Supplementary Material for: An Asthma Action Plan Created by Physician, Educator and Patient Online Collaboration with Usability and Visual Design Optimization

<b><i>Background:</i></b> Asthma action plans (AAPs), which decrease hospitalizations and improve symptom control, are recommended in guidelines, but are seldom delivered to patients. Existing AAPs have been developed by experts, without the inclusion of all stakeholders (such as patients with asthma) and without specifically addressing usability and visual design. <b><i>Objective:</i></b> Our objective was to develop a more usable AAP by involving all stakeholders and considering design preferences. <b><i>Methods:</i></b> We created a Wiki-based system for multiuser AAP development. Pulmonologists, primary care physicians, asthma educators and patients used the system to collaboratively compile a single AAP by making multiple online selections over 1 week. We combined common elements from 3 AAPs developed in this way into 1, optimized visual design features and tested face validity in focus groups. <b><i>Results:</i></b> A total of 41 participants averaged 646 selections/week over a login-time of 28.8 h/week. Of 35 participants, 28 (80%) were satisfied with the final AAP and 32 (91%) perceived that they would be able to use it. The plans created by the 3 groups were very similar, with a unanimous or majority agreement in the handling of 100/110 (91%) AAP options. <b><i>Conclusions:</i></b> Inclusion of multiple stakeholders and focus on design preferences predict enhanced usability and uptake of medical tools. The validity of our AAP is further supported by the similarity between the AAPs created by each group, user engagement and satisfaction with the plan and agreement with existing validity criteria proposed by experts. This AAP can be implemented in care with a concurrent measurement of uptake and health impact

Are Patient Education Materials about Cancer Screening More Effective When Co-Created with Patients? A Qualitative Interview Study and Randomized Controlled Trial

Background: Patient education materials (PEMS) are frequently used to help patients make cancer screening decisions. However, because PEM are typically developed by experts, they might inadequately address patient barriers to screening. We co-created, with patients, a prostate cancer (pca) screening PEM, and we compared how the co-created PEM and a PEM developed by experts affected decisional conflict and screening intention in patients. Methods: We identified and used patient barriers to pca screening to co-create a pca screening PEM with patients, clinicians, and researchers. We then conducted a parallel-group randomized controlled trial with men 40 years of age and older in Ontario to compare decisional conflict and intention about pca screening after those men had viewed the co-created PEM (intervention) or an expert-created PEM (control). Participants were randomized using dynamic block randomization, and the study team was blinded to the allocation. Results: Of 287 participants randomized to exposure to the co-created PEM, 230 were analyzed, and of 287 randomized to exposure to the expert-created PEM, 223 were analyzed. After PEM exposure, intervention and control participants did not differ significantly in Decisional Conflict Scale scores [mean difference: 0.37 ± 1.23; 95% confidence interval (CI): −2.05 to 2.79]; in sure (Sure of myself, Understand information, Risk–benefit ratio, or Encouragement) scores (odds ratio: 0.75; 95% CI: 0.52 to 1.08); or in screening intention (mean difference: 0.09 ± 0.08; 95% CI: −0.06 to 0.24]). Conclusions: The effectiveness of the co-created PEM did not differ from that of the PEM developed by experts. Thus, PEM developers should choose the method that best fits their goals and resources