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Seniors with loss of autonomy may face decisions about whether they should stay at home or move elsewhere. Most seniors would prefer to stay home and be independent for as long as possible, but most are unaware of options that would make this possible.
The study aimed to develop and test the acceptability of an interactive website for seniors, their caregivers, and health professionals with short interlinked videos presenting information about options for staying independent at home.
The approach for design and data collection varied, involving a multipronged, user-centered design of the development process, qualitative interviews, and end-user feedback to determine content (ie, needs assessment) in phase I; module development (in English and French) in phase II; and survey to test usability and acceptability with end users in phase III. Phase I participants were a convenience sample of end users, that is, seniors, caregivers, and professionals with expertise in modifiable factors (eg, day centers, home redesign, equipment, community activities, and finances), enabling seniors to stay independent at home for longer in Quebec and Alberta, Canada. Phase II participants were bilingual actors; phase III participants included phase I participants and new participants recruited through snowballing. Qualitative interviews were thematically analyzed in phase II to determine relevant topics for the video-scripts, which were user-checked by interview participants. In phase III, the results of a usability questionnaire were analyzed using descriptive statistics.
In phase I, interviews with 29 stakeholders, including 4 seniors, 3 caregivers, and 22 professionals, showed a need for a one-stop information resource about options for staying independent at home. They raised issues relating to 6 categories: cognitive autonomy, psychological or mental well-being, functional autonomy, social autonomy, financial autonomy, and people involved. A script was developed and evaluated by participants. In phase II, after 4 days in a studio with 15 bilingual actors, 30 videos were made of various experts (eg, family doctor, home care nurse, and social worker) presenting options and guidance for the decision-making process. These were integrated into an interactive website, which included a comments tool for visitors to add information. In phase III (n=21), 8 seniors (7 women, mean age 75 years), 7 caregivers, and 6 professionals evaluated the acceptability of the module and suggested improvements. Clarity of the videos scored 3.6 out of 4, length was considered right by 17 (separate videos) and 13 participants (all videos together), and 18 participants considered the module acceptable. They suggested that information should be tailored more, and that seniors may need someone to help navigate it.
Our interactive website with interlinked videos presenting information about options for staying independent at home was deemed acceptable and potentially helpful by a diverse group of stakeholders.
Most seniors want to live at home and remain independent for as long as possible, a goal reflected in many government policies [
Although there are multiple options for seniors to remain at home [
According to the Ottawa Decision Support Framework, people cannot make preference-based shared decisions without accurate knowledge of the options, an understanding of what is most important to them, and effective support from others [
We used a 3-phase, multiprong, user-centered design [
Because health care in Canada is delivered under provincial and territorial rather than federal health insurance plans, we focused on 2 Canadian provinces: Quebec, a largely French-speaking province in eastern Canada with over 8 million inhabitants including 1.5 million seniors, and Alberta, an English-speaking province in western Canada with over 4 million inhabitants and almost 500,000 seniors. English and French versions of the module were developed simultaneously.
We were guided by a multidisciplinary steering committee of experts in SDM (MG, FL), primary care (FL), rehabilitation (AJ), architecture (NR), intensive care (PA), and a caregiver (LB), who met during each phase of the research and were responsible for data collection and analysis, determining the content of the module, and designing it. Video development, structure, and content were informed by the Interprofessional Shared Decision Making (IP-SDM) model [
We recruited convenience samples of potential end users of the module (seniors, caregivers, and health care professionals) from Quebec and Alberta. Participants were identified using snowballing [
Inspired by other needs assessments [
Interviews were audio-recorded and transcribed verbatim. They were descriptively content coded by a researcher using a deductive approach (coding emerged from the data), and then checked by the research assistants who had conducted the interviews. We listed and then produced an overview of the most important information needs (factors most mentioned) for decision making about housing options, that is, options that could best support staying independent at home, barriers or facilitators, costs, and relevant sources of information. In collaboration with team members, these information needs were organized into 6 categories: cognitive autonomy, psychological or mental well-being, functional autonomy, social autonomy, financial autonomy, and people involved. The categories emerged from the data and were congruent with literature on stated reasons for institutionalization [
We linked information needs to solutions (options) and labeled them according to the IP-SDM model (focusing on identifying the decision and people involved, definition of their role, and providing information about options, including benefits, risks, and consequences) to ensure that they were addressed in the videos [
Interactive videos presented the options that best responded to the decision-making needs identified by end users. In the videos, the 15 stakeholders relate personal anecdotes, but include balanced, evidence-based information [
Although some evidence supports the use of the Internet by seniors [
Participants were seniors, caregivers, and professionals who participated in phase I, and new participants recruited by snowballing and networking of team members. Participants were invited by personal email or by phone, and with an advertisement on the Arthritis Society of Canada website (Joint Health Express). The survey was also available on the interactive website itself (but not mandatory for visitors). A completed questionnaire was considered informed consent. No incentives were offered.
Participants were sent a Web-based questionnaire with instructions to view the interactive website at their own pace and convenience, and then answer 14 questions about its acceptability and usability (
Seniors/caregivers
Introduction
What is your/your loved one’s year of birth?
What is your/your loved one’s living situation?
Do you/your loved one currently receive home care? (If so, which?)
Which resources have you/your loved one added to your home to keep living there?
Which community resources are available to you/your loved one and which do you/your loved one use?
Can you tell me briefly what you think about your/your loved one’s situation and whether you have ever thought about moving or trying to stay as long as possible at home, and how?
(For caregivers only) What is your relationship with the senior?
Can you tell me about the extent to which you are involved in the care of your loved one, and decision making about social and medical decisions?
Main
As you/your loved one have grown older, what are the important factors to keep mobile (independent) in your/your loved one’s home and your community? (ie, who/what helps you stay mobile/independent?)
What do you think are the most important issues associated with staying independent at home (issues that should be addressed in our videos)?
Do you know anything about your options, and the cost of each, in terms of staying at home or moving? Where did you/your loved one get information about these things?
Did anybody ever bring up the question whether or not to stay at home or move with you/your loved one?
Professionals
Introduction
What is your profession?
Home or acute care?
What is the percentage of older people in your clientele?
How many years have you worked in this profession?
Can you give me a short example of what the job is about (something you would tell a senior when they come to see you and do not know what you do)?
Main
From your (professional) point of view, what factors or issues are important when considering mobility/independence in the home or community for older adults?
What options are most often available for seniors for remaining mobile and independent at home, from your (professional) point of view?
What do you think are the most important issues (issues that should be addressed in our videos)?
Can you give an estimate of costs of the options that you mentioned?
How do people get reimbursed for this?
Please rate each section of the module by circling one of the following to show what you think about the clarity of the information: 4—Everything clear, 3—Most things clear, 2—Some things unclear, and 1—Many things unclear.
The length of each separate video was: Too short/Just right/Too long.
The total time needed to watch all the videos was: Too short/Just right/Too long.
The amount of information was: Too little /Just right /Too much.
I found the presentation: Slanted toward staying at home/Balanced/Slanted toward moving elsewhere.
Do you think the module would be helpful for people making this decision? Yes/No
Do you think the module would be acceptable to use with people making this decision? Yes/No
Did the full module (including the videos) meet your expectations?
Would you like to use (or keep using) the module?
What did you like about the module?
What did you dislike about the module? (concerns)
At what point would it be useful for seniors to see this module? When they are still able to function at home without help/When they are beginning to lose autonomy /When they can no longer function on their own at home/Other, please specify.
All questions were posted on the same page, and answers could be reviewed and changed until submission of the questionnaire. One reminder was sent after 4 weeks.
We performed a descriptive analysis of the data, and calculated mean, median, and range when relevant. Summary statistics were performed using Microsoft Excel.
Between March 20 and September 28, 2015, we interviewed 29 stakeholders: 15 in Alberta and 14 in Quebec. Participants included 4 seniors, 3 caregivers, and 22 health care and other professionals (see
Respondents mentioned the need for seniors to think about future housing options before there is cognitive decline or an emergency (eg, a fall). Seniors also should be encouraged to consider their changing needs over time to avoid having to frequently reevaluate them. This way, when the time comes to relocate, they may avoid long waiting lists for assisted living facilities and adjust more easily to the new environment. At the same time, seniors may be well aware of risks, and what to do about them should be in their hands.
Depression among seniors was frequently mentioned. It may be associated with isolation, as well as with the general effects of aging and loss of autonomy. Depression medication is associated with reduced mobility and risk of falls, whereas social or exercise programs (eg, walking or gardening) may improve both mental and physical health. It was mentioned that all who are involved in decision making should encourage seniors to participate in activities that they enjoy. Participants also mentioned the importance of seniors being happy and feeling safe where they are, but that they must accept that their needs are changing before they decide to make adjustments (eg, use a walker). Having a positive attitude toward the options for staying at home and being involved in the decisions about them were considered important decisional needs. Attitudes often change once people have tried the equipment and seen the benefits for themselves.
Functional autonomy encompasses physical ability (muscle mass, strength, and balance), the environment, and prevention and support. If seniors are less able to perform certain tasks or activities, instead of doing the task for them, it is important to teach them a new way to perform the task themselves. Autonomy also depends on their home environment. Environmental barriers indoors (furniture, carpets, clutter, and distance to the toilet in case of incontinence) and outdoors (curbs and stairs) should be assessed in terms of safety. In suggesting equipment such as walkers or grab bars, it is important to discuss with seniors what is important for them and what limits them from being active. Specialized architects and occupational therapists can suggest how to redesign the living environment, such as moving the bedroom and toilet downstairs. Urban planners, who are more concerned with the external environment, pay attention to curbs and other walkability features of cities and public spaces. However, it should be recognized that whatever adaptations one makes to the home and environment, choosing to stay independent at home may one day no longer be realistic, safe, or affordable.
Sociodemographic characteristics of participants in phase I (N=29).
| Characteristics | Quebec | Alberta | Total | ||
| 2 | 2 | 4 | |||
| Age, range | 87-88 | 82-84 | 82-88 | ||
| Sex (female), n (%) | 1 (50) | 1 (50) | 2 (50) | ||
| Married | 2 | 1 | 2 | ||
| Widowed | - | 1 | 1 | ||
| House or suburban or urban area | 2 | 1 | 2 | ||
| Apartment style condo or urban | - | 1 | 1 | ||
| 1 | 2 | 3 | |||
| Mean age, range | 67 (N/A)a | 69 (56-82) | 68.3 (56-82) | ||
| Sex (female), n (%) | 1 (100) | 2 (100) | 3 (100) | ||
| Spouse | - | 1 | 1 | ||
| Child | 1 | 1 | 2 | ||
| House with senior or urban | 1 | 1 | 2 | ||
| Bungalow with senior or urban | - | 1 | 1 | ||
| 11 | 11 | 22 | |||
| Dietitian | 1 | 1 | 2 | ||
| Physiotherapist | 2 | 2 | 4 | ||
| Occupational therapist | 2 | 1 | 3 | ||
| Social worker | 1 | 1 | 2 | ||
| Family physician | 1 | - | 1 | ||
| Transition nurse in geriatrics | 1 | - | 1 | ||
| Geriatrician | 1 | 1 | 2 | ||
| Architect | 1 | 1 | 2 | ||
| Human resources consultant (community activities) | 1 | - | 1 | ||
| Pharmacist | - | 1 | 1 | ||
| Recreational therapist | - | 1 | 1 | ||
| Nurse or case manager in homecare | - | 1 | 1 | ||
| Coordinator at community organization that helps the elderly | - | 1 | 1 | ||
| Sex (female), n (%) | 10 (91) | 10 (91) | 20 (91) | ||
| Years of experience, range | 15.2 (5-33) | 16 (5-31) | 15.6 (5-33) | ||
| Percentage of elderly clients, range | 82.3 (40-100) | 77 (30-100) | 79.5 (30-100) | ||
aN/A: not applicable.
It is also important to assess people’s mode of transportation to access services in the community. People who drive their own cars are often more active, but at some point, this may no longer be safe. Many special seniors’ transport options exist such as buses for people with disabilities, taxis, as well as special seniors’ services that offer drivers to accompany seniors to their medical appointments.
When people age, their contemporaries start to die, leaving some people feeling isolated. Being socially active was mentioned several times. Although not everyone minds being alone, many benefit from having company and participating in activities with others. Social participation and having a social network are safer (somebody to call for help) and can be an information source about options. Many seniors are reluctant to ask for help, which means admitting to themselves and others that they are no longer autonomous. This reluctance can also make caring for them more difficult.
To receive the help they need at home, seniors in many jurisdictions have to be willing and able to pay for services. Although some services are provided or reimbursed through government programs or tax credits, other services require direct payment from the senior. To be reimbursed, the senior must have the mental agility and patience to fill out difficult forms or have somebody to help him or her. With the Internet, it is increasingly possible to order and pay for things online and have them delivered (groceries, medication, or clothes) to the home, but many seniors are not able to do this, whether from lack of a computer, knowledge, or confidence.
Seniors, caregivers, and health professionals need to understand each other’s limits and communicate about their difficulties. As informal caregivers are often key to keeping seniors independent at home, they should be kept informed of everything regarding the senior’s health care needs and options that help them stay at home. Without a single care coordinator, it is often the informal caregiver who manages the patient’s
On the basis of the factors identified in phase I, we developed scripts for 15 stakeholders in decisions about seniors’ housing options: a decision coach, a senior, 3 types of caregivers (son, daughter, or spouse), a caregiver representative, a home support worker, a family doctor, a home care nurse, a nutritionist, a social worker, a pharmacist, a physiotherapist, an architect, and an occupational therapist. The decision coach explained how a decision should be made and introduced the rest of the videos, and the architect added information about community, the built environment, and home adaptation. We kept the scripts as general as possible so that the information would not quickly become outdated and that it could be used in several contexts. Information that frequently changes, such as costs and resources, was presented on the resource page.
In total, 4 stakeholders commented on the script (caregiver, pharmacist, architect, and physiotherapist). Overall, they were positive about it. On the basis of their expert opinion, we made some editorial changes to the script and the list of resources, and a senior (female, 85 years old, living independently at home with her daughter) evaluated the final scripts. She was positive about them and the initiative as a whole, and she thought the information was complete and relevant.
The final product is an interactive website with video links and additional text-based resources for seniors, caregivers, and professionals, called
Visitors select English or French, and then choose whether to see the videos, consult the resources, or comment on or add to the resource page.
A team of 15 members sitting around a table shows visitors the range of stakeholders involved in making decisions with seniors who wish to stay independent at home (
The resource page provides with background information on options for staying independent at home (eg, local resources, equipment, and links to informative websites). Visitors can add comments or additional information about local services. A webmaster evaluates them and controls publication.
Quotes illustrating the main categories from phase I.
| Theme | Quotes | ||
| Cognitive autonomy | |||
| Depression |
|||
| Attitude |
|||
| Physical functioning | … |
||
| Environment | |||
| Transport | |||
| Social autonomy | |||
| People involved | |||
Overview of the categories and factors mentioned in the interviews (phase I).
| Category, factor (code), and examples (subcodes) | Solutions | Barriers to implementation | ||
| Estimate risks, being self-critical | Avoid risks | Attachment to belongings | ||
| Incompetent | Power of attorney, personal directive | Needs to be put in place before cognitive decline | ||
| Competent: making decisions yourself makes adapting easier | Incorporate everyone’s values and preferences | |||
| Remember to eat, take meds, and turn off oven | Caregiver, calendar, box for pills, and microwave instead of oven | Isolation, confusion | ||
| Thinking ahead | People do not know what their needs will be in 5-10 years | |||
| Happy at home | Stay at home | Functional incapacity, isolation | ||
| Stays in because is afraid to walk outside | Motivation, support people | Attitude—not willing to use aids or ask for help | ||
| Due to isolation, general effects of aging, loss of autonomy | Medication, exercise programs, and caregiver | Medication can affect mobility; lack of awareness about benefits of participation for mental and physical health | ||
| Medication | Community and social care services, check with pharmacist | Medication interactions with comorbidity | ||
| Hygiene | Grab bars in bathroom, care services offered by public health care system | Adaptability of homes, attitude of seniors | ||
| Food preparation and access (quantity and quality) | Meal services, vitamin D supplements and calcium | Attitude—willingness or ability to cook |
||
| Good muscle mass, cardiorespiratory | Exercise program, services at home | Lack of motivation, accessible programs, awareness, education, or confidence; fear of falling; focus on disability, pain versus on ability | ||
| Design of the environment | Remove architectural barriers (internal: furniture, carpets; external: sidewalks, stairs) | Attitude: do not want change, want to design own house |
||
| Transport | Bus or taxi for seniors or caregiver transport | Access to information, costs | ||
| Mobility | Walkers, canes | Attitude: “those are for old people,” giving up dignity and independence | ||
| Pay attention to environment | Height of curb, height and number of stairs, and rugs | Awareness of need to change habits (people already use the walls and counters for balance or support), muscles that have not been used for a long time, current habits not safe | ||
| Of falls, eating problems | Programs, equipment, awareness; learning new things that they can still do themselves instead of taking it out of their hands | |||
| Hobbies, activities | Day centers, friends | People have habits and do not like to change. Try to find intrinsic motivation, but decision is up to them | ||
| Friends, family, neighbors | Social worker or caregiver | Not everybody wants to meet other people and do things together | ||
| Emergency system, lifeline | Bracelet, call someone | Attitude: children are too busy | ||
| Pension, reimbursement, subsidies | Financial support, tax benefits, and health insurance | Income: not enough to pay for services |
||
| Caregiver and health care professionals understand each other’s limits, communicate | Do not get on with social worker | |||
| Decrease the burden | Respite care |
Access to information, capacity to advocate, family member differences regarding how they view the senior | ||
A total of 21 people completed the acceptability survey: 8 seniors, 7 caregivers, and 6 professionals. Respondents were mostly female (15/21). Mean age of seniors was 76 years (range 66-91), whereas the mean age of caregivers was 69 years (range 36-70;
With a mean overall rating of 3.6 out of 4, participants thought the videos were very clear (
Most participants were positive about the length of each video (17/21; 81%) and the amount of information (17/21; 81%), but fewer people liked the length of the videos altogether (13/21; 62%). Some thought the module was too long (n=7) or had too much information (n=2), whereas others wanted more information (n=2). Others indicated that the module could be better tailored to specific characteristics of the senior (n=4).
Acceptability test results for seniors, caregivers, and professionals (N=21).
| Acceptability test question | Seniors (n=8) | Caregivers (n=7) | Professionals (n=6) | Total group (N=21) | ||
| Video: decision coach | 3.7 | 3.8 | 3.5 | 3.7 | ||
| Video: senior 1 | 3.9 | 4 | 3.7 | 3.8 | ||
| Video: caregiver 1 | 3.4 | 3.8 | 3.7 | 3.6 | ||
| Video: caregiver 2 | 3.5 | 3.8 | 3.7 | 3.6 | ||
| Video: caregiver 3 | 3.9 | 3.8 | 3.7 | 3.7 | ||
| Video: caregiver representative | 3.3 | 3.7 | 3.7 | 3.5 | ||
| Video: home support worker | 3.6 | 3.8 | 3.7 | 3.7 | ||
| Video: family physician | 4 | 3.8 | 3.3 | 3.7 | ||
| Video: nurse in homecare | 3.7 | 3.8 | 3.3 | 3.6 | ||
| Video: dietitian | 3.8 | 4 | 3.7 | 3.8 | ||
| Video: social worker | 3.8 | 3.7 | 3.2 | 3.5 | ||
| Video: pharmacist | 3.7 | 4 | 3.7 | 3.7 | ||
| Video: physiotherapist | 3.9 | 4 | 3.7 | 3.8 | ||
| Video: architect | 3.6 | 4 | 2.8 | 3.4 | ||
| Video: occupational therapist | 3.6 | 4 | 3.2 | 3.6 | ||
| Too short | - | - | 1 (17) | 1 (5) | ||
| Just right | 7 (78) | 5 (83) | 5 (83) | 17 (81) | ||
| Too long | 2 (22) | 1b (17) | - | 3 (14) | ||
| Too short | - | - | 1 (17) | 1 (5) | ||
| Just right | 4 (44) | 5 (83) | 4 (67) | 13 (62) | ||
| Too long | 5 (56) | 12 (17) | 1(17) | 7 (33) | ||
| Not enough | 1 (11) | - | 1(17) | 2 (9) | ||
| Just right | 7 (78) | 5 (83) | 5 (83) | 17 (81) | ||
| Too much | 1 (11) | 1b (17) | - | 2 (9) | ||
| Presentation was balanced, yes | 6 (67) | 5 (83) | 6 (100) | 17 (81) | ||
| Helpful? yes | 6 (67) | 5 (83) | 5 (83) | 16 (77) | ||
| Acceptable to use for people in this situation? yes | 8 (89) | 5 (83) | 5 (83) | 18 (86) | ||
| Did module meet your expectations? yes | 6 (67) | 5 (83) | 5 (83) | 16 (77) | ||
| Would you like to use/keep using the module? yes | 3 (34) | 3 (50) | 6 (100) | 12 (58) | ||
| When they start losing their autonomy | 3 (34) | 2 (33) | 3 (50) | 8 (38) | ||
| When they are still able to function at home without help | 6 (66) | 4 (67) | 3 (50) | 13 (62) | ||
a4—Everything clear; 3—most things clear; 2—some things unclear; 1—many things unclear.
bOne caregiver did not watch any videos, and rated all as
Most respondents thought the module was helpful (16/21; 77%). In total, 4 people did not agree because of navigation difficulties (1 senior), inadequate detail, 1 professional), lack of specificity or tailoring (1 senior), or design (1 caregiver). Of the participants, 1 senior was not prepared to accept her need to make any adaptations, so the information was of no interest to her.
Most respondents thought the module was acceptable (18/21; 86%), but 3 people did not because of a lack of information (1 professional), too idealistic presentation of options (1 caregiver), and navigation difficulties (1 caregiver). All professionals were eager to start using the module with their clients when finalized (6/6; 100%), as were most caregivers (3/7; 43%). Seniors were less willing to continue using the module (5/8; 66%) because of navigation difficulties or because it needed changes (n=2), or their preference for information face-to-face or in a brochure (n=2). A senior said she would return to the module when it becomes more relevant to her situation.
Participants liked the interprofessional character of the module, the diversity of information, the concrete and practical examples, and the information about available services. They also liked the positive tone (focus on what can be done instead of what cannot).
The concern most often mentioned by seniors was its overall length. A senior and a caregiver mentioned that it did not portray the reality (eg, long wait times or services that are not available). A caregiver was negative about the whole module, saying he did not like watching videos. Some professionals wanted more details on the role of health professionals (eg, health evaluations by nurses). Others mentioned the challenge of using the module with people with dementia.
Using a 3-phase, user-centered design, we developed and tested the acceptability of an interactive Web-based module for seniors, their caregivers, and health professionals with videos presenting information about options for staying independent at home. A needs assessment (phase I) uncovered numerous decisional needs, including the need to start thinking about this decision early on, safety issues inside and outside the home, and the importance of social supports and psychological or mental well-being. In the production phase (phase II), we developed scripts that addressed these decisional needs, which were positively evaluated by end users and used to create 15 bilingual videos. These were integrated into an interactive Web-based module. In usability testing (phase III), this was found to be clear, comprehensible, and providing enough information, but users found that it took too long to watch all of the videos and that seniors might need assistance navigating the module. In total, 3 concluding reflections were derived from these findings.
First, research has shown that good levels of knowledge about services and support, as well as good housing, are associated with the likelihood of continuing to live in the community [
Second, staying active and being socially engaged were mentioned to be linked with staying healthy in both the needs assessment and the acceptability test. The concept of positive health refers to the capacity to live autonomously with physical, emotional, and social challenges [
Third, the module emphasizes the importance of involving seniors
Although people were initially enthusiastic about participating in several developmental rounds, the decreasing response per round indicated that more was needed to successfully create ownership and that participants were losing interest because of the lengthy process.
Data collection and identification of local resources took place in Quebec and Alberta only. Thus, although the videos are bilingual, generic, and in principle applicable to any context, local options are currently available only for Quebec and Alberta. Future studies could adapt the module to other Canadian contexts. Finally, the modest number of participants in this project was adequate for a user-centered development process, but future phases of this project should use different study designs (eg, pre-post or randomized trial designs) and larger samples of participants to achieve generalizable results, for example, with regard to the effectiveness of the module or its implementation.
We adopted a user-centered design to develop a Web-based decision support module for seniors, caregivers, and health professionals that incorporates discipline-specific information about options for staying independent at home. The module was deemed acceptable and potentially helpful.
Seniors are often anxious and fearful when the first signs of loss of autonomy appear, and confused about what they can do about it. These are first steps toward providing them with the information they and their caregivers need to make decisions about how to stay independent at home. We plan to adapt the module to better target the most important user (the senior), and to continue its development and evaluation, as well as develop implementation strategies. In the meantime, the module is available on the Web as the information on the module is already of use for many seniors.
Screenshot of stakeholders whose videos can be chosen using mouse scroll-over.
Screenshot of a stakeholder (architect).
Interprofessional Shared Decision Making
shared decision making
The authors would like to thank all participants for their input in developing this module. The authors are also grateful to Cheryl Koehn, president of Arthritis Consumer Experts, for promoting the acceptability test among the members.
None declared.