Evidence-based Health Information Research Articles

The McMaster Optimal Aging Portal: Usability Evaluation of a Unique Evidence-Based Health Information Website.

BackgroundIncreasingly, older adults and their informal caregivers are using the Internet to search for health-related information. There is a proliferation of health information online, but the quality of this information varies, often based on exaggerated or dramatic findings, and not easily comprehended by consumers. The McMaster Optimal Aging Portal (Portal) was developed to provide Internet users with high-quality evidence about aging and address some of these current limitations of health information posted online. The Portal includes content for health professionals coming from three best-in-class resources (MacPLUS, Health Evidence, and Health Systems Evidence) and four types of content specifically prepared for the general public (Evidence Summaries, Web Resource Ratings, Blog Posts, and Twitter messages).ObjectiveOur objectives were to share the findings of the usability evaluation of the Portal with particular focus on the content features for the general public and to inform designers of health information websites and online resources for older adults about key usability themes.MethodsData analysis included task performance during usability testing and qualitative content analyses of both the usability sessions and interviews to identify core themes.ResultsA total of 37 participants took part in 33 usability testing sessions and 21 focused interviews. Qualitative analysis revealed common themes regarding the Portal’s strengths and challenges to usability. The strengths of the website were related to credibility, applicability, browsing function, design, and accessibility. The usability challenges included reluctance to register, process of registering, searching, terminology, and technical features.ConclusionsThe study reinforced the importance of including end users during the development of this unique, dynamic, evidence-based health information website. The feedback was applied to iteratively improve website usability. Our findings can be applied by designers of health-related websites.

Unpacking the Black Box: A Formative Research Approach to the Development of Theory-Driven, Evidence-Based, and Culturally Safe Text Messages in Mobile Health Interventions.

BackgroundMobile-cellular subscriptions have increased steadily over the past decade. The accessibility of SMS messages over existing mobile networks is high and has almost universal availability even on older and unsophisticated mobile phones and in geographic settings where wireless coverage is weak. There is intensive exploration of this inexpensive mobile telecommunication technology to improve health services and promote behavior change among vulnerable populations. However, a neglected area of research is the documentation and critical analysis of the formative research process required in the development and refinement of effective SMS messages.ObjectiveThe objective of this qualitative research study was to identify major factors that may impact on the effectiveness of evidence-based SMS messages designed to reduce health inequities in hypertension management in low resource settings, including Aboriginal populations in high-income countries and rural populations in low-income countries. Specifically, we were interested in uncovering the range of mediators that impact on appropriate message content transmission and, ultimately, on health behavior improvements in a range of these sociocultural settings.MethodsCollaborative qualitative research with Canadian Aboriginal and Tanzanian participants was conducted to deconstruct the content and transmission of evidence-based health information contained in SMS messages in the context of an international research project designed to address health inequalities in hypertension, and to develop a grounded theory of the major factors that mediate the effectiveness of this communication. We also examined the interrelationship of these mediators with the three essential conditions of the behavior system of the Behavioral Change Wheel model (capability, opportunity, and motivation) and cultural safety.ResultsFour focus groups with a total of 45 participants were conducted. Our grounded theory research revealed how discrepancies develop between the evidence-based text message created by researchers and the message received by the recipient in mobile health interventions. These discrepancies were primarily generated by six mediators of meaning in SMS messages: (1) negative or non-affirming framing of advocacies, (2) fear- or stress-inducing content, (3) oppressive or authoritarian content, (4) incongruity with cultural and traditional practices, (5) disconnect with the reality of the social determinants of health and the diversity of cultures within a population, and (6) lack of clarity and/or practicality of content. These 6 mediators of meaning provide the basis for sound strategies for message development because they impact directly on the target populations’ capability, opportunity, and motivation for behavior change.ConclusionsThe quality of text messages impacts significantly on the effectiveness of a mobile health intervention. Our research underscores the urgent need for interventions to incorporate and evaluate the quality of SMS messages and to examine the mediators of meaning within each targeted cultural and demographic group. Reporting on this aspect of mobile health intervention research will allow researchers to move away from the current black box of SMS text message development, thus improving the transparency of the process as well as the quality of the outcomes.

Good practice guidelines for health information

Evidence-based health information is distinguished by the provision of an unbiased and trustworthy description of the current state of medical knowledge. It enables people to learn more about health and disease, and to make health-related decisions – on their own or together with others – reflecting their own attitudes and lifestyle. To adequately serve this purpose, health information must fulfill the requirements of being evidence-based.A working group from the German Network for Evidence-based Medicine (Deutsches Netzwerk Evidenzbasierte Medizin) has developed a first draft of good practice guidelines for health information (Gute Praxis Gesundheitsinformation) with the aim of providing support for authors and publishers of evidence-based health information. The group included researchers, patient representatives, journalists and developers of health information. The criteria for evidence-based health information were developed and agreed upon within this author group, and then made available for public comment. All submitted comments were documented and assessed regarding the need to revise or amend the draft. Changes were subsequently implemented following approval by the author group.Gute Praxis Gesundheitsinformation calls for a transparent methodological approach in the development of health information. To achieve this, evidence-based information must be based on (a) a systematic literature search, (b) a justified selection of evidence, (c) unbiased reporting of relevant result, (d) appropriate factual and linguistic communication of uncertainties, (e) either avoidance of any direct recommendations or a strict division between the reporting of results and the derivation of recommendations, (f) the consideration of current evidence on the communication of figures, risks and probabilities, and (g) transparent information about the authors and publishers of the health information, including their funding sources. Gute Praxis Gesundheitsinformation lists a total of 16 aspects to be addressed in methods papers.Gute Praxis Gesundheitsinformation is a tool that puts forward methodological aspects to be considered when developing health information. In order to be transparent, descriptions of the underlying methods and processes need to be published in easily accessible methods papers describing the general procedure.

Gute Praxis Gesundheitsinformation

Evidence-based health information is distinguished by the provision of an unbiased and trustworthy description of the current state of medical knowledge. It enables people to learn more about health and disease, and to make health-related decisions – on their own or together with others – reflecting their attitudes and lifestyle. To adequately serve this purpose, health information must be evidence-based.A working group from the German Network for Evidence-based Medicine (Deutsches Netzwerk Evidenzbasierte Medizin) has developed a first draft of good practice guidelines for health information (Gute Praxis Gesundheitsinformation) with the aim of providing support for authors and publishers of evidence-based health information. The group included researchers, patient representatives, journalists and developers of health information. The criteria for evidence-based health information were developed and agreed upon within this author group, and then made available for public comment. All submitted comments were documented and assessed regarding the need to revise or amend the draft. Changes were subsequently implemented following approval by the author group.Gute Praxis Gesundheitsinformation calls for a transparent methodological approach in the development of health information. To achieve this, evidence-based information must be based on (a) a systematic literature search, (b) a justified selection of evidence, (c) unbiased reporting of relevant results, (d) appropriate factual and linguistic communication of uncertainties, (e) either avoidance of any direct recommendations or a strict division between the reporting of results and the derivation of recommendations, (f) the consideration of current evidence on the communication of figures, risks and probabilities, and (g) transparent information about the authors and publishers of the health information, including their funding sources. Gute Praxis Gesundheitsinformation lists a total of 16 aspects to be addressed in methods papers.Gute Praxis Gesundheitsinformation is a tool that puts forward methodological aspects to be considered when developing health information. In order to be transparent, descriptions of the underlying methods and processes need to be published in easily accessible methods papers describing the general procedure.(For an English version of the complete paper, please, see http://www.dx.doi.org/10.1016/j.zefq.2016.01.004.)

Evidence-based health information and risk competence.

Consumers and patients want to be included in decisions regarding their own health and have an ethically justified claim on informed decisions. Therefore, sound information is required, but health information is often misleading and based on different interests. The risks of disease and the benefits of medical interventions tend to be overestimated, whereas harm is often underestimated. Evidence-based health information has to fulfil certain criteria, for instance, it should be evidence-based, independent, complete, true as well as understandable. The aim of a medical intervention has to be explained. The different therapeutic options including the option not to intervene have to be delineated. The probabilities for success, lack of success and unwanted side effects have to be communicated in a numerical and understandable manner. Patients have the right to reject medical interventions without any sanctions.

Information Therapy: Bridging the information gap between doctors and patients

Lack of understanding of medical terms and healthcare information by patients can lead to adverse health outcomes and decreased satisfaction with the clinician and medical encounter. Moreover, due to advent of information technology, lot of health and medical information is available on World Wide Web. However, the information available is not reliable and trustworthy and cause serious consequences. Therefore, the right information should reach right person at the right time in order to support the patient in making health-related decisions. ‘Information therapy’ (Ix) is an attempt to provide patients with the timely, adequate and evidence-based health information for making informed decision regarding their treatment. The information provided should be relevant, accurate, complete, reliable, easy to understand and practical. Ix is exactly like treatment prescription by a physician but it also includes reference to healthcare information resources to patients following a clinical visit. The patients or the care takers after going through these resources can understand their medical condition and may raise patient satisfaction, leads to better health outcomes and reduce medical errors. Ix is a cost-effective solution that allows the healthcare industry to patient-centered care. It also allows patients to serve themselves, and save doctor’s precious time, which ultimately helps to utilize limited resources in an efficient way, especially in developing countries. Ix is a need of the hour in today’s world, however, scope is limited by the challenges like inadequate literacy level of population, poor IT access to majority rural population, limited resources to develop right information and lack of information specialists and medical librarians in developing countries.South East Asia Journal of Public Health Vol.4(2) 2014: 47-50

Responsibility and accountability for well informed health-care decisions: a global challenge

Despite large investments during past decades in health-care research, evidence synthesis, and clinical practice guidelines, too much research is wasted and too many decisions are still not well informed. Why is this, and what can we do about it? The following four conditions must be met. First, relevant and reliable health-care research must exist and be disseminated. Often research is lacking— eg, there is no substantial research for between 2% and 53% (median 19%) of treatments off ered to patients (summarised in the appendix). At the same time, resources are used on unnecessary research, which does not address the right questions, nor use the right methods or provide suffi cient description of interventions. Research is sometimes also inapplicable because it does not address multimorbidity. Second, decision makers and patients must have access to reliable and relevant evidence synthesis. The over whelming volume of primary clinical research and the temptation to rely on single studies makes systematic reviews and health technology assessments (HTAs) prerequisites for well informed decisions (appendix). Epistemonikos, a database of all systematic reviews, contains more than 58 000 reviews, and although some independent replication of synthesis might be useful there are unnecessary duplications. As many as 11 meta-analyses for statins in the prevention of atrial fi brillation after cardiac surgery including almost the same primary studies have been published, and several HTAs were produced across Europe when human papillomavirus vaccination was introduced. At the same time, reviews addressing important questions are missing, and reviews are misleading because they are not updated when new trials are published. Access to reliable knowledge is often restricted for economic reasons. Third, patients, clinicians, and policy makers must be encouraged to ask for and use evidence synthesis. On average, clinicians have one question for every two patients they see, pursue only half of those questions, and fi nd answers to about 80%. Despite improved availability of online resources, this situation has changed little in the past 20 years. Patients frequently seek health information online. Worldwide, about 4·5% of all internet searches are for health-related information. However, patients’ search and evaluation skills are limited, and relevant and evidence-based health information is often not accessible to patients. Among policy makers, frequently reported barriers to evidence use are scarcity of timely, relevant research and poor access. Fourth, to improve patient outcomes, recommendations and decisions must be put into action and be implemented in policy and practice. Studies of the implementation of evidence-based recommendations indicate large gaps between the care that patients should receive and the care they do receive. Medical practice in Organisation for Economic Co-operation and Development countries varies widely across regions, hospitals, and physicians for almost every disorder. This situation indicates that many patients do not receive optimum care. Production of trustworthy guidelines is not in itself a solution. Health decisions are complex and many eff orts are needed to ensure that they are well informed. Clinicians and patients need to develop attitudes and skills to use evidence synthesis and resources for shared decision making. However, although indiv iduals, patients, and clinicians can address some barriers to well informed decisions, collective action is needed in many, if not most, cases. This statement is particularly true for low-income and middle-income settings where fi nancial barriers restrict people’s access to eff ective health care. Many stakeholders have responsibilities and they are accountable for a range of groups (appendix). Researchers and research organisations are responsible for using systematic reviews to inform their research, only doing research that is relevant, reliable, and needed, engaging stakeholders (including patients and health professionals) in their research, publishing all studies, and contributing to systematic reviews, HTAs, and guidelines production. They are accountable to patients, research participants, research funders, and peers for their use of resources and the quality of their research. Systematic review authors and editors, HTA agencies, and guideline developers are responsible for producing relevant, reliable, transparent, and up-to-date evidence synthesis and recommendations, avoiding unnecessary duplication, making their work accessible to decision makers, and engaging stakeholders. The academic community and journal editors must acknowledge the importance of evidence synthesis and open access. They are accountable to their funders and decision makers who use their products. Health-care professionals and managers are responsible for seeking reliable information and learning suffi cient skills to use evidence-based resources appropriately to provide optimum patient care, and to participate in research and guideline development. They are accountable to their patients, governments, and third party payers (as public representatives) for their use of health-care resources. Lancet 2015; 386: 826–28

“In rape cases we can use this pill”: A multimethods assessment of emergency contraception knowledge, access, and needs on the Thailand − Burma border

ObjectivesTo evaluate availability, service delivery, and barriers to access to emergency contraceptive pills (ECPs) along the Thailand–Burma border. MethodsFrom June 2010 to May 2011 we undertook a multimethods qualitative assessment among cross-border populations, migrants, and refugees. We conducted 46 key informant interviews with representatives from 25 organizations, 18 focus group discussions with migrant adults, migrant adolescents, and healthcare workers, and a service mapping exercise with 22 stakeholders. ResultsWe found low use of ECPs among the target populations. Structural barriers and lack of evidence-based reproductive health protocols, education, and information restrict access to the limited family planning resources available in this region. Misinformation about ECPs was widespread among health workers and organizational policies were often non-evidence based. ConclusionPotential policy and program interventions to improve access to ECPs along the Thailand–Burma border include integrating evidence-based practices into community efforts, expanding training opportunities for health workers, and improving communication and coordination among organizations serving populations on both sides of the border.

Strategy of health information seeking among physicians, medical residents, and students after introducing digital library and information technology in teaching hospitals of Iran.

It is important for physicians, medical students and health care organizations of developing countries to use reliable clinical information in order to deliver the best practice. Therefore, health sector of Iran endeavored to encourage physicians and medical students to integrate research findings into practice since 2005. Several educational interventions in the areas of information technology and databases were performed. Digital library was introduced in the teaching hospitals. The purpose of this study was to investigate whether these interventions increased the use of evidence-based health information resources among physicians, medical residents and students. This descriptive study involved 315 physicians, assistants and medical students in affiliated hospitals of Semnan University of medical sciences in 2013. A total 52.9% of physicians and 79.5% of medical residents and students always used patient data. 81.3% of physicians and 67.1% of medical residents and students reported using their own experiences, 26.5% of physicians and 16.9% of medical residents and students always used databases such as PubMed and MEDLINE for patient care. Our results revealed that in spite of providing educational and technical infrastructures for accomplishment of research utilization in medical education, the study subjects often identified and used what they regarded as reliable and relevant information from sources that do not truly represent the best evidence that is available.

Determination of Perceptions and Attitudes of Healthcare Professionals Regarding Health Information on the Internet

SUMMARY Today individuals can easily access to wide range of information about their health status, disease or treatments by internet. The aim of the study is determination of perceptions and attitudes of healthcare professionals regarding health information on the internet. This descriptive study was conducted in January-March 2013 with 103 healthcare professionals. Data about participants’ demographic features, internet use, opinions and experiences of health information on the internet were analyzed with SPSS 15.0. “Health information on internet positively influences individuals” statement was agreed by 36.3%, “Health information on internet is generally accurate” statement was disagreed by 41.2% of participants. Leading intents of patients ask questions to participants about health information on internet were stated to be “Looking for an opinion about the information” (53.4%), “Looking for a more equipped physician” (34.0%), “Demanding tests to be done” (34.0%). More than half of the participants stated that they refused to do what patients demanded in the light of health information on internet. It is recommended that healthcare providers should give up-to-date and evidence based health information on their official websites in order to feed patients with accurate, understandable and reliable health information. Keywords: Health Information, Healthcare Professional, Internet

Gesundheitsinformationen im Internet: Wer sucht was, wann und wie?

The Institute for Quality and Efficiency in Health Care (IQWiG, Germany) has a statutory mandate to provide patients and their family members as well as the wider public with evidence-based health information (www.informedhealthonline.org). Since 2006 IQWiG has maintained the publicly available website gesundheitsinformation.de. Currently, about 80 million people live in Germany, and the majority of them have internet access. The goal of this project was to evaluate published studies examining health information seeking behaviour (who, when and how) on the internet. A systematic search was conducted in several databases (PubMed, MEDLINE [Ovid)], PsycInfo [Ovid] und CINAHL [Ebsco]) for studies on internet searches for health information. No study type restrictions were imposed. Data were extracted from the relevant studies, and then discussed in the project group and summarised qualitatively. Of the 1,150 abstracts identified, 169 publications were analysed in full. 74 studies were included, most of which were surveys (n=59). The data were extracted from these studies and then summarised qualitatively to obtain an overview of the current state of research in this field. The results suggest that the group most often searching for health-related information on the internet - either on their own behalf or on behalf of others - consists of middle-aged women with a higher level of education and income. The most common reason for initiating a search for health information is a visit to the doctor, and the most common starting point is a search engine. Page layout and user-friendliness are the main criteria for assessing the credibility of websites and the information they provide. Users are more likely to trust information that is consistent with their own experiences and opinions. There is a growing trend of using the internet as a source for health information. It seems that trust in the credibility of a given website or information mostly depends on factors that are hardly related to the quality of content. This may pose a particular challenge for the creation and dissemination of evidence-based health information. Further research is required to examine the needs of the individual groups using internet-based health information.

Leitlinie evidenzbasierte Gesundheitsinformation: Einblick in die Methodik der Entwicklung und Implementierung

The "Guideline for the Development of Evidence-based Patient Information" project is a novelty. The aim of this project is to enhance the quality of health information. The development and implementation process is guided by national and international standards. Involvement of health information developers plays an essential role. This article provides an insight into the guideline's underlying methodology, using graphics as an example. In addition, the results of a qualitative study exploring the competencies of health information developers are presented. These results will guide the implementation of the guideline. We conducted systematic literature searches (until June 2014), critical appraisal and descriptive analyses applying GRADE for two selected guideline questions. Out of 3,287 hits 11 RCTs were included in the analysis. The evidence has been rated to be of low to moderate quality. Additional graphics may have a positive effect on cognitive outcomes. However, the relevance of the results is questionable. For graphics, we found some indication that especially pictograms but also bar graphs have a positive effect on cognitive outcomes and meet patients' preferences. In order to prepare for the implementation of the guideline, we conducted a qualitative study to explore the competencies of health information developers using expert interviews. Four telephone interviews were conducted, audio recorded, transcribed and analysed according to Grounded Theory. Six categories were identified: literature search, development of health information, participation of target groups, continuing education and further training of health information developers, cooperation with different institutions, essential competencies. Levels of competencies regarding the methods of evidence-based medicine and evidence-based health information vary considerably and indicate a need for training. These results have informed the development of a training programme that will support the implementation.

Communicating the benefits and harms of colorectal cancer screening needed for an informed choice: a systematic evaluation of leaflets and booklets.

ObjectiveEvidence-based health information (EBHI) can support informed choice regarding whether or not to attend colorectal cancer (CRC) screening. The present study aimed to assess if German leaflets and booklets appropriately inform consumers on the benefits and harms of CRC screening.MethodsA systematic search for print media on CRC screening was performed via email enquiry and internet search. The identified documents were assessed for the presence and correctness of information on benefits and harms by two reviewers independently using a comprehensive list of criteria.ResultsMany of the 28 leaflets and 13 booklets identified presented unbalanced information on the benefits and harms of CRC screening: one-third did not provide any information on harms. Numeracy information was often lacking. Ten cross-language examples of common misinterpretations or basically false and misleading information were identified.DiscussionMost of the CRC screening leaflets and booklets in Germany do not meet current EBHI standards. After the study, the publishers of the information materials were provided feedback, including a discussion of our findings. The results can be used to revise existing information materials or to develop new materials that provide correct, balanced, quantified, understandable and unbiased information on CRC screening.

Electronic health record (EHR) projects in Canada: participation options for Canadian health librarians

Research question: What are the major issues in the implementation of electronic health record (EHR) systems in Canada and what competencies can Canadian health librarians bring to their participation in these projects? Data sources: Health informatics and library science databases were searched for EHR literature. Grey literature was located at Canada Health Infoway's website, on provincial and federal government websites, and by searching online news websites. Study selection: The data sources were searched for journal articles, reviews, newspaper articles, government publications, interviews, grey literature, dissertations, editorials, and discussions. Data extraction: Data were extracted from the data sources using search strategies and keywords outlined in Appendix A. Due to the scope and focus of this paper, search terms were selected to emphasize a Canadian context; in particular, a British Columbian perspective in regards to EHR implementation. Results: This paper draws on a body of evidence to discuss EHR implementation issues and health librarian involvement in Canada. There is a growing body of research in the American biomedical literature about health librarian participation in EHR implementation but little in the Canadian health literature. Conclusion: This is the first paper of its kind that proposes new roles for Canadian health librarians in EHR implementation. Health librarians’ expertise in organizing and retrieving information makes them ideally suited for providing evidence-based medicine or consumer health information embedded directly in EHRs. Further research is needed to demonstrate the value of health librarians on EHR project teams.

Quality of online information on type 2 diabetes: a cross-sectional study

Evidence-based health information is a prerequisite for patients with type 2 diabetes to engage in self-management and to make informed medical decisions. The Internet is an important source of health information. In the present study, we systematically assessed formal quality, quality of decision support and usability of German and English language websites on type 2 diabetes. The search term 'type 2 diabetes' was entered in the two most popular search engines. Descriptive data on website quality are presented. Additionally, associations between website quality and affiliation (commercial vs. non-commercial), presence of the HON code quality seal and website traffic were explored. Forty-six websites were included. Most websites provided basic information necessary for decision-making, while only one website also provided decision support. Websites with a HON code had significantly better formal quality than websites without HON code. We found a highly significant correlation between usability and website traffic and a significant correlation between formal quality and website traffic. Most websites do not provide sufficient information to support patients in medical decision-making. Our finding that usability and website traffic are tightly associated is consistent with previous research indicating that design is the most important cue for users assessing website credibility.

Printmedien- und Internetangebote mit Informationen zur Darmkrebsfrüherkennung und ihre kriteriengestützte Bewertung aus Expertensicht

In Germany, individuals who have statutory health insurance have free access to colorectal cancer (CRC) screening tests, and can choose between a fecal occult blood test and a screening colonoscopy. Evidence-based health information may support informed choices regarding whether or not to undergo CRC screening. The aim of this study was to assess whether the available German information materials on CRC screening meet evidence-based health information standards. A systematic search was made for print media and websites on CRC screening addressed to German people with average CRC risk (search period for print media August 2010, for websites January-March 2012). The identified information was assessed with a newly developed comprehensive list of criteria. In all, 41 print media, including 28 flyers and 13 brochures, and 36 websites were identified and assessed. These materials reported more often the benefits than the risks of CRC screening, and quantified presentations of benefits and risks were less frequently given. Most of the materials called for participation and did not indicate the option to decide whether or not to attend CRC screening. This bias in favor of screening was increased by fear-provoking or downplayed wording. Most materials included false and misleading information. The requirements for evidence-based patient information were currently not met by most of the leaflets and websites in Germany. Feedback was given to the producers of the leaflets including a discussion of the findings. The results may be used to revise existing leaflets or to develop new health information on CRC screening.

Evidence-based health information from the users' perspective--a qualitative analysis.

BackgroundEvidence-based information is a precondition for informed decision-making and participation in health. There are several recommendations and definitions available on the generation and assessment of so called evidence-based health information for patients and consumers (EBHI). They stress the importance of objectively informing people about benefits and harms and any uncertainties in health-related procedures. There are also studies on the comprehensibility, relevance and user-friendliness of these informational materials. But to date there has been little research on the perceptions and cognitive reactions of users or lay people towards EBHI. The aim of our study is to define the spectrum of consumers’ reaction patterns to written EBHI in order to gain a deeper understanding of their comprehension and assumptions, as well as their informational needs and expectations.MethodsThis study is based on an external user evaluation of EBHI produced by the German Institute for Quality and Efficiency in Health Care (IQWiG), commissioned by the IQWiG. The EBHI were examined within guided group discussions, carried out with lay people. The test readers’ first impressions and their appraisal of the informational content, presentation, structure, comprehensibility and effect were gathered. Then a qualitative text analysis of 25 discussion transcripts involving 94 test readers was performed.ResultsBased on the qualitative text analysis a framework for reaction patterns was developed, comprising eight main categories: (i) interest, (ii) satisfaction, (iii) reassurance and trust, (iv) activation, (v) disinterest, (vi) dissatisfaction and disappointment, (vii) anxiety and worry, (viii) doubt.ConclusionsMany lay people are unfamiliar with core characteristics of this special information type. Two particularly critical issues are the description of insufficient evidence and the attendant absence of clear-cut recommendations. Further research is needed to examine strategies to explain the specific character of EBHI so as to minimize unintended or adverse reaction patterns. The presented framework describes the spectrum of users’ reaction patterns to EBHI. It may support existing best practice models for editing EBHI.

Development of a comprehensive list of criteria for evaluating consumer education materials on colorectal cancer screening

BackgroundAppropriate patient information materials may support the consumer’s decision to attend or not to attend colorectal cancer (CRC) screening tests (fecal occult blood test and screening colonoscopy). The aim of this study was to develop a list of criteria to assess whether written health information materials on CRC screening provide balanced, unbiased, quantified, understandable, and evidence-based health information (EBHI) about CRC and CRC screening.MethodsThe list of criteria was developed based on recommendations and assessment tools for health information in the following steps: (1) Systematic literature search in 13 electronic databases (search period: 2000–2010) and completed by an Internet search (2) Extraction of identified criteria (3) Grouping of criteria into categories and domains (4) Compilation of a manual of adequate answers derived from systematic reviews and S3 guidelines (5) Review by external experts (6) Modification (7) Final discussion with external experts.ResultsThirty-one publications on health information tools and recommendations were identified. The final list of criteria includes a total of 230 single criteria in three generic domains (formal issues, presentation and understandability, and neutrality and balance) and one CRC-specific domain. A multi-dimensional rating approach was used whenever appropriate (e.g., rating for the presence, correctness, presentation and level of evidence of information). Free text input was allowed to ensure the transparency of assessment. The answer manual proved to be essential to the rating process. Quantitative analyses can be made depending on the level and dimensions of criteria.ConclusionsThis comprehensive list of criteria clearly has a wider range of evaluation than previous assessment tools. It is not intended as a final quality assessment tool, but as a first step toward thorough evaluation of specific information materials for their adherence to EBHI requirements. This criteria list may also be used to revise leaflets and to develop evidence-based health information on CRC screening. After adjustment for different procedure-specific criteria, the list of criteria can also be applied to other cancer screening procedures.

Assessment of attitudes towards methadone maintenance treatment between heroin users at a compulsory detoxification centre and methadone maintenance clinic in Ningbo, China

BackgroundIn China, the Compulsory Detoxification Centres are the main response for people who use illegal drugs. Due to high relapse rates among people released from the Compulsory Detoxification Centres, it is likely that they may seek medical help, including Methadone Maintenance Treatment (MMT) services, at some point. Therefore, better understanding of the attitudes and beliefs of people in the Compulsory Detoxification Centres can help to provide more adequate response to opioid dependence.MethodsIn total, 329 detained heroin users and 112 active MMT clients were recruited from a local Compulsory Detoxification Centre and MMT clinic, respectively. The survey contained specific questions relating to attitudes and beliefs regarding MMT.ResultsParticipants at the Compulsory Detoxification Centre and the MMT clinic expressed different opinions, regarding positive and negative attitudes and beliefs towards MMT. In addition, participants from both sites hold certain negative attitudes and beliefs about methadone despite their acknowledgement of the positive effects of MMT. Finally, participants at the Compulsory Detoxification Centre and the MMT clinic reported distinctive treatment preferences, with the former preferring community-based treatment and the latter MMT.ConclusionsDeveloping targeted education about MMT for people at the Compulsory Detoxification Centres could help improve access to accurate and evidence-based health and treatment information. The study may also help providers understand and adjust services needed for target population in the future.

Development of a complex intervention to improve health literacy skills.

BackgroundProviding insight into the developmental processes involved in building interventions is an important way to ensure methodological transparency and inform future research efforts. The objective of this study was to describe the development of a web portal designed to improve health literacy skills among the public.MethodsThe web portal was tailored to address three key barriers to obtaining information, using the conceptual frameworks of shared decision-making and evidence-based practice and based on explicit criteria for selecting the content and form of the intervention.ResultsThe web portal targeted the general public and took the form of structured sets of tools. Content included: an introduction to research methods, help on how to find evidence-based health information efficiently based on the steps of evidence-based practice, an introduction to critical appraisal, information about patient participation rights in decision-making, and a decision aid for consultations.ConclusionsThe web portal was designed in a systematic and transparent way and address key barriers to obtaining and acting upon reliable health information. The web portal provides open access to the tools and can be used independently by health care users, or during consultations with health professionals.