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Making health care interventions and technologies usable, safe, and effective
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Background: Providing clinical performance data to health professionals, a process known as audit and feedback, can play an important role in health system improvement. However, audit and feedback too...
Background: Providing clinical performance data to health professionals, a process known as audit and feedback, can play an important role in health system improvement. However, audit and feedback tools can only be effective if the targeted health professionals access and actively review their data. Email is a popular channel for communicating with physicians and could be used to encourage engagement with performance data; however, little guidance exists for the development of effective email messages in this context. Objective: To describe the process of developing email content to promote the use of Cancer Care Ontario’s Screening Activity Report (SAR) that incorporates user input and behaviour change techniques (BCTs). The SAR is an online tool with patient-level data that is intended to help Ontario family physicians improve rates of timely and appropriate screening in their practice. Methods: Our interdisciplinary research team first identified BCTs shown to be effective in other settings that could be adapted to promote use of the SAR. We then developed draft BCT-informed email content. Next, we conducted co-creation workshops with physicians who had logged in to the SAR more than once over the past year. Participants provided reactions to researcher-developed BCT-informed content and helped to develop an email that they believed would prompt their colleagues to use the SAR. Content from co-creation workshops was brought to focus groups with physicians who had not used the SAR in the past year. We analyzed notes from co-creation workshops and focus groups to inform decisions about content. Finally, eight emails were created to test BCT-informed content in a 2X2X2 factorial randomized experiment. Results: We identified three key tensions during the development of the email that required us to balance user input with scientific evidence, organizational policies, and our scientific objectives: 1) conflict between user preference and scientific evidence, 2) privacy constraints around personalizing unencrypted emails with performance data, 3) using co-creation methods in a study with the objective of developing an email that featured unique BCT-informed content. Conclusions: Teams tasked with developing content to promote health professional engagement with audit and feedback or other quality improvement tools might consider co-creation processes for developing communications that are informed by both users and BCTs. Teams should be cautious about making decisions solely based on user reactions since what users seem to prefer is not always the same as what works. Furthermore, implementing user recommendations may not always be feasible. Teams may face tensions when using co-creation methods to develop a product with the simultaneous goal of having unique variables to test in later studies. The expected role of users, evidence, and the implementation context all warrant consideration to determine whether and how co-creation methods could help to achieve design and scientific objectives.
The power and outreach of the media is enormous and has re-structured our society today. The author acknowledges the impact, appreciates the outreach. However, we question the relative lack of focus o...
The power and outreach of the media is enormous and has re-structured our society today. The author acknowledges the impact, appreciates the outreach. However, we question the relative lack of focus on physical human interactions and express concern over future training efforts. We compare and attempt to highlight the components of two interaction scenarios- those of teacher-student, and those of physician-patient. The physician-educators need to generate a discussion regarding the value of each interaction. As a teacher, there is value in online classrooms, and a different value to face to face interactions. Similarly, a physician can have major outreach impact by online, tele-medicine and tele-education efforts, but in some instances, may need to have the human, physical interaction with the patient. The value to these interactions depends on the roles in which these interactions are experienced. Medical education training must incorporate an understanding of the unique value of different interactions.