | | - Isabelle Cummings
- Centre de recherche sur les milieux insulaires et maritimes, Havre-aux-Maisons, Qc, Canada
| | - Julie Brousseau
- Faculty of Medicine, University of Montreal, Montreal, Qc, Canada
| | - Marie Marquis
- Faculty of Medicine, University of Montreal, Montreal, Qc, Canada
| | - Nicolas Paquet
- franC doc, rang Saint-Adolphe, Saint-Alexandre-de-Kamouraska, Qc, Canada
| | - Steve Plante
- Université du Québec à Rimouski, Rimouski, Qc, Canada
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22
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Michou L, Julien AS, Witteman HO, Légaré J, Ratelle L, Godbout A, Tardif J, Côté S, Boily G, Lui R, Ikic A, Trudeau J, Tremblay JL, Fortin I, Bessette L, Chetaille AL, Fortin PR. Measuring the impact of an educational intervention in rheumatoid arthritis: An open-label, randomized trial. Arch Rheumatol 2021; 37:169-179. [PMID: 36017212 PMCID: PMC9377171 DOI: 10.46497/archrheumatol.2022.8965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives
This study aims to determine whether patients with active rheumatoid arthritis (RA), either starting on or changing biological or targeted synthetic disease-modifying antirheumatic drugs (DMARDs), demonstrate better self-management safety skills three months after receiving a multidisciplinary educational intervention compared to patients receiving usual care. Patients and methods
Between October 2015 and October 2018 , this open-label, randomized-controlled trial included a total of 107 RA patients (27 males, 80 females; mean age: 60.2±10.4 years; range, 54 to 71 years) who were on treatment or in whom treatment was changed with a biological or targeted synthetic DMARD. The patients were randomized into two groups: Group 1 (n=57) received additional intervention with educational DVD and one teleconference session and Group 2 (n=55) received usual care and were offered the intervention at three months. All patients underwent a final visit at six months. At each visit, the patients completed the BioSecure questionnaire measuring the self-care safety skills, a behavioral intention questionnaire, and the Beliefs about Medicines Questionnaire (BMQ). Results
No significant difference was observed in the Biosecure score at three months between the two groups (p=0.08). After pooling the first three-month data in Group 1 and the last three-month data in Group 2, the mean score of the BioSecure questionnaire increased to 7.10±0.92 in the group receiving educational intervention (p<0.0001). This increase was maintained at six months in Group 2 (p=0.88). The rate of appropriate behavioral intention increased over time (76% at baseline and 85% at six months for both groups). There was no significant change in the BMQ (p=0.44 to 0.84). Conclusion
The development of an educational DVD followed by a teleconference seem to improve self-care safety skills of the patients in practical situations.
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Affiliation(s)
- Laëtitia Michou
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Anne-Sophie Julien
- Department of Mathematics and statistics, Université Laval, Québec (Québec) Canada
| | - Holly O. Witteman
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec (Québec) Canada
| | - Jean Légaré
- Arthritis Alliance of Canada, Québec (Québec) Canada
| | - Lucie Ratelle
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
| | - Alexandra Godbout
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
| | | | - Suzanne Côté
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | | | - Rebecca Lui
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Alena Ikic
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Judith Trudeau
- Department of Rheumatology, Hôtel-Dieu de Lévis, Lévis, (Québec) Canada
| | - Jean-Luc Tremblay
- Clinique de Rhumatologie du Centre du Québec, Trois-Rivières, (Québec) Canada
| | - Isabelle Fortin
- Centre de Rhumatologie de l’Est du Québec, Rimouski, (Québec) Canada
| | - Louis Bessette
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Anne-Laure Chetaille
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
| | - Paul R Fortin
- CHU de Québec-Université Laval Research Centre, Québec (Québec) Canada
- Department of Medicine, Division of Rheumatology, Université Laval, Québec (Québec) Canada
- CHU de Québec-Université Laval, Québec (Québec) Canada
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23
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Delaney RK, Pinto NM, Ozanne EM, Stark LA, Pershing ML, Thorpe A, Witteman HO, Thokala P, Lambert LM, Hansen LM, Greene TH, Fagerlin A. Study protocol for a randomised clinical trial of a decision aid and values clarification method for parents of a fetus or neonate diagnosed with a life-threatening congenital heart defect. BMJ Open 2021; 11:e055455. [PMID: 34893487 PMCID: PMC8666895 DOI: 10.1136/bmjopen-2021-055455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Parents who receive the diagnosis of a life-threatening, complex heart defect in their fetus or neonate face a difficult choice between pursuing termination (for fetal diagnoses), palliative care or complex surgical interventions. Shared decision making (SDM) is recommended in clinical contexts where there is clinical equipoise. SDM can be facilitated by decision aids. The International Patient Decision Aids Standards collaboration recommends the inclusion of values clarification methods (VCMs), yet little evidence exists concerning the incremental impact of VCMs on patient or surrogate decision making. This protocol describes a randomised clinical trial to evaluate the effect of a decision aid (with and without a VCM) on parental mental health and decision making within a clinical encounter. METHODS AND ANALYSIS Parents who have a fetus or neonate diagnosed with one of six complex congenital heart defects at a single tertiary centre will be recruited. Data collection for the prospective observational control group was conducted September 2018 to December 2020 (N=35) and data collection for two intervention groups is ongoing (began October 2020). At least 100 participants will be randomised 1:1 to two intervention groups (decision aid only vs decision aid with VCM). For the intervention groups, data will be collected at four time points: (1) at diagnosis, (2) postreceipt of decision aid, (3) postdecision and (4) 3 months postdecision. Data collection for the control group was the same, except they did not receive a survey at time 2. Linear mixed effects models will assess differences between study arms in distress (primary outcome), grief and decision quality (secondary outcomes) at 3-month post-treatment decision. ETHICS AND DISSEMINATION This study was approved by the University of Utah Institutional Review Board. Study findings have and will continue to be presented at national conferences and within scientific research journals. TRIAL REGISTRATION NUMBER NCT04437069 (Pre-results).
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Affiliation(s)
- Rebecca K Delaney
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Nelangi M Pinto
- Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Elissa M Ozanne
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Louisa A Stark
- Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mandy L Pershing
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alistair Thorpe
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Holly O Witteman
- Family and Emergency Medicine, Laval University, Quebec City, Quebec, Canada
| | - Praveen Thokala
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Linda M Lambert
- Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Lisa M Hansen
- Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Tom H Greene
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Angela Fagerlin
- Population Health Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, USA
- VA HSR&D Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, USA
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Abstract
OBJECTIVES Evidence on repeating vaccination misinformation or "myths" in debunking text is inconclusive; repeating myths may unintentionally increase agreement with myths or help discredit myths. In this study we aimed to compare the effect of repeating vaccination myths and other text-based debunking strategies on parents' agreement with myths and their intention to vaccinate their children. METHODS For this online experiment we recruited 788 parents of children aged 0 to 5 years; 454 (58%) completed the study. We compared 3 text-based debunking strategies (repeating myths, posing questions, or making factual statements) and a control. We measured changes in agreement with myths and intention to vaccinate immediately after the intervention and at least 1 week later. The primary analysis compared the change in agreement with vaccination myths from baseline, between groups, at each time point after the intervention. RESULTS There was no evidence that repeating myths increased agreement with myths compared with the other debunking strategies or the control. Posing questions significantly decreased agreement with myths immediately after the intervention compared with the control (difference: -0.30 points, 99.17% confidence interval: -0.58 to -0.02, P = .004, d = 0.39). There was no evidence of a difference between other debunking strategies or the control at either time point, or on intention to vaccinate. CONCLUSIONS Debunking strategies that repeat vaccination myths do not appear to be inferior to strategies that do not repeat myths.
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Affiliation(s)
- Maryke S Steffens
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Adam G Dunn
- Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mathew D Marques
- School of Psychology and Public Health, Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Margie Danchin
- Vaccine Uptake Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec, Canada
| | - Julie Leask
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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25
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Witteman HO, Ndjaboue R, Vaisson G, Dansokho SC, Arnold B, Bridges JFP, Comeau S, Fagerlin A, Gavaruzzi T, Marcoux M, Pieterse A, Pignone M, Provencher T, Racine C, Regier D, Rochefort-Brihay C, Thokala P, Weernink M, White DB, Wills CE, Jansen J. Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis. Med Decis Making 2021; 41:801-820. [PMID: 34565196 PMCID: PMC8482297 DOI: 10.1177/0272989x211037946] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, –0.04; 95% confidence interval [CI], –0.06 to –0.02; P < 0.001) and decisional conflict (standardized mean difference, –0.20; 95% CI, –0.29 to –0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (χ2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ2 = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Ruth Ndjaboue
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada
| | - Gratianne Vaisson
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Bob Arnold
- UPMC Palliative and Supportive Institute, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sandrine Comeau
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Melina Marcoux
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Arwen Pieterse
- Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Pignone
- Departments of Internal Medicine and Population Health, Dell Medical School, University of Texas, Austin, TX, USA
| | - Thierry Provencher
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Charles Racine
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Dean Regier
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte Rochefort-Brihay
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Celia E Wills
- College of Nursing, Center on Healthy Aging, Self-Management and Complex Care, The Ohio State University, Columbus, OH, USA
| | - Jesse Jansen
- Department of Family Medicine/CAPHRI, Maastricht University, Maastricht, The Netherlands
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26
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Witteman HO, Maki KG, Vaisson G, Finderup J, Lewis KB, Dahl Steffensen K, Beaudoin C, Comeau S, Volk RJ. Systematic Development of Patient Decision Aids: An Update from the IPDAS Collaboration. Med Decis Making 2021; 41:736-754. [PMID: 34148384 DOI: 10.1177/0272989x211014163] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The 2013 update of the evidence informing the quality dimensions behind the International Patient Decision Aid Standards (IPDAS) offered a model process for developers of patient decision aids. OBJECTIVE To summarize and update the evidence used to inform the systematic development of patient decision aids from the IPDAS Collaboration. METHODS To provide further details about design and development methods, we summarized findings from a subgroup (n = 283 patient decision aid projects) in a recent systematic review of user involvement by Vaisson et al. Using a new measure of user-centeredness (UCD-11), we then rated the degree of user-centeredness reported in 66 articles describing patient decision aid development and citing the 2013 IPDAS update on systematic development. We contacted the 66 articles' authors to request their self-reports of UCD-11 items. RESULTS The 283 development processes varied substantially from minimal iteration cycles to more complex processes, with multiple iterations, needs assessments, and extensive involvement of end users. We summarized minimal, medium, and maximal processes from the data. Authors of 54 of 66 articles (82%) provided self-reported UCD-11 ratings. Self-reported scores were significantly higher than reviewer ratings (reviewers: mean [SD] = 6.45 [3.10]; authors: mean [SD] = 9.62 [1.16], P < 0.001). CONCLUSIONS Decision aid developers have embraced principles of user-centered design in the development of patient decision aids while also underreporting aspects of user involvement in publications about their tools. Templates may reduce the need for extensive development, and new approaches for rapid development of aids have been proposed when a more detailed approach is not feasible. We provide empirically derived benchmark processes and a reporting checklist to support developers in more fully describing their development processes.[Box: see text].
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Canada.,VITAM Research Centre, Quebec City, Canada.,CHU de Québec Research Centre, Quebec City, Canada
| | - Kristin G Maki
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gratianne Vaisson
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Québec, Canada
| | - Jeanette Finderup
- Research Centre for Patient Involvement & Department of Renal Medicine, Aarhus University & Aarhus University Hospital, Aarhus, Denmark
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Karina Dahl Steffensen
- Center for Shared Decision Making/Department of Oncology, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark.,Institute of Regional Health Research, Faculty of Health Sciences, Vejle, Denmark
| | - Caroline Beaudoin
- Department of Family and Emergency Medicine, Laval University, Quebec, Canada
| | - Sandrine Comeau
- Department of Family and Emergency Medicine, Laval University, Quebec, Canada
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
OBJECTIVES We aimed to develop a systematic synthesis of systematic reviews of health impacts of climate change, by synthesising studies' characteristics, climate impacts, health outcomes and key findings. DESIGN We conducted an overview of systematic reviews of health impacts of climate change. We registered our review in PROSPERO (CRD42019145972). No ethical approval was required since we used secondary data. Additional data are not available. DATA SOURCES On 22 June 2019, we searched Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane and Web of Science. ELIGIBILITY CRITERIA We included systematic reviews that explored at least one health impact of climate change. DATA EXTRACTION AND SYNTHESIS We organised systematic reviews according to their key characteristics, including geographical regions, year of publication and authors' affiliations. We mapped the climate effects and health outcomes being studied and synthesised major findings. We used a modified version of A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) to assess the quality of studies. RESULTS We included 94 systematic reviews. Most were published after 2015 and approximately one-fifth contained meta-analyses. Reviews synthesised evidence about five categories of climate impacts; the two most common were meteorological and extreme weather events. Reviews covered 10 health outcome categories; the 3 most common were (1) infectious diseases, (2) mortality and (3) respiratory, cardiovascular or neurological outcomes. Most reviews suggested a deleterious impact of climate change on multiple adverse health outcomes, although the majority also called for more research. CONCLUSIONS Most systematic reviews suggest that climate change is associated with worse human health. This study provides a comprehensive higher order summary of research on health impacts of climate change. Study limitations include possible missed relevant reviews, no meta-meta-analyses, and no assessment of overlap. Future research could explore the potential explanations between these associations to propose adaptation and mitigation strategies and could include broader sociopsychological health impacts of climate change.
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Affiliation(s)
- Rhea J Rocque
- Prairie Climate Centre, The University of Winnipeg, Winnipeg, Manitoba, Canada
| | | | - Ruth Ndjaboue
- Faculty of Medicine, Université Laval, Quebec, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec, QC, Canada
| | - Laura Cameron
- Prairie Climate Centre, The University of Winnipeg, Winnipeg, Manitoba, Canada
| | | | | | - Catherine Fallon
- Faculty of Medicine, Université Laval, Quebec, QC, Canada
- CHUQ Research Centre, Quebec, QC, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Holly O Witteman
- Faculty of Medicine, Université Laval, Quebec, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec, QC, Canada
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28
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Tricco AC, Lachance CC, Rios P, Darvesh N, Antony J, Radhakrishnan A, Anand SS, Baxter N, Burns KEA, Coyle D, Curran JA, Fiest K, Graham ID, Hawker G, Légaré F, Watt J, Witteman HO, Clark JP, Bourgeault IL, Leigh JP, Ahmed SB, Lawford K, Aiken A, Falk-Krzesinski HJ, Langlois EV, McCabe C, Shepperd S, Skidmore B, Pattani R, Leon N, Lundine J, Adisso L, El-Adhami W, Straus SE. Global evidence of gender inequity in academic health research: a living scoping review protocol. JBI Evid Synth 2021; 18:2181-2193. [PMID: 32925395 DOI: 10.11124/jbies-20-00078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of this review is to describe the global evidence of gender inequity among individuals with appointments at academic institutions that conduct health research, and examine how gender intersects with other social identities to influence outcomes. INTRODUCTION The gender demographics of universities have shifted, yet the characteristics of those who lead academic health research institutions have not reflected this change. Synthesized evidence will guide decision-making and policy development to support the progress of gender and other under-represented social identities in academia. INCLUSION CRITERIA This review will consider any quantitative, qualitative, or mixed methods primary research that reports outcome data related to gender equity and other social identities among individuals affiliated with academic or research institutions that conduct health research, originating from any country. METHODS The JBI Manual for Evidence Synthesis and the Cochrane Collaboration's guidance on living reviews will inform the review methods. Information sources will include electronic databases, unpublished literature sources, reference scanning of relevant systematic reviews, and sources provided by experts on the research team. Searches will be run regularly to monitor the development of new literature and determine when the review will be updated. Study selection and data extraction will be conducted by two reviewers working independently, and all discrepancies will be resolved by discussion or a third reviewer. Data synthesis will summarize information using descriptive frequencies and simple thematic analysis. Results will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension to scoping reviews. REGISTRATION Open Science Framework: https://osf.io/8wk7e/.
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Affiliation(s)
- Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Kingston, ON, Canada
| | | | - Patricia Rios
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Nazia Darvesh
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jesmin Antony
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Amruta Radhakrishnan
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sonia S Anand
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nancy Baxter
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Surgery, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Karen E A Burns
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kirsten Fiest
- Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gillian Hawker
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Jennifer Watt
- Division of Geriatric Medicine, University of Toronto, Toronto, ON, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.,Office of Education and Professional Development, Université Laval, Quebec City, QC, Canada
| | - Jocalyn P Clark
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,The Lancet, London, ON, United Kingdom
| | | | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Lawford
- Department of Gender Studies, Queen's University, Haudenosaunee and Anishinaabek Territories, Settlement of Kingston, ON, Canada
| | - Alice Aiken
- Research and Innovation, Dalhousie University, Halifax, NS, Canada
| | - Holly J Falk-Krzesinski
- Global Strategic Networks, Elsevier Incorporated, New York City, NY, USA.,School of Professional Studies, Northwestern University, Chicago, IL, USA
| | - Etienne V Langlois
- Partnership for Maternal, Newborn and Child Health, World Health Organization, Geneva, Switzerland
| | - Chris McCabe
- Institute of Health Economics, Edmonton, AB, Canada
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - Reena Pattani
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Internal Medicine, Department of Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Lionel Adisso
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Wafa El-Adhami
- Science in Australia Gender Equity, Acton, ACT, Australia
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael 's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Haines ER, Dopp A, Lyon AR, Witteman HO, Bender M, Vaisson G, Hitch D, Birken S. Harmonizing evidence-based practice, implementation context, and implementation strategies with user-centered design: a case example in young adult cancer care. Implement Sci Commun 2021; 2:45. [PMID: 33902748 PMCID: PMC8077816 DOI: 10.1186/s43058-021-00147-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Attempting to implement evidence-based practices in contexts for which they are not well suited may compromise their fidelity and effectiveness or burden users (e.g., patients, providers, healthcare organizations) with elaborate strategies intended to force implementation. To improve the fit between evidence-based practices and contexts, implementation science experts have called for methods for adapting evidence-based practices and contexts and tailoring implementation strategies; yet, methods for considering the dynamic interplay among evidence-based practices, contexts, and implementation strategies remain lacking. We argue that harmonizing the three can be facilitated by user-centered design, an iterative and highly stakeholder-engaged set of principles and methods. METHODS This paper presents a case example in which we used a three-phase user-centered design process to design and plan to implement a care coordination intervention for young adults with cancer. Specifically, we used usability testing to redesign and augment an existing patient-reported outcome measure that served as the basis for our intervention to optimize its usability and usefulness, ethnographic contextual inquiry to prepare the context (i.e., a comprehensive cancer center) to promote receptivity to implementation, and iterative prototyping workshops with a multidisciplinary design team to design the care coordination intervention and anticipate implementation strategies needed to enhance contextual fit. RESULTS Our user-centered design process resulted in the Young Adult Needs Assessment and Service Bridge (NA-SB), including a patient-reported outcome measure and a collection of referral pathways that are triggered by the needs young adults report, as well as implementation guidance. By ensuring NA-SB directly responded to features of users and context, we designed NA-SB for implementation, potentially minimizing the strategies needed to address misalignment that may have otherwise existed. Furthermore, we designed NA-SB for scale-up; by engaging users from other cancer programs across the country to identify points of contextual variation which would require flexibility in delivery, we created a tool intended to accommodate diverse contexts. CONCLUSIONS User-centered design can help maximize usability and usefulness when designing evidence-based practices, preparing contexts, and informing implementation strategies-in effect, harmonizing evidence-based practices, contexts, and implementation strategies to promote implementation and effectiveness.
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Affiliation(s)
- Emily R. Haines
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, 525 Vine Street, Winston-Salem, NC 27101 USA
| | - Alex Dopp
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main St, Santa Monica, CA 90401 USA
| | - Aaron R. Lyon
- Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Holly O. Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine,, Quebec City, QC G1V 0A6 Canada
| | - Miriam Bender
- Sue & Bill Gross School of Nursing, University of California, Irvine, 252C Berk Hall, Irvine, CA 92697-3959 USA
| | - Gratianne Vaisson
- Occupational Therapy, Faculty of Medicine, Laval University, Ferdinand Vandry Pavillon, 1050 Avenue de la Médecine, Quebec City, QC G1V 0A6 Canada
| | - Danielle Hitch
- Department of Physical Activity and Nutrition Research, School of Health and Social Development, Deakin University, Waterfront Campus, 1 Gheringhap Street, Geelong, VIC 3220 Australia
| | - Sarah Birken
- Department of Implementation Science, Wake Forest School of Medicine, 525@Vine Room 5219, Medical Center Boulevard, Winston-Salem, NC 27157 USA
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Lafleur A, Côté L, Witteman HO. Analysis of Supervisors' Feedback to Residents on Communicator, Collaborator, and Professional Roles During Case Discussions. J Grad Med Educ 2021; 13:246-256. [PMID: 33897959 PMCID: PMC8054588 DOI: 10.4300/jgme-d-20-00842.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/06/2020] [Accepted: 01/10/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Literature examining the feedback supervisors give to residents during case discussions in the realms of communication, collaboration, and professional roles (intrinsic roles) focuses on analyses of written feedback and self-reporting. OBJECTIVES We quantified how much of the supervisors' verbal feedback time targeted residents' intrinsic roles and how well feedback time was aligned with the role targeted by each case. We analyzed the educational goals of this feedback. We assessed whether feedback content differed depending on whether the residents implied or explicitly expressed a need for particular feedback. METHODS This was a mixed-methods study conducted from 2017 to 2019. We created scripted cases for radiology and internal medicine residents to present to supervisors, then analyzed the feedback given both qualitatively and quantitatively. The cases were designed to highlight the CanMEDS intrinsic roles of communicator, collaborator, and professional. RESULTS Radiologists (n = 15) spent 22% of case discussions providing feedback on intrinsic roles (48% aligned): 28% when the case targeted the communicator role, 14% for collaborator, and 27% for professional. Internists (n = 15) spent 70% of discussions on intrinsic roles (56% aligned): 66% for communicator, 73% for collaborator, and 72% for professional. Radiologists' goals were to offer advice (66%), reflections (21%), and agreements (7%). Internists offered advice (41%), reflections (40%), and clarifying questions (10%). We saw no consistent effects when residents explicitly requested feedback on an intrinsic role. CONCLUSIONS Case discussions represent frequent opportunities for substantial feedback on intrinsic roles, largely aligned with the clinical case. Supervisors predominantly offered monologues of advice and agreements.
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Affiliation(s)
- Alexandre Lafleur
- Alexandre Lafleur, MD, MHPE, is Associate Clinical Professor, Department of Medicine, Laval University Faculty of Medicine, Quebec City, Canada, and Co-Chairholder, CMA-MD Educational Leadership Chair in Health Professions Education
| | - Luc Côté
- Luc Côté, MSW, PhD, is Professor and Medical Education Researcher, Department of Family and Emergency Medicine, Office of Education and Continuing Professional Development, Laval University Faculty of Medicine, Quebec City, Canada
| | - Holly O. Witteman
- Holly O. Witteman, PhD, is Associate Professor, Department of Family and Emergency Medicine, Office of Education and Continuing Professional Development, Laval University Faculty of Medicine, Quebec City, Canada
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van Allen Z, Dogba MJ, Brent MH, Bach C, Grimshaw JM, Ivers NM, Wang X, McCleary N, Asad S, Chorghay Z, Hakim H, Sutakovic O, Drescher O, Légaré F, Witteman HO, Zettl M, Squires J, Tremblay MC, Randhawa A, Lopez G, Ben Guiza A, Presseau J. Barriers to and enablers of attendance at diabetic retinopathy screening experienced by immigrants to Canada from multiple cultural and linguistic minority groups. Diabet Med 2021; 38:e14429. [PMID: 33068305 DOI: 10.1111/dme.14429] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/11/2020] [Accepted: 10/14/2020] [Indexed: 12/27/2022]
Abstract
AIM To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes. METHODS Using a patient-oriented research approach leveraging Diabetes Action Canada's patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French-speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development. RESULTS We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group-specific barriers/enablers included a preference to return to one's country of birth for screening, the impact of winter, and preferences for alternative medicine. CONCLUSION Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.
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Affiliation(s)
- Zack van Allen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Catherine Bach
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Xiaoqin Wang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Evidence-based Medicine Centre, Lanzhou University, Lanzhou, China
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sarah Asad
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Zahraa Chorghay
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Mary Zettl
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Janet Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Marie-Claude Tremblay
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | | | | | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Witteman HO, Vaisson G, Provencher T, Chipenda Dansokho S, Colquhoun H, Dugas M, Fagerlin A, Giguere AM, Haslett L, Hoffman A, Ivers NM, Légaré F, Trottier ME, Stacey D, Volk RJ, Renaud JS. An 11-Item Measure of User- and Human-Centered Design for Personal Health Tools (UCD-11): Development and Validation. J Med Internet Res 2021; 23:e15032. [PMID: 33724194 PMCID: PMC8074832 DOI: 10.2196/15032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/27/2020] [Accepted: 10/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Researchers developing personal health tools employ a range of approaches to involve prospective users in design and development. OBJECTIVE The aim of this paper was to develop a validated measure of the human- or user-centeredness of design and development processes for personal health tools. METHODS We conducted a psychometric analysis of data from a previous systematic review of the design and development processes of 348 personal health tools. Using a conceptual framework of user-centered design, our team of patients, caregivers, health professionals, tool developers, and researchers analyzed how specific practices in tool design and development might be combined and used as a measure. We prioritized variables according to their importance within the conceptual framework and validated the resultant measure using principal component analysis with Varimax rotation, classical item analysis, and confirmatory factor analysis. RESULTS We retained 11 items in a 3-factor structure explaining 68% of the variance in the data. The Cronbach alpha was .72. Confirmatory factor analysis supported our hypothesis of a latent construct of user-centeredness. Items were whether or not: (1) patient, family, caregiver, or surrogate users were involved in the steps that help tool developers understand users or (2) develop a prototype, (3) asked their opinions, (4) observed using the tool or (5) involved in steps intended to evaluate the tool, (6) the process had 3 or more iterative cycles, (7) changes between cycles were explicitly reported, (8) health professionals were asked their opinion and (9) consulted before the first prototype was developed or (10) between initial and final prototypes, and (11) a panel of other experts was involved. CONCLUSIONS The User-Centered Design 11-item measure (UCD-11) may be used to quantitatively document the user/human-centeredness of design and development processes of patient-centered tools. By building an evidence base about such processes, we can help ensure that tools are adapted to people who will use them, rather than requiring people to adapt to tools.
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Affiliation(s)
- Holly O Witteman
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
- CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Gratianne Vaisson
- Université Laval, Quebec City, QC, Canada
- CHU de Québec-Université Laval, Quebec City, QC, Canada
| | | | | | | | - Michele Dugas
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
| | - Angela Fagerlin
- University of Utah, Salt Lake City, UT, United States
- Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance, Salt Lake City, UT, United States
| | - Anik Mc Giguere
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
| | - Lynne Haslett
- East End Community Health Centre, Toronto, ON, Canada
| | - Aubri Hoffman
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Noah M Ivers
- University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - France Légaré
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
| | - Marie-Eve Trottier
- Université Laval, Quebec City, QC, Canada
- CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Dawn Stacey
- University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert J Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jean-Sébastien Renaud
- Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Quebec City, QC, Canada
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Agarwal P, Gordon D, Griffith J, Kithulegoda N, Witteman HO, Sacha Bhatia R, Kushniruk AW, Borycki EM, Lamothe L, Springall E, Shaw J. Assessing the quality of mobile applications in chronic disease management: a scoping review. NPJ Digit Med 2021; 4:46. [PMID: 33692488 PMCID: PMC7946941 DOI: 10.1038/s41746-021-00410-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/21/2021] [Indexed: 01/31/2023] Open
Abstract
While there has been a rapid growth of digital health apps to support chronic diseases, clear standards on how to best evaluate the quality of these evolving tools are absent. This scoping review aims to synthesize the emerging field of mobile health app quality assessment by reviewing criteria used by previous studies to assess the quality of mobile apps for chronic disease management. A literature review was conducted in September 2017 for published studies that use a set of quality criteria to directly evaluate two or more patient-facing apps supporting promote chronic disease management. This resulted in 8182 citations which were reviewed by research team members, resulting in 65 articles for inclusion. An inductive coding schema to synthesize the quality criteria utilized by included articles was developed, with 40 unique quality criteria identified. Of the 43 (66%) articles that reported resources used to support criteria selection, 19 (29%) used clinical guidelines, and 10 (15%) used behavior change theory. The most commonly used criteria included the presence of user engagement or behavior change functions (97%, n = 63) and technical features of the app such as customizability (20%, n = 13, while Usability was assessed by 24 studies (36.9%). This study highlights the significant variation in quality criteria employed for the assessment of mobile health apps. Future methods for app evaluation will benefit from approaches that leverage the best evidence regarding the clinical impact and behavior change mechanisms while more directly reflecting patient needs when evaluating the quality of apps.
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Affiliation(s)
- Payal Agarwal
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
| | - Dara Gordon
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Janessa Griffith
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Faculty of Health Sciences, Douglas College, New Westminster, BC, Canada
| | - Natasha Kithulegoda
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Québec City, QC, Canada
- Office of Education and Continuing Development, Faculty of Medicine, Laval University, Québec City, QC, Canada
- Center Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval CERSSPL-UL, Québec City, QC, Canada
- Population Health and Optimal Health Practices, Research Centre of the CHU de Québec-Université Laval (CRCHU-UL), Québec City, QC, Canada
| | - R Sacha Bhatia
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andre W Kushniruk
- School of Health Information Science, University of Victoria, Greater Victoria, BC, Canada
| | - Elizabeth M Borycki
- School of Health Information Science, University of Victoria, Greater Victoria, BC, Canada
| | - Lise Lamothe
- École de santé publique, Université de Montréal, Montreal, QC, Canada
| | - Elena Springall
- Gerstein Library, University of Toronto, Toronto, ON, Canada
| | - James Shaw
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Vaisson G, Provencher T, Dugas M, Trottier MÈ, Chipenda Dansokho S, Colquhoun H, Fagerlin A, Giguere AMC, Hakim H, Haslett L, Hoffman AS, Ivers NM, Julien AS, Légaré F, Renaud JS, Stacey D, Volk RJ, Witteman HO. User Involvement in the Design and Development of Patient Decision Aids and Other Personal Health Tools: A Systematic Review. Med Decis Making 2021; 41:261-274. [PMID: 33655791 DOI: 10.1177/0272989x20984134] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND When designing and developing patient decision aids, guidelines recommend involving patients and stakeholders. There are myriad ways to do this. We aimed to describe how such involvement occurs by synthesizing reports of patient decision aid design and development within a user-centered design framework and to provide context by synthesizing reports of user-centered design applied to other personal health tools. METHODS We included articles describing at least one development step of 1) a patient decision aid, 2) user- or human-centered design of another personal health tool, or 3) evaluation of these. We organized data within a user-centered design framework comprising 3 elements in iterative cycles: understanding users, developing/refining prototype, and observing users. RESULTS We included 607 articles describing 325 patient decision aid projects and 65 other personal health tool projects. Fifty percent of patient decision aid projects reported involving users in at least 1 step for understanding users, 35% in at least 1 step for developing/refining the prototype, and 84% in at least 1 step for observing users' interaction with the prototype. In comparison, other personal health tool projects reported 91%, 49%, and 92%, respectively. A total of 74% of patient decision aid projects and 92% of other personal health tool projects reported iterative processes, both with a median of 3 iterative cycles. Preliminary evaluations such as usability or feasibility testing were reported in 66% of patient decision aid projects and 89% of other personal health tool projects. CONCLUSIONS By synthesizing design and development practices, we offer evidence-based portraits of user involvement. Those wishing to further align patient decision aid design and development with user-centered design methods could involve users earlier, design and develop iteratively, and report processes in greater detail.
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Affiliation(s)
| | | | - Michèle Dugas
- Universite Laval Faculte de Medicine, Quebec City, QC, Canada
| | | | | | | | - Angela Fagerlin
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anik M C Giguere
- McMaster University Faculty of Health Sciences, Quebec, QC, Canada
| | - Hina Hakim
- Universite Laval Faculte de Medicine, Quebec City, QC, Canada
| | - Lynne Haslett
- East End Community Health Centre, Toronto, ON, Canada
| | - Aubri S Hoffman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - France Légaré
- Universite Laval Faculte de Medicine, Quebec City, QC, Canada
| | | | - Dawn Stacey
- University of Ottawa Faculty of Health Sciences, Ottawa, ON, Canada
| | - Robert J Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Lawani MA, Turgeon Y, Côté L, Légaré F, Witteman HO, Morin M, Kroger E, Voyer P, Rodriguez C, Giguere A. User-centered and theory-based design of a professional training program on shared decision-making with older adults living with neurocognitive disorders: a mixed-methods study. BMC Med Inform Decis Mak 2021; 21:59. [PMID: 33596874 PMCID: PMC7888116 DOI: 10.1186/s12911-021-01396-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We know little about the best approaches to design training for healthcare professionals. We thus studied how user-centered and theory-based design contribute to the development of a distance learning program for professionals, to increase their shared decision-making (SDM) with older adults living with neurocognitive disorders and their caregivers. METHODS In this mixed-methods study, healthcare professionals who worked in family medicine clinics and homecare services evaluated a training program in a user-centered approach with several iterative phases of quantitative and qualitative evaluation, each followed by modifications. The program comprised an e-learning activity and five evidence summaries. A subsample assessed the e-learning activity during semi-structured think-aloud sessions. A second subsample assessed the evidence summaries they received by email. All participants completed a theory-based questionnaire to assess their intention to adopt SDM. Descriptive statistical analyses and qualitative thematic analyses were integrated at each round to prioritize training improvements with regard to the determinants most likely to influence participants' intention. RESULTS Of 106 participants, 98 completed their evaluations of either the e-learning activity or evidence summary (93%). The professions most represented were physicians (60%) and nurses (15%). Professionals valued the e-learning component to gain knowledge on the theory and practice of SDM, and the evidence summaries to apply the knowledge gained through the e-learning activity to diverse clinical contexts. The iterative design process allowed addressing most weaknesses reported. Participants' intentions to adopt SDM and to use the summaries were high at baseline and remained positive as the rounds progressed. Attitude and social influence significantly influenced participants' intention to use the evidence summaries (P < 0.0001). Despite strong intention and the tailoring of tools to users, certain factors external to the training program can still influence the effective use of these tools and the adoption of SDM in practice. CONCLUSIONS A theory-based and user-centered design approach for continuing professional development interventions on SDM with older adults living with neurocognitive disorders and their caregivers appeared useful to identify the most important determinants of learners' intentions to use SDM in their practice, and validate our initial interpretations of learners' assessments during the subsequent evaluation round.
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Affiliation(s)
- Moulikatou Adouni Lawani
- Laval University, Pavillon Ferdinand-Vandry, Room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Yves Turgeon
- CISSS de la Gaspésie – Service externe de gériatrie ambulatoire, 455 rue Mgr Ross Est, Chandler, QC G0C 1K0 Canada
| | - Luc Côté
- Laval University, Pavillon Ferdinand-Vandry, Room 1323, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - France Légaré
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Pavillon Landry-Poulin, Door A-1-2, 4th floor, Room 4578, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Holly O. Witteman
- Laval University, Pavillon Ferdinand-Vandry, Room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Michèle Morin
- Laval University, Pavillon Ferdinand-Vandry, room 4211, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Edeltraut Kroger
- Quebec Excellence Centre in Aging, St-Sacrement Hospital, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
| | - Philippe Voyer
- Pavillon Ferdinand-Vandry, Room 3445, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Charo Rodriguez
- Departmentof Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC H3S 1Z1 Canada
| | - Anik Giguere
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2nd floor, Room 2416, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
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Tremblay MC, Bradette-Laplante M, Witteman HO, Dogba MJ, Breault P, Paquette JS, Careau E, Echaquan S. Providing culturally safe care to Indigenous people living with diabetes: Identifying barriers and enablers from different perspectives. Health Expect 2020; 24:296-306. [PMID: 33350572 PMCID: PMC8077144 DOI: 10.1111/hex.13168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/08/2020] [Accepted: 11/05/2020] [Indexed: 11/28/2022] Open
Abstract
In recent years, cultural safety has been proposed as a transformative approach to health care allowing improved consideration of Indigenous patient needs, expectations, rights and identities. This community‐based participatory study aimed to identify potential barriers and enablers to cultural safety in health care provided to Atikamekw living with diabetes in Québec, Canada. Based on a qualitative descriptive design, the study uses talking circles as a data collection strategy. Three talking circles were conducted with Atikamekw living with diabetes and caregivers, as well as with health professionals of the family medicine teaching clinic providing services to the community. Two team members performed deductive thematic analysis based on key dimensions of cultural safety. Results highlight four categories of barriers and enablers to cultural safety for Atikamekw living with diabetes, related to social determinants of health (including colonialism), health services organization, language and communication, as well as Atikamekw traditional practices and cultural perspectives of health. This study is one of the few that provides concrete suggestions to address key aspects of diabetes care in a culturally respectful way. Our findings indicate that potential enablers of cultural safety reside at different (from individual to structural) levels of change. Solutions in this matter will require strong political will and policy support to ensure intervention sustainability. Patient or public contribution Partners and patients have been involved in identifying the need for this study, framing the research question, developing the data collection tools, recruiting participants and interpreting results.
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Affiliation(s)
- Marie-Claude Tremblay
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Maude Bradette-Laplante
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Holly O Witteman
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Maman Joyce Dogba
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Pascale Breault
- Groupe de Médecine de famille universitaire du Nord de Lanaudière, Joliette, QC, Canada
| | - Jean-Sébastien Paquette
- Département de médecine familiale et médecine d'urgence, Faculté de médecine Université Laval, Québec, QC, Canada.,Groupe de Médecine de famille universitaire du Nord de Lanaudière, Joliette, QC, Canada
| | - Emmanuelle Careau
- Vice-décanat à la responsabilité sociale, Faculté de médecine Université Laval, Québec, QC, Canada
| | - Sandro Echaquan
- Centre Mihawoso, Centre de pédiatrie sociale, Manawan, QC, USA
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McCleary N, Ivers NM, Schwalm JD, Witteman HO, Taljaard M, Desveaux L, Bouck Z, Grace SL, Natarajan MK, Grimshaw JM, Presseau J. Interventions supporting cardiac rehabilitation completion: Process evaluation investigating theory-based mechanisms of action. Health Psychol 2020; 39:1048-1061. [DOI: 10.1037/hea0000958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dubé E, Gagnon D, Kaminsky K, Green CR, Ouakki M, Bettinger JA, Brousseau N, Castillo E, Crowcroft NS, Driedger SM, Greyson D, Fell D, Fisher W, Gagneur A, Guay M, Halperin D, Halperin SA, MacDonald S, Meyer SB, Waite NM, Wilson K, Witteman HO, Yudin M, Cook JL. Vaccination during pregnancy: Canadian maternity care providers' opinions and practices. Hum Vaccin Immunother 2020; 16:2789-2799. [PMID: 32271655 DOI: 10.1080/21645515.2020.1735225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A number of countries have implemented vaccination in pregnancy as a strategy to reduce the burden of influenza and pertussis. The aim of this study was to assess the involvement of Canadian maternity care providers in administration of vaccines to their pregnant patients. A cross-sectional web-based survey was sent to family physicians, obstetricians-gynecologists, midwives, pharmacists, and nurses. A multivariable logistic regression model was used to determine variables independently associated with offering vaccination services in pregnancy in providers' practice. A total of 1,135 participants participated. Overall, 64% (n = 724) of the participants reported offering vaccines in their practice and 56% (n = 632) reported offering vaccines to pregnant patients. The main reasons reported for not offering vaccination services in pregnancy were the belief that vaccination was outside of the scope of practice; logistical issues around access to vaccines; or lack of staff to administer vaccines. In multivariable analysis, the main factors associated with vaccination of pregnant patients in practices where vaccination services were offered were: providers' confidence in counseling pregnant patients about vaccines, seeing fewer than 11 pregnant patients on average each week, and being a nurse or a family physician. Although the majority of participants expressed strong support for vaccination during pregnancy, half were not offering vaccination services in their practice. Many were not equipped to offer vaccines in their practice or felt that it was not their role to do so. To enhance vaccine acceptance and uptake in pregnancy, it will be important to address the logistical barriers identified in this study.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Kyla Kaminsky
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
| | - Courtney R Green
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
| | - Manale Ouakki
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, University of British Columbia , Vancouver, Canada
| | - Nicholas Brousseau
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Eliana Castillo
- Cumming School of Medicine, University of Calgary , Calgary, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, Institute for Clinical Evaluative Sciences and University of Toronto , Toronto, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba , Winnipeg, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, University of British Columbia , Vancouver, Canada
| | - Deshayne Fell
- School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada.,Research Institute, Children's Hospital of Eastern Ontario , Ottawa, Canada
| | - William Fisher
- Department of Psychology, Western University , London, Canada
| | - Arnaud Gagneur
- Département des soins de santé communautaire, Université de Sherbrooke , Sherbrooke, Canada
| | - Maryse Guay
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada.,Centre de recherche de l'hôpital Charles Le Moyne , Longueuil, Canada
| | - Donna Halperin
- School of Nursing, St. Francis Xavier University , Antigonish, Canada
| | - Scott A Halperin
- Department of Pediatrics, Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre , Halifax, Canada
| | - Shannon MacDonald
- Faculty of Nursing, School of Public Health, University of Alberta , Edmonton, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo , Waterloo, Canada
| | - Nancy M Waite
- Department of Pharmacy, University of Waterloo , Waterloo, Canada
| | | | - Holly O Witteman
- Département de médecine familiale et de médecine d'urgence, Université Laval , Québec, Canada
| | - Mark Yudin
- Department of Obstetrics and Gynecology, University of Toronto , Toronto, Canada
| | - Jocelynn L Cook
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
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Hakim H, Bettinger JA, Chambers CT, Driedger SM, Dubé E, Gavaruzzi T, Giguere AMC, Kavanagh É, Leask J, MacDonald SE, Orji R, Parent E, Paquette JS, Roberge J, Sander B, Scherer AM, Tremblay-Breault M, Wilson K, Reinharz D, Witteman HO. A Web Application About Herd Immunity Using Personalized Avatars: Development Study. J Med Internet Res 2020; 22:e20113. [PMID: 33124994 PMCID: PMC7665952 DOI: 10.2196/20113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Herd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated. OBJECTIVE This study aims to design a web application about community immunity and optimize it based on users' cognitive and emotional responses. METHODS Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants' cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization's content and messaging. RESULTS Among 110 participants across all four cycles, 68 (61.8%) were women and 38 (34.5%) were men (4/110, 3.6%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users' emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention. CONCLUSIONS Visualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada, Winnipeg, MB, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy, Padova, Italy
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Éric Kavanagh
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Julie Leask
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia
| | | | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Elizabeth Parent
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | | | - Jacynthe Roberge
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Beate Sander
- University Health Network, Toronto General Hospital, Eaton Building, Toronto, ON, Canada
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa, IA, United States
| | | | - Kumanan Wilson
- Department of Medicine, Bruyere Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
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McCleary N, Desveaux L, Reis C, Linklater S, Witteman HO, Taljaard M, Thavorn K, Grimshaw JM, Ivers NM, Presseau J. A multiple-behaviour investigation of goal prioritisation in physicians receiving audit and feedback to address high-risk prescribing in nursing homes. Implement Sci Commun 2020; 1:33. [PMID: 32885191 PMCID: PMC7427855 DOI: 10.1186/s43058-020-00019-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Background As part of their professional role, healthcare providers enact multiple competing goal-directed behaviours in time-constrained environments. Better understanding healthcare providers’ motivation to engage in the pursuit of particular goals may help inform the development of implementation interventions. We investigated healthcare providers’ pursuit of multiple goals as part of a trial evaluating the effectiveness of an audit and feedback intervention in supporting appropriate adjustment of high-risk medication prescribing by physicians working in nursing homes. Our objectives were to determine whether goal priority and constructs from Social Cognitive Theory (self-efficacy, outcome expectations, and descriptive norms) predicted intention to adjust prescribing of multiple high-risk medications and to investigate how physicians in nursing homes prioritise their goals related to high-risk medication prescribing. Methods Physicians in Ontario, Canada, who signed up for and accessed the audit and feedback report were invited to complete a questionnaire assessing goal priority, self-efficacy, outcome expectations, descriptive norms, and intention in relation to the three targeted behaviours (adjusting prescribing of antipsychotics, benzodiazepines, and antidepressants) and a control behaviour (adjusting statin prescribing). We conducted multiple linear regression analyses to identify predictors of intention. We also conducted semi-structured qualitative interviews to investigate how physicians in nursing homes prioritise their goals in relation to appropriately adjusting prescribing of the medications included in the report: analysis was informed by the framework analysis method. Results Thirty-three of 89 (37%) physicians completed the questionnaire. Goal priority was the only significant predictor of intention for each medication type; the greater a priority it was for physicians to appropriately adjust their prescribing, the stronger was their intention to do so. Across five interviews, physicians reported prioritising adjustment of antipsychotic prescribing specifically. This was influenced by negative media coverage of antipsychotic prescribing in nursing homes, the provincial government’s mandate to address antipsychotic prescribing, and by the deprescribing initiatives or best practice routines in place in their nursing homes. Conclusions Goal priority predicted nursing home physicians’ intention to adjust prescribing. Targeting goal priority through implementation interventions therefore has the potential to influence behaviour via increased motivation. Implementation intervention developers should consider the external factors that may drive physicians’ prioritization.
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Affiliation(s)
- Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Laura Desveaux
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Catherine Reis
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Stefanie Linklater
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada
| | - Holly O Witteman
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,Department of Family and Emergency Medicine, and Office of Education and Continuing Professional Development, Laval University, Québec City, Canada.,Laval University Research Institute for Primary Care and Health Services, Laval University, Québec City, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kednapa Thavorn
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,ICES, Toronto, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, 501 Smyth Road, Room L1202, Box 711, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
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Desveaux L, Saragosa M, Russell K, McCleary N, Presseau J, Witteman HO, Schwalm JD, Ivers NM. How and why a multifaceted intervention to improve adherence post-MI worked for some (and could work better for others): an outcome-driven qualitative process evaluation. BMJ Open 2020; 10:e036750. [PMID: 32883724 PMCID: PMC7473621 DOI: 10.1136/bmjopen-2019-036750] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To explore (1) the extent to which a multicomponent intervention addressed determinants of the desired behaviours (ie, adherence to cardiac rehabilitation (CR) and cardiovascular medications), (2) the associated mechanism(s) of action and (3) how future interventions might be better designed to meet the needs of this patient population. DESIGN A qualitative evaluation embedded within a multicentre randomised trial, involving purposive semistructured interviews. SETTING Nine cardiac centres in Ontario, Canada. PARTICIPANTS Potential participants were stratified according to the trial's primary outcomes of engagement and adherence, resulting in three groups: (1) engaged, adherence outcome positive, (2) engaged, adherence outcome negative and (3) did not engage, adherence outcome negative. Participants who did not engage but had positive adherence outcomes were excluded. Individual domains of the Theoretical Domains Framework were applied as deductive codes and findings were analysed using a framework approach. RESULTS Thirty-one participants were interviewed. Participants who were engaged with positive adherence outcomes attributed their success to the intervention's ability to activate determinants including behavioural regulation and knowledge, which encouraged an increase in self-monitoring behaviour and awareness of available supports, as well as reinforcement and social influences. The behaviour of those with negative adherence outcomes was driven by beliefs about consequences, emotions and identity. As currently designed, the intervention failed to target these determinants for this subset of participants, resulting in partial engagement and poor adherence outcomes. CONCLUSION The intervention facilitated CR adherence through reinforcement, behavioural regulation, the provision of knowledge and social influence. To reach a broader and more diverse population, future iterations of the intervention should target aberrant beliefs about consequences, memory and decision-making and emotion. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registry; NCT02382731.
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Affiliation(s)
- Laura Desveaux
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marianne Saragosa
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Kirstie Russell
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Nicola McCleary
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada
| | - J-D Schwalm
- Translation and Health Systems Research Program, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Noah Michael Ivers
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Bogza LM, Patry-Lebeau C, Farmanova E, Witteman HO, Elliott J, Stolee P, Hudon C, Giguere AMC. User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study. J Med Internet Res 2020; 22:e17406. [PMID: 32442151 PMCID: PMC7468645 DOI: 10.2196/17406] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/07/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023] Open
Abstract
Background Mild cognitive impairment (MCI) is often considered a transitional state between normal and pathologic (eg, dementia) cognitive aging. Although its prognosis varies largely, the diagnosis carries the risk of causing uncertainty and overtreatment of older adults with MCI who may never progress to dementia. Decision aids help people become better informed and more involved in decision making by providing evidence-based information about options and possible outcomes and by assisting them in clarifying their personal values in relation to the decision to be made. Objective This study aimed to incorporate features that best support values clarification and adjust the level of detail of a web-based decision aid for individuals with MCI. Methods We conducted a rapid review to identify options to maintain or improve cognitive functions in individuals with MCI. The evidence was structured into a novel web-based decision aid designed in collaboration with digital specialists and graphic designers. Qualitative and user-centered evaluations were used to draw on users’ knowledge, clarify values, and inform potential adoption in routine clinical practice. We invited clinicians, older adults with MCI, and their caregivers to evaluate the decision aid in 6 consecutive rounds, with new participants in each round. Quantitative data were collected using the Values Clarity and Informed subscales of the Decisional Conflict Scale, the System Usability Scale, the Ottawa Acceptability questionnaire, and a 5-point satisfaction rating scale. We verified their comprehension using a teach-back method and recorded usability issues. We recorded the audio and computer screen during the session. An inductive thematic qualitative analysis approach was used to identify and describe the issues that arose. After each round, an expert panel met to prioritize and find solutions to mitigate the issues. An integrated analysis was conducted to confirm our choices. Results A total of 7 clinicians (social workers, nurses, family physicians, psychologists) and 12 older (≥60 years) community-dwelling individuals with MCI, half of them women, with education levels going from none to university diploma, were recruited and completed testing. The thematic analysis revealed 3 major issues. First, the user should be guided through the decision-making process by tailoring the presentation of options to users’ priorities using the values clarification exercise. Second, its content should be simple, but not simplistic, notably by using information layering, plain language, and pictograms. Third, the interface should be intuitive and user friendly, utilize pop-up windows and information tips, avoid drop-down menus, and limit the need to scroll down. The quantitative assessments corroborated the qualitative findings. Conclusions This project resulted in a promising web-based decision aid that can support decision making for MCI intervention, based on the personal values and preferences of the users. Further ongoing research will allow its implementation to be tested in clinical settings.
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Affiliation(s)
- Laura-Mihaela Bogza
- Laval University Research Centre on Community-Based Primary Health Care, Quebec, QC, Canada.,Quebec Centre for Excellence on Aging, Québec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada
| | - Cassandra Patry-Lebeau
- Quebec Centre for Excellence on Aging, Québec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada
| | - Elina Farmanova
- Quebec Centre for Excellence on Aging, Québec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Holly O Witteman
- Laval University Research Centre on Community-Based Primary Health Care, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Carol Hudon
- School of Psychology, Laval University, Québec, QC, Canada
| | - Anik M C Giguere
- Laval University Research Centre on Community-Based Primary Health Care, Quebec, QC, Canada.,Quebec Centre for Excellence on Aging, Québec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Laval University, Québec, QC, Canada
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Lawani MA, Côté L, Coudert L, Morin M, Witteman HO, Caron D, Kroger E, Voyer P, Rodriguez C, Légaré F, Giguere AMC. Professional training on shared decision making with older adults living with neurocognitive disorders: a mixed-methods implementation study. BMC Med Inform Decis Mak 2020; 20:189. [PMID: 32787829 PMCID: PMC7424655 DOI: 10.1186/s12911-020-01197-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/22/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Shared decision making with older adults living with neurocognitive disorders is challenging for primary healthcare professionals. We studied the implementation of a professional training program featuring an e-learning activity on shared decision making and five Decision Boxes on the care of people with neurocognitive disorders, and measured the program's effects. METHODS In this mixed-methods study, we recruited healthcare professionals in family medicine clinics and homecare settings in the Quebec City area (Canada). The professionals signed up for training as a continuing professional development activity and answered an online survey before and after training to assess their knowledge, and intention to adopt shared decision making. We recorded healthcare professionals' access to each training component, and conducted telephone interviews with a purposeful sample of extreme cases: half had completed training and the other half had not. We performed bivariate analyses with the survey data and a thematic qualitative analysis of the interviews, as per the theory of planned behaviour. RESULTS Of the 47 participating healthcare professionals, 31 (66%) completed at least one training component. Several factors restricted participation, including lack of time, training fragmentation into several components, poor adaptation of training to specific professions, and technical/logistical barriers. Ease of access, ease of use, the usefulness of training content and the availability of training credits fostered participation. Training allowed Healthcare professionals to improve their knowledge about risk communication (p = 0.02), and their awareness of the options (P = 0.011). Professionals' intention to adopt shared decision making was high before training (mean ± SD = 5.88 ± 0.99, scale from 1 to 7, with 7 high) and remained high thereafter (5.94 ± 0.9). CONCLUSIONS The results of this study will allow modifying the training program to improve participation rates and, ultimately, uptake of meaningful shared decision making with patients living with neurocognitive disorders.
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Affiliation(s)
- Moulikatou Adouni Lawani
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Luc Côté
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 1323, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Laetitia Coudert
- Quebec Excellence Centre on Aging, St-Sacrement Hospital, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
| | - Michèle Morin
- Laval University, Pavillon Ferdinand-Vandry, room 4211, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Holly O. Witteman
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2nd floor, Room 2416, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Danielle Caron
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Edeltraut Kroger
- Quebec Excellence Centre on Aging, St-Sacrement Hospital, Office L-2, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
| | - Philippe Voyer
- Pavillon Ferdinand-Vandry, room 3445, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC H3S 1Z1 Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 4th floor, Room 4578, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Anik M. C. Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2nd floor, Room 2416, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
- Quebec Excellence Centre on Aging, St-Sacrement Hospital, Office L-2, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
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Archambault PM, Rivard J, Smith PY, Sinha S, Morin M, LeBlanc A, Couturier Y, Pelletier I, Ghandour EK, Légaré F, Denis JL, Melady D, Paré D, Chouinard J, Kroon C, Huot-Lavoie M, Bert L, Witteman HO, Brousseau AA, Dallaire C, Sirois MJ, Émond M, Fleet R, Chandavong S. Learning Integrated Health System to Mobilize Context-Adapted Knowledge With a Wiki Platform to Improve the Transitions of Frail Seniors From Hospitals and Emergency Departments to the Community (LEARNING WISDOM): Protocol for a Mixed-Methods Implementation Study. JMIR Res Protoc 2020; 9:e17363. [PMID: 32755891 PMCID: PMC7439141 DOI: 10.2196/17363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/17/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Elderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition coaches, to improve the care transition experiences of frail elderly patients. The ACE program reduced the lengths of hospital stay and readmission for elderly patients, increased patient satisfaction, and saved the health care system over Can $4.2 million (US $2.6 million) in 2014. In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA) with a focus on improving transitions between hospitals and the community. The quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a "Wiki-suite" (free web-based database containing evidence-based knowledge tools) to engage multiple stakeholders. OBJECTIVE The objectives of this study are to (1) implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient-, caregiver-, clinical-, and hospital-level outcomes; (2) identify underlying mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly; and (3) identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools. METHODS Objective 1 will involve staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites and interrupted time series to measure the impact on hospital-, patient-, and caregiver-level outcomes. Objectives 2 and 3 will involve a parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation, implementation, and scaling up of geriatric knowledge tools. RESULTS Data collection started in January 2019. As of January 2020, we enrolled 1635 patients and 529 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has not yet begun. Results are expected to be published in 2022. Expected results will be presented to different key internal stakeholders to better support the effort and resources deployed in the transition of seniors. Through key interventions focused on seniors, we are expecting to increase patient satisfaction and quality of care and reduce readmission and ED revisit. CONCLUSIONS This study will provide evidence on effective knowledge translation strategies to adapt best practices to the local context in the transition of care for elderly people. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology in other settings in Canada. TRIAL REGISTRATION ClinicalTrials.gov NCT04093245; https://clinicaltrials.gov/ct2/show/NCT04093245. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17363.
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Affiliation(s)
- Patrick Michel Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Josée Rivard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Pascal Y Smith
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Samir Sinha
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, QC, Canada
- Department of Medicine, University of Toronto, Toronto, QC, Canada
| | - Michèle Morin
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Annie LeBlanc
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
| | - Yves Couturier
- Department of Social Work, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Isabelle Pelletier
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - El Kebir Ghandour
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Institut national d'excellence en sante et en services sociaux, Québec, QC, Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada
| | - Jean-Louis Denis
- Département de gestion, d'évaluation et de politique de santé, École de santé publique, Université de Montréal, Montreal, QC, Canada
| | - Don Melady
- Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Paré
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Josée Chouinard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Chantal Kroon
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, QC, Canada
| | - Maxime Huot-Lavoie
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Laetitia Bert
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Audrey-Anne Brousseau
- Centre intégré universitaire de santé et de services sociaux de l'Estrie - CHUS, Sherbrooke, QC, Canada
| | - Clémence Dallaire
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Marie-Josée Sirois
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre d'excellence sur le vieillissement du Québec, Hôpital du Saint-Sacrement, Québec, QC, Canada
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Marcel Émond
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- CHU de Québec-Université Laval, Québec, QC, Canada
| | - Richard Fleet
- Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Sam Chandavong
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
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Rocque R, Chipenda Dansokho S, Grad R, Witteman HO. What Matters to Patients and Families: A Content and Process Framework for Clarifying Preferences, Concerns, and Values. Med Decis Making 2020; 40:722-734. [PMID: 32696715 DOI: 10.1177/0272989x20940660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Values clarification, or sorting out what matters to a patient or family relevant to a health decision, is a fundamental part of shared decision making. We aimed to describe how values clarification occurs in routine primary care. Methods. Using framework analysis and an established taxonomy, 2 independent researchers analyzed 260 consultations in 5 family medicine clinics across Quebec. Two questions guided our analyses: 1) What categories exist regarding what matters to patients? 2) What patterns exist in discussions of what matters to patients? Results. 1) Five distinct categories of what matters to patients and families were discussed during values clarification: preferences, concerns, treatment-specific values, life goals or philosophies, and broader contextual or sociocultural values. Preferences and concerns were the matters most commonly raised. 2) Diverse patterns of values clarification emerged based on 3 analytical questions: Who initiates the discussion about what matters to patients? When? What information is discussed? The most frequent pattern was clinicians soliciting patients' concerns and preferences during the information-gathering phase. The second most common pattern was similar, except that patients' spontaneously raised what matters to them. Limitations. The study was descriptive and based on audio-recorded visits. We did not interview patients and clinicians to elicit their perspectives. Conclusions. There are 5 distinct categories of what matters to patients and families as well as clear patterns of how values clarification occurs in routine primary care consultations. Clinicians could be sensitive to these categories when engaging in the process of values clarification and may wish to pay particular attention to the opening minutes of a consultation. This study provides a structure for future identification of best practices in values clarification.
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Affiliation(s)
- Rhéa Rocque
- School of Psychology, Laval University, Quebec City, QC, Canada
| | - Selma Chipenda Dansokho
- Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Roland Grad
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Herzl Family Practice Centre, Jewish General Hospital, Montreal, QC, Canada
| | - Holly O Witteman
- Office of Education and Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Research Centre in Sustainable Health (VITAM - Centre de recherche en santé durable), Quebec City, QC, Canada.,Research Center of the Laval University Academic Medical Centre (Centre de recherche du CHU de Québec-Université Laval), Quebec City, QC, Canada
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Tremblay MC, Bradette-Laplante M, Bérubé D, Brière É, Moisan N, Niquay D, Dogba MJ, Légaré F, McComber A, McGavock J, Witteman HO. Engaging indigenous patient partners in patient-oriented research: lessons from a one-year initiative. Res Involv Engagem 2020; 6:44. [PMID: 32760594 PMCID: PMC7376932 DOI: 10.1186/s40900-020-00216-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Patient-oriented research (POR) is a specific application of participatory research that promotes active patient engagement in health research. There is a growing concern that people involved in POR do not reflect the diversity of the population such research aims to serve, but are rather those more 'easily' engaged with institutions, organizations and society. Indigenous peoples are among such groups generally underrepresented in POR. The "Indigenous patient partners platform project" was a small-scale initiative aimed to address the issue of the underrepresentation of Indigenous people in patient-oriented research by recruiting, orienting and supporting Indigenous patient partners in Québec (Canada). This article reports on the findings of an evaluation conducted at the end of the project to garner lessons and identify strategies for engaging Indigenous patient partners in patient-oriented research. METHODS The evaluation of this initiative used a case study design hinging on documentary analysis and committee member interviews. Project documents (n = 29) included agendas and meeting minutes, support documents from the orientation workshop and workshop evaluations, and tools the committee developed as part of the project. Interview participants (n = 6) were patients and organizational partners. Thematic analysis was performed by two members of the research team. Patient partners actively contributed to validating the interpretation of result and knowledge translation. RESULTS Results point to four key components of Indigenous patient partner engagement in POR: initiation of partnership, interest development, capacity building and involvement in research. Specific lessons emphasize the importance of community connections in recruiting, sustaining and motivating patient partners, the need to be flexible in the engagement process, and the importance of consistently valuing patient partner contributions and involvement. CONCLUSIONS There is a need to engage Indigenous patient partners in POR to ensure that healthcare practices, policies and research take their particular needs, stories and culture into account. While results of this evaluation are generally consistent with the existing literature on patient engagement, they offer additional insight into how to effectively engage Indigenous patient partners in research, which might also be relevant to the involvement of other marginalized populations who have been historically and systemically disempowered.
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Affiliation(s)
- Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
- Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Québec City, Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Maude Bradette-Laplante
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Danielle Bérubé
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Élaine Brière
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Nicole Moisan
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Daniel Niquay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
| | - Maman-Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
- Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Québec City, Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
| | - Alex McComber
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, Canada
| | - Jonathan McGavock
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Holly O. Witteman
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec City, Canada
- Office of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Québec City, Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec City, Canada
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Gagnon MP, Ndiaye MA, Larouche A, Chabot G, Chabot C, Buyl R, Fortin JP, Giguère A, Leblanc A, Légaré F, Motulsky A, Sicotte C, Witteman HO, Kavanagh É, Lépinay F, Roberge J, Hakim H, Brunet-Gauthier M, Délétroz C, Rahimi SA, Tchuente J, Sasseville M. User-Centered Design for Promoting Patient Engagement in Chronic Diseases Management: The Development of CONCERTO. Stud Health Technol Inform 2020; 270:1423-1424. [PMID: 32570690 DOI: 10.3233/shti200473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Multimorbidity increases care needs among people with chronic diseases. In order to support communication between patients, their informal caregivers and their healthcare teams, we developed CONCERTO+, a patient portal for chronic disease management in primary care. A user-centered design comprising 3 iterations with patients and informal caregivers was performed. Clinicians were also invited to provide feedback on the feasibility of the solution. Several improvements were brought to CONCERTO+, and it is now ready to be implemented in real-life setting.
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Affiliation(s)
- Marie-Pierre Gagnon
- Centre de Recherche sur les Soins et les Services de Première Ligne, Québec, Canada
- Faculty of Nursing, Université Laval, Québec, Canada
| | - Mame-Awa Ndiaye
- Centre de Recherche sur les Soins et les Services de Première Ligne, Québec, Canada
| | | | | | | | - Ronald Buyl
- Department of Public Health, Vrije Universiteit Brussel, Jette, Belgium
| | - Jean-Paul Fortin
- Centre de Recherche sur les Soins et les Services de Première Ligne, Québec, Canada
| | - Anik Giguère
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Annie Leblanc
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - France Légaré
- Centre de Recherche sur les Soins et les Services de Première Ligne, Québec, Canada
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Aude Motulsky
- School of Public Health, Université de Montréal, Montréal, Canada
| | - Claude Sicotte
- School of Public Health, Université de Montréal, Montréal, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | | | | | | | - Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | | | - Carole Délétroz
- School of Health Sciences (HESAV), HES-SO, Lausanne, Switzerland
| | - Samira A Rahimi
- Department of Health Sciences, Université du Québec à Chicoutimi, Canada
| | - Jack Tchuente
- Centre de Recherche sur les Soins et les Services de Première Ligne, Québec, Canada
| | - Maxime Sasseville
- Centre de Recherche sur les Soins et les Services de Première Ligne, Québec, Canada
- Department of Health Sciences, Université du Québec à Chicoutimi, Canada
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Ivers NM, Schwalm JD, Bouck Z, McCready T, Taljaard M, Grace SL, Cunningham J, Bosiak B, Presseau J, Witteman HO, Suskin N, Wijeysundera HC, Atzema C, Bhatia RS, Natarajan M, Grimshaw JM. Interventions supporting long term adherence and decreasing cardiovascular events after myocardial infarction (ISLAND): pragmatic randomised controlled trial. BMJ 2020; 369:m1731. [PMID: 32522811 PMCID: PMC7284284 DOI: 10.1136/bmj.m1731] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To test a scalable health system intervention to improve long term adherence to secondary prevention treatments among patients who have had a recent myocardial infarction. DESIGN Three arm, pragmatic randomised controlled trial with blinded outcome assessment. SETTING Nine cardiac centres in Ontario, Canada. PARTICIPANTS 2632 patients with obstructive coronary artery disease after a myocardial infarction, identified from a centralised cardiac registry. INTERVENTIONS Participants were randomised 1:1:1 to receive usual care, five mail-outs developed through a user centred design process, or mail-outs plus phone calls. The phone calls were delivered first by an interactive automated system to screen for non-adherence to treatment. Trained lay health workers followed up as necessary. Interventions were coordinated centrally but delivered from each patient's hospital site. MAIN OUTCOME MEASURES Co-primary outcomes were completion of cardiac rehabilitation and adherence to recommended medication. Data were collected by blinded assessors through patient report and from administrative health databases at 12 months. RESULTS 2632 patients (mean age 66, 71% male) were randomised: 878 to the full intervention (mail plus phone calls), 878 to mail only, and 876 to usual care. Of the respondents, 174 (27%) of 643 in the usual care group, 200 (32%) of 628 in the mail only group, and 196 (37%) of 531 allocated to the full intervention completed cardiac rehabilitation (adjusted odds ratio 1.55, 95% confidence interval 1.18 to 2.03). In the mail plus phone group, 11.7%, 6.0%, 14.4%, 32.9%, and 35.0% reported adherence to 0, 1, 2, 3, and 4 drug classes after one year, respectively, in comparison with 12.5%, 6.8%, 13.6%, 30.2%, and 36.8% in the mail only group, and 12.2%, 8.4%, 13.1%, 30.3%, and 36.1% in the usual care group, respectively (mail only v usual care, odds ratio 0.98, 95% confidence interval 0.81 to 1.19; full intervention v usual care, 0.99, 0.82 to 1.20). CONCLUSIONS Scalable interventions delivered by mail plus phone can increase completion of cardiac rehabilitation after myocardial infarction but not adherence to medication. More intensive interventions should be tested to improve adherence to medication and to evaluate the association between attendance at cardiac rehabilitation and adherence to medication. TRIAL REGISTRATION ClinicalTrials.gov NCT02382731, registered 9 March 2015 before any patient enrolment.
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Affiliation(s)
- Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S1B2, Canada
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto ON, Canada
| | - Jon-David Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, and McMaster University, Hamilton, ON, Canada
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Tara McCready
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Population and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jennifer Cunningham
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Beth Bosiak
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Population and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Neville Suskin
- Cardiac Rehabilitation and Secondary Prevention Programme of St Joseph's Health Care London, ON, Canada
- Lawson Health Research Institute, Departments of Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Harindra C Wijeysundera
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Clare Atzema
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madhu Natarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, and McMaster University, Hamilton, ON, Canada
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Population and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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49
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Ndjaboue R, Farhat I, Ferlatte CA, Ngueta G, Guay D, Delorme S, Ivers N, Shah BR, Straus S, Yu C, Witteman HO. Predictive models of diabetes complications: protocol for a scoping review. Syst Rev 2020; 9:137. [PMID: 32513304 PMCID: PMC7282106 DOI: 10.1186/s13643-020-01391-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/18/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes is a highly prevalent chronic disease that places a large burden on individuals and health care systems. Models predicting the risk (also called predictive models) of other conditions often compare people with and without diabetes, which is of little to no relevance for people already living with diabetes (called patients). This review aims to identify and synthesize findings from existing predictive models of physical and mental health diabetes-related conditions. METHODS We will use the scoping review frameworks developed by the Joanna Briggs Institute and Levac and colleagues. We will perform a comprehensive search for studies from Ovid MEDLINE and Embase databases. Studies involving patients with prediabetes and all types of diabetes will be considered, regardless of age and gender. We will limit the search to studies published between 2000 and 2018. There will be no restriction of studies based on country or publication language. Abstracts, full-text screening, and data extraction will be done independently by two individuals. Data abstraction will be conducted using a standard methodology. We will undertake a narrative synthesis of findings while considering the quality of the selected models according to validated and well-recognized tools and reporting standards. DISCUSSION Predictive models are increasingly being recommended for risk assessment in treatment decision-making and clinical guidelines. This scoping review will provide an overview of existing predictive models of diabetes complications and how to apply them. By presenting people at higher risk of specific complications, this overview may help to enhance shared decision-making and preventive strategies concerning diabetes complications. Our anticipated limitation is potentially missing models because we will not search grey literature.
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Affiliation(s)
- Ruth Ndjaboue
- VDepartment of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.
| | - Imen Farhat
- VDepartment of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.,Faculté de Médecine, Université Laval, 1050, Avenue de la médecine, Quebec City, Quebec, G1V A06, Canada
| | - Carol-Ann Ferlatte
- VDepartment of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.,Faculté de Médecine, Université Laval, 1050, Avenue de la médecine, Quebec City, Quebec, G1V A06, Canada
| | - Gérard Ngueta
- Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, 1050, Avenue de la médecine, Quebec City, Quebec, G1V A06, Canada
| | - Daniel Guay
- Diabetes Action Canada, Montreal, Quebec, Canada
| | | | - Noah Ivers
- Family Practice Health Centre, Women's College Hospital, 77 Grenville Street, Toronto, Ontario, M5S 1B3, Canada
| | - Baiju R Shah
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room G106, Toronto, Ontario, M4N 3M5, Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada
| | - Catherine Yu
- Division of Endocrinology & Metabolism, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Holly O Witteman
- VDepartment of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Canada.,Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, 1050, Avenue de la médecine, Quebec City, Quebec, G1V A06, Canada
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50
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Witteman HO, Julien AS, Ndjaboue R, Exe NL, Kahn VC, (Angie) Fagerlin A, Zikmund-Fisher BJ. What Helps People Make Values-Congruent Medical Decisions? Eleven Strategies Tested across 6 Studies. Med Decis Making 2020; 40:266-278. [DOI: 10.1177/0272989x20904955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. High-quality health decisions are often defined as those that are both evidence informed and values congruent. A values-congruent decision aligns with what matters to those most affected by the decision. Values clarification methods are intended to support values-congruent decisions, but their effects on values congruence are rarely evaluated. Methods. We tested 11 strategies, including the 3 most commonly used values clarification methods, across 6 between-subjects online randomized experiments in demographically diverse US populations ( n1 = 1346, n2 = 456, n3 = 840, n4 = 1178, n5 = 841, n6 = 2033) in the same hypothetical decision. Our primary outcome was values congruence. Decisional conflict was a secondary outcome in studies 3 to 6. Results. Two commonly used values clarification methods (pros and cons, rating scales) reduced decisional conflict but did not encourage values-congruent decisions. Strategies using mathematical models to show participants which option aligned with what mattered to them encouraged values-congruent decisions and reduced decisional conflict when assessed. Limitations. A hypothetical decision was necessary for ethical reasons, as we believed some strategies may harm decision quality. Later studies used more outcomes and covariates. Results may not generalize outside US-based adults with online access. We assumed validity and stability of values during the brief experiments. Conclusions. Failing to explicitly support the process of aligning options with values leads to increased proportions of values-incongruent decisions. Methods representing more than half of values clarification methods commonly in use failed to encourage values-congruent decisions. Methods that use models to explicitly show people how options align with their values offer more promise for helping people make decisions aligned with what matters to them. Decisional conflict, while arguably an important outcome in and of itself, is not an appropriate proxy for values congruence.
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Affiliation(s)
| | | | - Ruth Ndjaboue
- Universite Laval Faculte de medecine, Quebec, QC, Canada
| | - Nicole L. Exe
- University of Michigan Medical School, Ann Arbor, MI, USA
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