Emergency medicine residents' beliefs about contributing to an online collaborative slideshow.

OBJECTIVE: Collaborative writing applications (CWAs), such as the Google DocsTM platform, can improve skill acquisition, knowledge retention, and collaboration in medical education. Using CWAs to support the training of residents offers many advantages, but stimulating them to contribute remains challenging. The purpose of this study was to identify emergency medicine (EM) residents' beliefs about their intention to contribute summaries of landmark articles to a Google DocsTM slideshow while studying for their Royal College of Physicians and Surgeons of Canada (RCPSC) certification exam. METHOD: Using the Theory of Planned Behavior, the authors interviewed graduating RCPSC EM residents about contributing to a slideshow. Residents were asked about behavioral beliefs (advantages/disadvantages), normative beliefs (positive/negative referents), and control beliefs (barriers/facilitators). Two reviewers independently performed qualitative content analysis of interview transcripts to identify salient beliefs in relation to the defined behaviors. RESULTS: Of 150 eligible EM residents, 25 participated. The main reported advantage of contributing to the online slideshow was learning consolidation (n=15); the main reported disadvantage was information overload (n=3). The most frequently reported favorable referents were graduating EM residents writing the certification exam (n=16). Few participants (n=3) perceived any negative referents. The most frequently reported facilitator was peer-reviewed high-quality scientific information (n=9); and the most frequently reported barrier was time constraints (n=22). CONCLUSION: Salient beliefs exist regarding EM residents' intention to contribute content to an online collaborative writing project using a Google DocsTM slideshow. Overall, participants perceived more advantages than disadvantages to contributing and believed that this initiative would receive wide support. However, participants reported several barriers that need to be addressed to increase contributions. Our intention is for the beliefs identified in this study to contribute to the design of a theory-based questionnaire to explore determinants of residents' intentions to contribute to an online collaborative writing project. This will help develop implementation strategies for increasing contributions to other CWAs in medical education.

Wikis and collaborative writing applications in health care: a scoping review.

BACKGROUND: Collaborative writing applications (eg, wikis and Google Documents) hold the potential to improve the use of evidence in both public health and health care. The rapid rise in their use has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use. OBJECTIVE: Through the Levac six-stage methodology, a scoping review was undertaken to explore the depth and breadth of evidence about the effective, safe, and ethical use of wikis and collaborative writing applications (CWAs) in health care. METHODS: Multiple strategies were used to locate studies. Seven scientific databases and 6 grey literature sources were queried for articles on wikis and CWAs published between 2001 and September 16, 2011. In total, 4436 citations and 1921 grey literature items were screened. Two reviewers independently reviewed citations, selected eligible studies, and extracted data using a standardized form. We included any paper presenting qualitative or quantitative empirical evidence concerning health care and CWAs. We defined a CWA as any technology that enables the joint and simultaneous editing of a webpage or an online document by many end users. We performed qualitative content analysis to identify the factors that affect the use of CWAs using the Gagnon framework and their effects on health care using the Donabedian framework. RESULTS: Of the 111 studies included, 4 were experimental, 5 quasi-experimental, 5 observational, 52 case studies, 23 surveys about wiki use, and 22 descriptive studies about the quality of information in wikis. We classified them by theme: patterns of use of CWAs (n=26), quality of information in existing CWAs (n=25), and CWAs as KT tools (n=73). A high prevalence of CWA use (ie, more than 50%) is reported in 58% (7/12) of surveys conducted with health care professionals and students. However, we found only one longitudinal study showing that CWA use is increasing in health care. Moreover, contribution rates remain low and the quality of information contained in different CWAs needs improvement. We identified 48 barriers and 91 facilitators in 4 major themes (factors related to the CWA, users' knowledge and attitude towards CWAs, human environment, and organizational environment). We also found 57 positive and 23 negative effects that we classified into processes and outcomes. CONCLUSIONS: Although we found some experimental and quasi-experimental studies of the effectiveness and safety of CWAs as educational and KT interventions, the vast majority of included studies were observational case studies about CWAs being used by health professionals and patients. More primary research is needed to find ways to address the different barriers to their use and to make these applications more useful for different stakeholders.

The effect of implementation intentions on physical activity among obese older adults: a randomised control study.

OBJECTIVES: Physical activity is a key factor for healthy ageing and obesity management. The aim of this study was to test the effect of implementation intentions (IIs) on physical activity and body weight among inactive obese older adults. DESIGN AND MEASURES: At baseline, 101 obese (classes I and II) older adults were randomised to an experimental or a control condition. IIs were delivered in the experimental condition in addition to the common intervention activities. Physical activity (primary outcome) was assessed by means of pedometers. The effect of IIs on body weight (secondary outcome) was also evaluated. RESULTS: No main effects for IIs were observed for all outcomes (ps > 0.21). A significant time × condition interaction was observed for the number of steps per day (p = 0.01). At the 6-month follow-up, the improvement in physical activity was greater among participants in the experimental condition (d = 0.59). None of the measured cognitions moderated or mediated IIs. CONCLUSION: RESULTS suggest that IIs could be appropriate to favour the maintenance of physical activity among inactive obese older adults. However, this technique seems to have limited impacts over and above common intervention activities on weight loss.

Health care professionals' beliefs about using wiki-based reminders to promote best practices in trauma care.

BACKGROUND: Wikis are knowledge translation tools that could help health professionals implement best practices in acute care. Little is known about the factors influencing professionals' use of wikis. OBJECTIVES: To identify and compare the beliefs of emergency physicians (EPs) and allied health professionals (AHPs) about using a wiki-based reminder that promotes evidence-based care for traumatic brain injuries. METHODS: Drawing on the theory of planned behavior, we conducted semistructured interviews to elicit EPs' and AHPs' beliefs about using a wiki-based reminder. Previous studies suggested a sample of 25 EPs and 25 AHPs. We purposefully selected participants from three trauma centers in Quebec, Canada, to obtain a representative sample. Using univariate analyses, we assessed whether our participants' gender, age, and level of experience were similar to those of all eligible individuals. Participants viewed a video showing a clinician using a wiki-based reminder, and we interviewed participants about their behavioral, control, and normative beliefs-that is, what they saw as advantages, disadvantages, barriers, and facilitators to their use of a reminder, and how they felt important referents would perceive their use of a reminder. Two reviewers independently analyzed the content of the interview transcripts. We considered the 75% most frequently mentioned beliefs as salient. We retained some less frequently mentioned beliefs as well. RESULTS: Of 66 eligible EPs and 444 eligible AHPs, we invited 55 EPs and 39 AHPs to participate, and 25 EPs and 25 AHPs (15 nurses, 7 respiratory therapists, and 3 pharmacists) accepted. Participating AHPs had more experience than eligible AHPs (mean 14 vs 11 years; P = .04). We noted no other significant differences. Among EPs, the most frequently reported advantage of using a wiki-based reminder was that it refreshes the memory (n = 14); among AHPs, it was that it provides rapid access to protocols (n = 16). Only 2 EPs mentioned a disadvantage (the wiki added stress). The most frequently reported favorable referent was nurses for EPs (n = 16) and EPs for AHPs (n = 19). The most frequently reported unfavorable referents were people resistant to standardized care for EPs (n = 8) and people less comfortable with computers for AHPs (n = 11). The most frequent facilitator for EPs was ease of use (n = 19); for AHPs, it was having a bedside computer (n = 20). EPs' most frequently reported barrier was irregularly updated wiki-based reminders (n = 18); AHPs' was undetermined legal responsibility (n = 10). CONCLUSIONS: We identified EPs' and AHPs' salient beliefs about using a wiki-based reminder. We will draw on these beliefs to construct a questionnaire to measure the importance of these determinants to EPs' and AHPs' intention to use a wiki-based reminder promoting evidence-based care for traumatic brain injuries.

Question-behaviour effect: a randomised controlled trial of asking intention in the interrogative or declarative form.

OBJECTIVE: This study investigated the question-behaviour effect of measuring intention in the interrogative or declarative form combined or not with a measure of moral norm. DESIGN: A sample of 762 participants was randomised according to a 2 × 2 factorial design. MAIN OUTCOME MEASURES: Cognitions were assessed at the baseline, and physical activity behaviour was self-reported three weeks later. RESULTS: At baseline, there were no significant differences on the studied variables. An ANOVA showed a significant interaction effect between the two experimental conditions (p = 0.04). Post-hoc contrast analyses showed that the interrogative intention-only condition significantly differed from the declarative intention-only (d = 0.21, p = 0.03) and interrogative intention + moral norm (d = 0.22, p = 0.03) conditions. CONCLUSION: Results suggest that self-posed questions about a future action increases the likelihood of doing it when these questions are not accompanied by measures of moral norm. This provides support for using introspective self-talk to favour the adoption of behaviour.

Wikis and collaborative writing applications in health care: a scoping review protocol.

The rapid rise in the use of collaborative writing applications (eg, wikis, Google Documents, and Google Knol) has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use. While researchers have conducted systematic reviews on a range of software-based information and communication technologies as well as other social media (eg, virtual communities of practice, virtual peer-to-peer communities, and electronic support groups), none have reviewed collaborative writing applications in the medical sector. The overarching goal of this project is to explore the depth and breadth of evidence for the use of collaborative writing applications in health care. Thus, the purposes of this scoping review will be to (1) map the literature on collaborative writing applications; (2) compare the applications' features; (3) describe the evidence of each application's positive and negative effects as a KT intervention in health care; (4) inventory and describe the barriers and facilitators that affect the applications' use; and (5) produce an action plan and a research agenda. A six-stage framework for scoping reviews will be used: (1) identifying the research question; (2) identifying relevant studies within the selected databases (using the EPPI-Reviewer software to classify the studies); (3) selecting studies (an iterative process in which two reviewers search the literature, refine the search strategy, and review articles for inclusion); (4) charting the data (using EPPI-Reviewer's data-charting form); (5) collating, summarizing, and reporting the results (performing a descriptive, numerical, and interpretive synthesis); and (6) consulting knowledge users during three planned meetings. Since this scoping review concerns the use of collaborative writing applications as KT interventions in health care, we will use the Knowledge to Action (KTA) framework to describe and compare the various studies and collaborative writing projects we find. In addition to guiding the use of collaborative writing applications in health care, this scoping review will advance the science of KT by testing tools that could be used to evaluate other social media. We also expect to identify areas that require further systematic reviews and primary research and to produce a highly relevant research agenda that explores and leverages the potential of collaborative writing software. To date, this is the first study to use the KTA framework to study the role collaborative writing applications in KT, and the first to involve three national and international institutional knowledge users as part of the research process.

Emergency medicine residents' beliefs about contributing to a Google Docs presentation: a survey protocol.

BACKGROUND: Web 2.0 collaborative writing technologies have shown positive effects on medical education. One such technology, Google Docs(™), offers collaborative writing applications that improve healthcare students' sharing of information. Since 2008, all graduating residents in emergency medicine in Canada have had access to an online Google Docs(™) slideshow designed to help them share summaries of landmark articles in preparation for their Royal College of Physicians and Surgeons of Canada certification exam. A recent evaluation showed that contributions to the presentation were low. OBJECTIVE: This study will identify the factors that influence residents' decision to contribute or not to contribute to this online collaborative project. METHODS: Using the Theory of Planned Behaviour, semistructured interviews will be conducted with 25 graduating emergency medicine residents in Canada. Content from the interviews will be analysed to determine the most important beliefs in relation to the defined behaviour. CONCLUSION: To our knowledge, this study will be the first to use a theory based framework to identify healthcare trainees' salient beliefs concerning their decision whether to contribute to an online collaborative writing project using Google Docs(™).