Patient and caregiver perceptions of Chiari malformation: a qualitative analysis of online discussion boards

OBJECTIVE

Patients and their caregivers utilize online discussion board forums as a means to seek and exchange information about their or a loved one's condition. It is important for providers to be aware of such concerns and experiences. The goal of this study was to identify the primary concerns expressed on these discussion boards regarding Chiari malformation type I (CM) and to help guide clinicians in understanding patient challenges in the treatment of CM.

METHODS

The authors performed thematic analysis of anonymous online discussion board posts as identified through internet search engines. They then adopted a previously developed grounded theory method that utilizes a three-tiered coding and grouping process of posts based on commonly discovered content themes.

RESULTS

Analysis of 400 discussion board posts identified four distinct themes raised by CM patients and their caregivers: the path to diagnosis, symptoms experienced, surgical intervention, and high emotional burden. Although each individual experience was unique, the path toward a CM diagnosis was expressed as a journey involving multiple physicians, alternative diagnoses, and feelings of dismissal from providers. The most common reported symptoms included dizziness, headaches, neck and back pain, sensory issues, weakness and paresthesias of the extremities, speech issues, and general fatigue. Additionally, there was an overall sense of uncertainty from patients seeking advice regarding surgical intervention, with users expressing diverse sentiments that included both positive and negative outcomes regarding surgical treatment. Lastly, a wide range of emotions was expressed related to a CM diagnosis, including concern, worry, anxiety, depression, stress, fear, and frustration.

CONCLUSIONS

CM is a frequent imaging diagnosis identified in patients presenting with a wide range of symptoms, and as a result this leads to a diverse set of patient experiences. Analysis of CM patient and caregiver discussion boards revealed key themes that clinicians may address when counseling for CM.

Learning how to learn: can embedded discussion boards help first-year students discover new learning strategies?

Learning anatomy and physiology at university can be challenging, as students need to understand both the language of the discipline and complex topics, such as system integration. Yet learning strategies are rarely taught at university, making it difficult for students to adopt new strategies, if their approach to learning has not been effective or efficient. This study evaluated the use of small-group peer discussion boards as an avenue for sharing learning strategies between students in a first-year anatomy and physiology course. The majority of students (91%) identified strategies from the discussion board worth trying before they completed the midsemester exam. The most frequently reported type of strategy was transforming records. By the end of semester, 76% of students had adopted at least one new strategy; however, these students performed significantly worse on the exam compared with students who did not adopt new strategies. The students who adopted new strategies learned about them from peers (33%), the discussion board (32%), or through self-discovery (32%). The majority of students (83%) found the discussion boards to be useful as a source of new learning strategies and for insight into how others learn. Although the discussion boards provided an avenue for students to learn about new strategies from each other, further guidance from instructors may be required to help students evaluate the effectiveness of these learning strategies.

Analysis of online discussion boards for male infertility

We aimed to identify what information patients and partners are seeking on male infertility forums. Online discussion boards were identified. Posts were analysed in three steps: open coding, axial coding and selective coding, to determine common themes. A total of 1,118 posts were analysed. The majority of posts (20.2%) were related to "Questions about male fertility diagnosis and testing", with 47.8% asking for assistance interpreting semen analysis results. About 15.7% of posts were about "Feelings associated with male infertility", with 26.7% expressing anger or frustration, 26.1% encouraging hope, 21% seeking hope and 12.5% expressing fear. About 15.4% of posts were about "Lifestyle factors to improve male fertility", 24.4% of which were about vitamins and 6.4% about intercourse timing. About 15.4% of posts were about "Male infertility conditions", with 43% about semen parameters. Other themes included "Questions about male factor treatments", "Questions about assisted reproductive technologies (ART)", "Relationship issues", "Asking for advice", "Financial concerns" and "Information sharing". About 63.6% of posts were written by female partners [t(1,117) = 9.451, p < .001]. The most common posts posed questions about male fertility diagnosis and testing. Users discussed feelings involved in infertility, and counselling should be integrated. About 63.6% of posts were by partners, highlighting the importance of partners having access to infertility information.