Definition of Health 2.0 and Medicine 2.0: A Systematic Review

Background

During the last decade, the Internet has become increasingly popular and is now an important part of our daily life. When new “Web 2.0” technologies are used in health care, the terms “Health 2.0" or "Medicine 2.0” may be used.

Objective

The objective was to identify unique definitions of Health 2.0/Medicine 2.0 and recurrent topics within the definitions.

Methods

A systematic literature review of electronic databases (PubMed, Scopus, CINAHL) and gray literature on the Internet using the search engines Google, Bing, and Yahoo was performed to find unique definitions of Health 2.0/Medicine 2.0. We assessed all literature, extracted unique definitions, and selected recurrent topics by using the constant comparison method.

Results

We found a total of 1937 articles, 533 in scientific databases and 1404 in the gray literature. We selected 46 unique definitions for further analysis and identified 7 main topics.

Conclusions

Health 2.0/Medicine 2.0 are still developing areas. Many articles concerning this subject were found, primarily on the Internet. However, there is still no general consensus regarding the definition of Health 2.0/Medicine 2.0. We hope that this study will contribute to building the concept of Health 2.0/Medicine 2.0 and facilitate discussion and further research.     

Cancer survivors information seeking behaviors: a comparison of survivors who do and do not seek information about cancer

OBJECTIVE: To examine the cancer information seeking behaviors and preferences of cancer survivors. METHODS: This cross-sectional study used the National Cancer Institute's 2003 Health Information National Trends Survey data to evaluate 619 cancer survivors. RESULTS: Two-thirds (67.5%, n = 418) of the survivors sought cancer information (InfoSeek) and 32.5% (n = 201) did not (NoInfoSeek). Significant predictors of cancer information seeking included age (less than 65), gender (female), income (>US$ 25,000/year), and having a regular health care provider (HCP). CONCLUSION: Not all survivors actively look for cancer information. Although most survivors prefer receiving cancer information from their HCP, many turn to a variety of other sources, primarily the Internet. PRACTICE IMPLICATIONS: HCPs should periodically assess information seeking behaviors and preferences of cancer survivors and actively refer patients to the Internet as an extension of and enhancement to their patient interactions. Credible and useful websites could be identified and recommended by the HCP as a means to address some of the barriers identified by survivors.     

Online health information seeking,medical care beliefs and timeliness of medical check-ups among African Americans

ObjectiveThis study aims to investigate the relationship among different types of internet sources for health, medical check-up beliefs and the timeliness of annual medical check-ups among African Americans, accounting for both health TV usage and health service use.MethodsHierarchical linear regression analysis was conducted on data from 1734 African Americans surveyed in the 2013 Consumer Health Multimedia Audience Research Systems national pharmaceutical study of 19,420 U.S. adults.ResultsThe results indicate a positive association between seeking health information on medical websites (β = 0.052, p = 0.04) and consumer-driven health sites (β = 0.066, p < 0.01), and the timeliness of check-ups among African Americans, an association not found in relation to mainstream or news-related sites. Health TV program use was not associated with timeliness of medical check-ups. Medical check-up belief is positively associated with seeking health info on consumer-driven health sites (β = 0.072, p < 0.01) but not on medical sites or on TV.ConclusionSeeking information on health-specific websites was associated with more timely check-ups in African Americans and more positive preventative medical care belief, even after controlling for traditional barriers, such as poor provider relationship.Practice ImplicationsHealth specific websites may provide an avenue for intervention to improve preventative care use in African Americans.     

语义网的研究及其在生物医学中的应用

随着互联网和数字图书馆的进一步发展，对网络信息资源的描述与组织变得越来越重要。本文针对目前对网络信息资源组织的语义网研究，在确认其与医学信息学连接的过程中，介绍易于理解的语义技术概念，并探讨图书馆员如果利用语义技术进行医学信息管理。     

Expectations and experiences of eHealth in primary care: A qualitative practice-based investigation

Objectives

(1) To assess expectations and experiences of a new eHealth service by patients and staff in three primary care settings; (2) to ascertain attitudes to a range of future, primary care-oriented eHealth services.

Design

Qualitative case study.

Setting

Three UK general practices introducing an eHealth service for booking patient appointments.

Participants

Ninety patients purposively selected from users and non-users of the new service and 28 staff (clinicians, management and administrative staff).

Results

Actual patient use of the service was lower than stated intention. Patients and staff felt that more active promotion of the service would have resulted in more use. Low usage did not result in a negative assessment of the service by most staff. Different patient groupings were identified with characteristics that may be used as predictors of eHealth service use and indicators of training needs. GPs and patients expressed opposing viewpoints on a range of future eHealth services.

Conclusions

Take-up of eHealth services may be lower than expected. To overcome patient barriers, factors that may narrow the intention-behaviour gap such as level of service promotion, GP endorsement, and usage by different patient groups, should be investigated. For clinician barriers, the eHealth evidence base needs strengthening, while for primary care practices, a learning process including staff training needs to be instituted. The differing views of patients and GPs about components of eHealth means that policymakers need to plan for a lengthy political process to obtain agreement on contentious issues if they are to achieve successful eHealth services.     

Clinical simulation: A method for development and evaluation of clinical information systems

Use of clinical simulation in the design and evaluation of eHealth systems and applications has increased during the last decade. This paper describes a methodological approach for using clinical simulations in the design and evaluation of clinical information systems. The method is based on experiences from more than 20 clinical simulation studies conducted at the ITX-lab in the Capital Region of Denmark during the last 5 years. A ten-step approach to conducting simulations is presented in this paper. To illustrate the approach, a clinical simulation study concerning implementation of Digital Clinical Practice Guidelines in a prototype planning and coordination module is presented. In the case study potential benefits were assessed in a full-scale simulation test including 18 health care professionals. The results showed that health care professionals can benefit from such a module. Unintended consequences concerning terminology and changes in the division of responsibility amongst healthcare professionals were also identified, and questions were raised concerning future workflow across sector borders. Furthermore unexpected new possible benefits concerning improved communication, content of information in discharge letters and quality management emerged during the testing. In addition new potential groups of users were identified. The case study is used to demonstrate the potential of using the clinical simulation approach described in the paper.     

Internet-based patient education and support interventions: a review of evaluation studies and directions for future research

The Internet provides patients, families, and health providers with unparalleled opportunities to learn, inform, and communicate with one another. This paper is a review of studies that have evaluated the impact of professionally facilitated Internet-based programs for diverse clinical populations on health outcomes, utilization, and user satisfaction. The findings suggest that some outcomes in certain groups can be moderately improved and that user satisfaction has been generally positive. Given the increasing need to provide timely and effective patient-centered care, a stronger evidence base for eHealth applications must be established before broader deployment of such programs will take place.     

A qualitative analysis of student Balint groups in medical education: contexts and triggers of case presentations and discussion themes

OBJECTIVE: No previous rigorous qualitative studies exist on student Balint groups. The aim of this study was to explore the contexts and triggers of cases presented in student Balint groups and to clarify the themes in the group discussions. METHODS: Fifteen student Balint sessions in two groups were organised. Nine female students participated. A grounded theory-based approach with thematic content analysis of the field notes was used. RESULTS: We identified five triggers for case narrations (witnessing injustice, value conflict, difficult human relationships, incurable patient, role confusion) that originated from three distinct contexts (patient encounters, confusing experiences in medical education, tension between privacy and profession). Four main discussion themes could be identified (feelings related to patients, building professional identity, negative role models, cooperation with other medical professionals). CONCLUSION: The concept of case in student Balint groups was wider than in traditional Balint groups. Feelings related to patients and to one's own role as a doctor were openly discussed in groups. The discussions often touched on professional growth and future professional identity as doctors. PRACTICE IMPLICATIONS: The Balint groups may support medical students' professional growth process. This topic warrants further study in more heterogeneous student groups.     

Reflexivity as a tool for medical students to identify and address gender bias in clinical practice: A qualitative study

ObjectivesGender bias interferes with medical care for both men and women, leading to health inequalities. Reflexivity is used in medical education to improve health provision. This study aims to understand if a reflective approach integrated in medical practice enables raising awareness of gender bias during medical school teaching.MethodsWe conducted this study in general ambulatory medicine in Lausanne Hospital, Switzerland with 160 Master’s students. Through group discussions and reflection questionnaires, students were asked to discuss clinical cases they encountered focusing on potential gender bias. We analyzed the data using a thematic analysis approach.ResultsThe reflection on the clinical reasoning steps from a real case identified gender bias at each stage of the clinical case management. The analysis revealed two factors that facilitated gender reflexivity: guidance from a gender expert and peer-to-peer exchange.ConclusionsOur study shows that a reflective approach integrated in medical practice enables raising awareness of gender bias during medical teaching. It provides students with a systematic method they can apply in their future clinical work, thus improving care processes and experiences towards more equitable care.Practice implicationsAll gender and medicine curricula should include teaching such as this linking theory and practice through reflexivity.     

Development of a behaviour change communication tool for medical students: The ‘Tent Pegs’ booklet

Objective

To describe the development and validation of a behaviour change communication tool for medical students.

Methods

Behaviour change techniques (BCTs) were identified within the literature and used to inform a communication tool to support medical students in discussing health-related behaviour change with patients. BCTs were organized into an accessible format for medical students (the ‘Tent Pegs’ booklet) and validated using discriminant content validity methods with 11 expert judges.

Results

One-sample t-tests showed that judges reliably mapped BCTs onto six of the seven Tent Pegs domains (confidence rating means ranged from 4.0 to 5.1 out of 10, all p ≤ 0.002). Only BCTs within the ‘empowering people to change’ domain were not significantly different from the value zero (mean confidence rating = 1.2, p > 0.05); these BCTs were most frequently allocated to the ‘addressing thoughts and emotions’ domain instead.

Conclusion

BCTs within the Tent Pegs booklet are reliably allocated to corresponding behaviour change domains with the exception of those within the ‘empowering people to change’ domain.

Practice implications

The existing evidence-base on BCTs can be used to directly inform development of a communication tool to support medical students facilitate health behaviour change with patients.     

A pilot project to study the use of ultrasonography for teaching physical examination to medical students

The purpose of this study was to study the use of ultrasound as an aid to teaching physical examination. Five medical students were given a 1-week course in ultrasound, and were then assigned to clinical rotations to perform ultrasound and physical examinations on patients. Basic ultrasound skills were assessed by having each student scan the same normal model at the conclusion of the first week and at the conclusion of the project. Clinical cases were presented to a preceptor, and the ultrasound images were graded on a five-point scale. At the end of the first week, the mean grade of ultrasound examinations performed on the control model was 3.2, improving to 4.4 at the end of the project. Grading of ultrasound exams performed during the first clinical week averaged 4.1, improving to 4.5 at the end of the project. An exit survey indicated a favorable response to using ultrasound as an educational tool.     

Bringing clinical pharmacogenomics information to pharmacists: A qualitative study of information needs and resource requirements

IntroductionAs key experts in supporting medication-decision making, pharmacists are well-positioned to support the incorporation of pharmacogenomics into clinical care. However, there has been little study to date of pharmacists’ information needs regarding pharmacogenomics. Understanding those needs is critical to design information resources that help pharmacists effectively apply pharmacogenomics information.ObjectivesWe sought to understand the pharmacogenomics information needs and resource requirements of pharmacists.MethodsWe conducted qualitative inquiries with 14 pharmacists representing 6 clinical environments, and used the results of those inquiries to develop a model of pharmacists’ pharmacogenomics information needs and resource requirements.ResultsThe inquiries identified 36 pharmacogenomics-specific and pharmacogenomics-related information needs that fit into four information needs themes: background information, patient information, medication information, and guidance information. The results of the inquiries informed a model of pharmacists’ pharmacogenomics resource requirements, with 3 themes: structure of the resource, perceptions of the resource, and perceptions of the information.ConclusionResponses suggest that pharmacists anticipate an imminently growing role for pharmacogenomics in their practice. Participants value information from trust-worthy resources like FDA product labels, but struggle to find relevant information quickly in labels. Specific information needs include clinically relevant guidance about genotypes, phenotypes, and how to care for their patients with known genotypes. Information resources supporting the goal of incorporating complicated genetic information into medication decision-making goals should be well-designed and trustworthy.     

Tested communication strategies for providing information to patients in medical consultations: A scoping review and quality assessment of the literature

ObjectivesTo systematize the scientific knowledge of empirically tested strategies for verbally providing medical information in patient-physician consultations.MethodsA scoping review searching for terms related to physician, information, oral communication, and controlled study. Four pairs of reviewers screened articles. For each selected study, we assessed the quality and summarized aspects on participants, study, intervention, and outcomes. Information provision strategies were inductively classified by types and main categories.ResultsAfter screening 9422 articles, 39 were included. The methodological quality was moderate. We identified four differently used categories of strategies for providing information: cognitive aid (n = 13), persuasive (n = 8), relationship- (n = 3), and objectivity-oriented strategies (n = 4); plus, one “mixed” category (n = 11). Strategies were rarely theoretically derived.ConclusionsCurrent research of tested strategies for verbally providing medical information is marked by great heterogeneity in methods and outcomes, and lack of theory-driven approaches. The list of strategies could be used to analyse real life communication.Practice implicationsFindings may aid the harmonization of future efforts to develop empirically-based information provision strategies to be used in clinical and teaching settings.     

The use of simulation in medical student education on the topic of breaking bad news: A systematic review

BackgroundSimulated patients (SPs) are widely used, but the most effective way of utilising them in undergraduate breaking bad news (BBN) medical education is unknown.ObjectivesTo conduct a systematic review into SP’s use in developing BBN skills in medical students.Methods14 databases searched with the terms “Medical education”, “Patient simulation”, “Bad news”. Data was systematically extracted, and thematic analysis undertaken.ResultsOf 2117 articles screened, 29 publications met the inclusion criteria. These demonstrated a variety of SP models, including actors as patients (65.5%), peers (7.0%), and cancer survivors (3.5%). with delivery at varying times in the curricula. SPs are uniformly reported as having positive impact, but there is a lack of high-quality evidence comparing the use of differing forms of training. There was some evidence that virtual SPs were as useful as in-person SPs.ConclusionsSPs allow students to practise vital BBN communication skills without risking detriment to patient care. Despite the heterogeneity of ways in which SPs have been used, the benefits of different approaches and when and how these should be delivered remains unclear.Practice implicationsFurther educational development and research is needed about the use of SPs to support undergraduate BBN communication skills development.     

Facing uncertainty as a medical student—A qualitative study of their reflective learning diaries and writings on specific themes during the first clinical year

Objective

Tolerance of uncertainty related to the complex work is a major dimension of general practitioner's (GP) profession. Strategies for managing uncertainty have been studied among GPs but less is known about how medical students develop tolerance of uncertainty during their studies. The aim of this study was to investigate how the medical students experience uncertainty during their first clinical years and how their feelings develop with time as they progress from the 3rd year to the 4th year.

Methods

The material consisted of 22 students’ reflective learning diaries and writings on specific themes collected during the 3rd and 4th year of their medical studies. The analysis was performed using thematic content analysis. In this article we present the results related to the theme of uncertainty.

Results

Uncertainty is a major cause of mental strain for medical students, particularly fear of making mistakes. Main themes related to facing uncertainty and found in the diaries and writings were insecurity of professional skills, own credibility, facing with the inexactness of medicine, fear of making mistakes, coping with responsibility, and tolerating oneself as incomplete and accepting oneself as a good-enough doctor-to-be. Common steps of development towards tolerance of uncertainty were found in diaries over a one-year time period as the students progressed in their clinical studies.

Conclusions

Reflective writing showed to be an effective means for the students of both expressing and dealing with uncertainty, both with the difficult and the pleasant feelings and the experiences the students had with their first patient contacts. It also gave some of them the means of self-reflection which they afterwards found worthwhile.

Practice implications

Reflective writing is powerful tool which medical students could use to facilitate their maturation process what comes to uncertainty during their first clinical year.     

The use of video for patient information and education: A scoping review of the variability and effectiveness of interventions

ObjectiveTo provide an overview of video interventions used for patient information and education, and of the tools used to evaluate their effectiveness, in order to consider the feasibility of developing generic guidelines and appraisal tools for the use of video in patient care.MethodsA scoping review was carried out to describe and synthesise emerging knowledge, using thematic analysis of data. Studies focussed upon videos for health professional education were excluded, as were those which consider the impact of videos available via social media.ResultsA narrative overview of 65 identified papers provides insight into the range and scope of studies. Common themes emerge, notably the aim of reducing anxiety and the variety of instruments designed to measure this. The use of self-report questionnaires was common, but their design is variable.ConclusionTargeted video-based intervention can improve patient experience and outcomes. High utility guidelines and appraisal tools, transferable between contexts, are needed to facilitate deployments at scale for sustainable outcomes.Practice implicationsVideo production guidelines and appraisal tools will be of value to those engaged in video development and deployment. Guidance should be based upon emerging evidence of effectiveness and incorporate an emphasis on reusability.     

Health-related information needs and preferences for information of individuals with cardiovascular disease from underserved populations: A systematic review

ObjectiveThis systematic review aimed to identify the information needs and preferences of individuals with CVD from underserved populations.MethodsFive databases were searched from data inception to February 2022. Pilot and case report studies, non-peer-reviewed literature, and studies published in a language other than English, Portuguese, or Spanish were excluded. Structured and thematic analysis of all included studies were performed. The Critical Appraisal Skills Program and the Downs and Black Checklist were used to assess the quality of the qualitative and quantitative studies, respectively.ResultsOf 35,698 initial records, 19 studies were included, most in observational design and classified as “fair” quality. Underserved populations – women, people living in rural areas, ethnic minority groups, older people, and those with low socioeconomic status – presented unique needs in four main groups, with some similarities across them: information about CVD, primary and secondary prevention of CVD, CVD management, and health care, policies and practices. Across the studies there was a lack of standardization on how individuals’ needs were assessed and reported.ConclusionUnderserved populations with CVD have unique information needs and preferences that should be address during their care.Practical implicationInformation from this study may assist health care professionals with the development of comprehensive strategies to improve their provision of care for specific CVD patient groups.     

Tailored information for cancer patients on the Internet: effects of visual cues and language complexity on information recall and satisfaction

Objective

This study was designed to investigate the effects of visual cues and language complexity on satisfaction and information recall using a personalised website for lung cancer patients. In addition, age effects were investigated.

Methods

An experiment using a 2 (complex vs. non-complex language) × 3 (text only vs. photograph vs. drawing) factorial design was conducted. In total, 200 respondents without cancer were exposed to one of the six conditions.

Results

Respondents were more satisfied with the comprehensibility of both websites when they were presented with a visual cue. A significant interaction effect was found between language complexity and photograph use such that satisfaction with comprehensibility improved when a photograph was added to the complex language condition. Next, an interaction effect was found between age and satisfaction, which indicates that adding a visual cue is more important for older adults than younger adults. Finally, respondents who were exposed to a website with less complex language showed higher recall scores.

Conclusion

The use of visual cues enhances satisfaction with the information presented on the website, and the use of non-complex language improves recall.

Practice implications

The results of the current study can be used to improve computer-based information systems for patients.     

Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study

Background

Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge.

Objective

The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success.

Methods

This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients.

Results

Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers’ beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies.

Conclusions

The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR’s strength of being broad and comprehensive also limits its usefulness as an implementation framework because it does not discriminate between the relative importance of its many constructs for implementation success. This is the first study to identify which CFIR constructs are the most promising to distinguish between high and low implementation success across settings and interventions. Findings from this study can contribute to the refinement of CFIR toward a more succinct and parsimonious framework for planning and evaluation of the implementation of clinical interventions.

ClinicalTrial

Clinicaltrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6cWeqN1uY)