For which clinical rules do doctors want decision support, and why? A survey of Dutch general practitioners.

Despite the promise of decision support for improving care, alerts are often overridden or ignored. We evaluated Dutch general practitioners’ intention to accept decision support in a proposed implementation based on clinical rules regarding care for elderly patients, and their reasons for wanting or not wanting support. We developed a survey based on literature and structured interviews and distributed it to all doctors who would receive support in the proposed implementation (n = 43), of which 65 percent responded. The survey consisted of six questions for each of 20 clinical rules. Despite concerns about interruption, doctors tended to choose more interruptive forms of support. Doctors wanted support when they felt the rule represented minimal care, perceived a need to improve care, and felt responsible for the action and that they might forget to perform the action; doctors declined support due to feeling that it was unnecessary and due to concerns about interruption

Understanding Advice Sharing among Physicians: Towards Trust-Based Clinical Alerts

Safe prescribing of medications relies on drug safety alerts, but up to 96% of such warnings are ignored by physicians. Prior research has proposed improvements to the design of alerts, but with limited increase in adherence. We propose a different perspective: before re-designing alerts, we focus on improving the trust between physicians and computerized advice by examining why physicians trust their medical colleagues. To understand trusted advice among physicians, we conducted three contextual inquiries in a hospital setting (22 participants), and corroborated our findings with a survey (37 participants). Drivers that guide physicians in trusting peer advice include: timeliness of the advice, collaborative language, empathy, level of specialization and medical hierarchy. Based on these findings, we introduce seven design directions for trust-based alerts: endorsement, transparency, team sensing, collaborative, empathic, conflict mitigating and agency laden. Our work contributes to novel alert design strategies to improve the effectiveness of drug safety advice

Elements Affecting Adoption and Implementation of Health Literacy Initiatives in Healthcare Organizations: A Qualitative Study

Nearly nine in ten U.S. adults struggle to use increasingly complex healthcare organizations and to understand the information these organizations provide. However, healthcare organizations are not yet widely addressing the need to make their services and health information easier to navigate, understand, and use. The purpose of this study was to expand knowledge about the facilitators and barriers to adoption and implementation of health literacy initiatives in healthcare organizations. Sixteen qualitative interviews with individuals who lead health literacy initiatives in 16 organizations across the U.S. were conducted. The study identified multiple facilitators and barriers to health literacy adoption and implementation efforts. Many of the elements had already been identified in the literature but four findings of this study were new. Executive level leadership support emerged as the most crucial element for success. Other important facilitators include (a) senior leadership being aware of the importance of addressing health literacy at the organizational level; (b) the person in charge of the health literacy initiative having authorization to meet with senior leaders, directors, and managers across the organization; (c) the health literacy office being located in an area with organization-wide authority; and (d) the use of a structured, strategic approach to plan and carry out change. Each of these elements is potentially influential in adoption and implementation of other change initiatives in healthcare as well as in health literacy initiatives. Further research to explore these elements could contribute to the literature, and to practical applications, in health literacy and other healthcare initiatives

A mixed methods approach to the development and validation of an assessment tool to measure psycho-social factors associated with willingless to participate in child-centred initiatives

Includes bibliographical references (leaves 206-239)The primary aim of the study was to develop a psychosocial assessment tool for determining willingness to participate in child-centred safety promotion interventions, specifically in a low-income community in South Africa. The secondary aim was to determine the factors associated with willingness to participate. The study employed a mixed methods approach to develop the measure, and included content validation, item writing and initial validation processes. Nominal Group Technique discussions were conducted with various role-players in the relevant communities to inform the development of the instrument, while participatory methodologies were utilised to conceptualise the instrument in relation to psycho-social factors associated with intervention participation, with these categorised according to core dimensions. A Delphi method utilising an expert panel reviewed items for relevance, difficulty and ambiguity, with items subsequently amended or removed. Item selection procedures were conducted on the English version of the instrument and these results were applied to the Afrikaans version. A pilot study was conducted as part of the initial validation in order to test the items and format the questionnaire. The instrument was then administered to Afrikaans speaking individuals in a community in the Western Cape. Iterative exploratory factor analysis was conducted at both the item and scale levels to select and reassign items and scales in order to determine the final composition of the questionnaire. The findings indicate that the instrument measures seven factors, namely incentives; priorities and community needs; perceived benefits; social approval; accessibility and values; altruistic capital; and community cohesion. These factors are explained in terms of the Process-Person-Context-Time model and the Theory of Planned Behaviour, considered within a participatory framework. The study findings indicate that the seven factors represent salient dimensions of the construct willingness to participate in interventions. The questionnaire and its subscales displayed acceptable to good reliability, with Cronbach’s α ranging from 0.55 to 0.80. Since willingness precedes actual participation, it is argued that insight into the factors that relate to willingness to participate provides an avenue for motivating actual participation.PsychologyPh. D. (Psychology