ABSTRACT
BACKGROUND: An ever-increasing number of patients seek health information via the internet. However, there is an overabundance of differing, often low-quality information available, while a lack of health literacy makes it difficult for patients to understand and assess the quality and trustworthiness of the information at hand. The web portal tala-med was thus conceived as an evidence-based, up-to-date, and trustworthy information resource for lower back pain (LBP), which could be used by primary care physicians (PCPs) and patients during and following consultations for LBP. The current evidence demonstrates that patients with LBP could benefit from web portals. However, the use of such portals by patients remains low, thus limiting their effectiveness. Therefore, it is important to explore the factors that promote or hinder the use of web portals and investigate how patients perceive their usability and utility. OBJECTIVE: In this study, we investigated the acceptance, usability, and utility of the web portal tala-med from the patient perspective. METHODS: This qualitative study was based on telephone interviews with patients who had access to the web portal tala-med from their PCP. We used a semistructured interview guide that consisted of questions about the consultation in which patients were introduced to tala-med, in addition to questions regarding patient perceptions, experiences, and utilization of tala-med. The interviews were recorded, transcribed, and analyzed through framework analysis. RESULTS: A total of 32 half-hour interviews were conducted with 16 female and 16 male patients with LBP. We identified 5 themes of interest: the use of tala-med by PCPs during the consultation, the use of tala-med by patients, its usability, added values derived from its use, and the resultant effects of using tala-med. PCPs used tala-med as an additional information resource for their patients and recommended the exercises. The patients appreciated these exercises and were willing to use tala-med at home. We also identified factors that promoted or hindered the use of tala-med by patients. Most patients rated tala-med positively and considered it a clear, comprehensible, trustworthy, and practical resource. In particular, the trustworthiness of tala-med was seen as an advantage over other information resources. The possibilities offered by tala-med to recap and reflect on the contents of consultations in a time-flexible and independent manner was perceived as an added value to the PCP consultation. CONCLUSIONS: Tala-med was well accepted by patients and appeared to be well suited to being used as an add-on to PCP consultations. Patient perception also supports its usability and utility. Tala-med may therefore enrich consultations and assist patients who would otherwise be unable to find good-quality web-based health information on LBP. In addition, our findings support the future development of digital health platforms and their successful use as a supplement to PCP consultations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12875-019-0925-8.
ABSTRACT
BACKGROUND: Evidence-based medicine (EbM) as a teaching subject is increasingly taken into account in the Master Plan 2020. To date, neither theoretical requirements nor practical applications of EbM have been consistently implemented in the clinical curriculum. To fill this gap, a digital and tutor-based EbM course has been developed. The aim is to identify the student characteristics (statistical competence, Need for Cognition (NFC), work and experience patterns (AVEM), diagnostic uncertainty) of the first cohort in order to ensure successful course implementation and to prepare future doctors for their role as mediators of health literacy using EbM methods. METHODS: The long-term study started in the summer term 2019 with 10 medical students during their clinical training. The measurements were conducted before (t0) and after course attendance (t1). Socio-demographic variables were taken at t0, the Quick Risk Test, PRU questionnaire, the NFC scale and the AVEM were collected at t0 and t1. RESULTS: Half of the students started their doctoral thesis before attending the course. The first test results of the Quick Risk Test (t0) were between 50 % and 90 % and at t1 between 60 % and 100 %. The students showed high scores on the NFC scale (X¯=4.6, SD=0.52, Δ X¯ t0 - t1=0.1) and medium scores on the Perfectionism scale (X¯=3.8, SD=0.51, Δ X¯ t0 - t1=0.1), Resignation Tendency (X¯=3.8, SD=1.17, Δ X¯ t0 - t1=0.1) and on the scale Aggressive Problem Solving (X¯=3.9, SD=1.06, Δ X¯ t0 - t1=0.2). They achieved high levels of Anxiety Due to Diagnostic Uncertainty (X¯=4.8, SD=0.69, Δ X¯ t0 - t1=0.4) and on the scale Concern about Poor Outcomes (X¯=3.9, SD=1.54, Δ X¯ t0 - t1=0.6). The scale Restraint in Disclosing Uncertainty to Patients was more pronounced than the scale Restraint in Disclosing Errors to Physicians (X¯=3.5, SD=0.93, Δ X¯ t0 - t1=-0.3 compared to X¯=2.3, SD=1.20, Δ X¯ t0 - t1=0.1). DISCUSSION: Statistical competence improved with course attendance, with only one student being able to correctly answer all items at t1. NFC and AVEM were strongly expressed and were not very sensitive to change in the sample. The greatest changes were observed on the scales of concern about poor results and fear of diagnostic uncertainty, both of which decreased with course participation. CONCLUSION: In the long term, the development of a new measuring instrument to assess EbM competencies instead of the Quick Risk Test is conceivable. The longitudinal design will also enable us to make causal interpretations and to track changes in students' competence feelings, behaviour and attitudes.
