TY - JOUR AU - Wiljer, David AU - Catton, Pam PY - 2003/8/29 TI - Multimedia Formats for Patient Education and Health Communication: Does User Preference Matter? JO - J Med Internet Res SP - e19 VL - 5 IS - 3 UR - http://www.jmir.org/2003/3/e19/ UR - http://dx.doi.org/10.2196/jmir.5.3.e19 UR - http://www.ncbi.nlm.nih.gov/pubmed/14517110 ID - info:doi/10.2196/jmir.5.3.e19 ER - TY - JOUR AU - Ong, R. Kenneth PY - 2003/8/29 TI - Just-in-time Database-Driven Web Applications JO - J Med Internet Res SP - e18 VL - 5 IS - 3 KW - Database applications N2 - "Just-in-time" database-driven Web applications are inexpensive, quickly-developed software that can be put to many uses within a health care organization. Database-driven Web applications garnered 73873 hits on our system-wide intranet in 2002. They enabled collaboration and communication via user-friendly Web browser-based interfaces for both mission-critical and patient-care-critical functions. Nineteen database-driven Web applications were developed. The application categories that comprised 80% of the hits were results reporting (27%), graduate medical education (26%), research (20%), and bed availability (8%). The mean number of hits per application was 3888 (SD = 5598; range, 14-19879). A model is described for just-in-time database-driven Web application development and an example given with a popular HTML editor and database program. UR - http://www.jmir.org/2003/3/e18/ UR - http://dx.doi.org/10.2196/jmir.5.3.e18 UR - http://www.ncbi.nlm.nih.gov/pubmed/14517109 ID - info:doi/10.2196/jmir.5.3.e18 ER - TY - JOUR AU - Farvolden, Peter AU - McBride, Carolina AU - Bagby, Michael R. AU - Ravitz, Paula PY - 2003/9/29 TI - A Web-Based Screening Instrument for Depression and Anxiety Disorders in Primary Care JO - J Med Internet Res SP - e23 VL - 5 IS - 3 KW - depression KW - anxiety disorders KW - assessment of health care needs KW - screening KW - web-based services KW - treatment KW - primary care KW - diagnosis KW - mental health N2 - Background: Major depressive disorder (MDD) and anxiety disorders are common and result in considerable suffering and economic loss. People suffering from major depressive disorder and/or anxiety disorders are commonly encountered in the primary care setting. Unfortunately, most people with these disorders remain either untreated or inadequately treated; current data suggest that general practitioners fail to diagnose up to half of cases of major depressive disorder or anxiety. There is a need for screening tools that will help physicians and other professionals in primary care recognize and adequately treat major depressive disorder and anxiety disorders. While the currently-available self-report screening instruments have been demonstrated to be reliable and valid, there remain considerable barriers to their widespread use in primary care. Objective: The purpose of the present study is to report preliminary validation data for a freely-available, brief, Web-based, self-report screener for major depressive disorder and anxiety disorders. Methods: The Web-Based Depression and Anxiety Test (WB-DAT) was administered to 193 subjects who presented for assessment and/or treatment in ongoing research projects being conducted at the Mood and Anxiety Program and Clinical Research Department at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. Subjects completed the Web-based screening instrument and were subsequently interviewed with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Axis I Disorders (SCID-I/P). The diagnostic data from the screening instrument were then compared with the data from the individual's SCID-I/P interview. Diagnostic concordance between SCID-I/P diagnoses and the Web-Based Depression and Anxiety Test were assessed using Cohen's kappa, sensitivity, specificity, positive predictive value, negative predictive value, and efficiency. Results: Agreement ranged from acceptable to good (0.57-0.70) for major depressive disorder, panic disorder with and without agoraphobia (PD+/-AG), social phobia/social anxiety disorder, obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), and post traumatic stress disorder (PTSD). With the exception of generalized anxiety disorder, the sensitivity (0.71-0.95) and specificity (0.87-0.97) for the major diagnostic categories assessed by the Web-Based Depression and Anxiety Test were good. The sensitivity for generalized anxiety disorder was somewhat lower (0.63) but acceptable. Positive predictive values were good (0.60-0.75) for major depressive disorder, obsessive compulsive disorder, generalized anxiety disorder, and post traumatic stress disorder, and acceptable for panic disorder with and without agoraphobia and for social phobia/social anxiety disorder. Conclusions: These preliminary data suggest that the Web-Based Depression and Anxiety Test is reliable for identifying patients with and without major depressive disorder and the anxiety disorders of panic disorder with and without agoraphobia, social phobia/social anxiety disorder, obsessive compulsive disorder, and post traumatic stress disorder. Further research is required in a larger sample in primary care. UR - http://www.jmir.org/2003/3/e23/ UR - http://dx.doi.org/10.2196/jmir.5.3.e23 UR - http://www.ncbi.nlm.nih.gov/pubmed/14517114 ID - info:doi/10.2196/jmir.5.3.e23 ER - TY - JOUR AU - Murray, Elizabeth AU - Lo, Bernard AU - Pollack, Lance AU - Donelan, Karen AU - Catania, Joe AU - Lee, Ken AU - Zapert, Kinga AU - Turner, Rachel PY - 2003/8/29 TI - The Impact of Health Information on the Internet on Health Care and the Physician-Patient Relationship: National U.S. Survey among 1.050 U.S. Physicians JO - J Med Internet Res SP - e17 VL - 5 IS - 3 KW - Physicians KW - Internet KW - physician-patient relations N2 - Background: Public use of the Internet for health information is increasing but its effect on health care is unclear. We studied physicians' experience of patients looking for health information on the Internet and their perceptions of the impact of this information on the physician-patient relationship, health care, and workload. Methods: Cross-sectional survey of a nationally-representative sample of United States physicians (1050 respondents; response rate 53%). Results: Eighty-five percent of respondents had experienced a patient bringing Internet information to a visit. The quality of information was important: accurate, relevant information benefited, while inaccurate or irrelevant information harmed health care, health outcomes, and the physician-patient relationship. However, the physician's feeling that the patient was challenging his or her authority was the most consistent predictor of a perceived deterioration in the physician-patient relationship (OR = 14.9; 95% CI, 5.5-40.5), in the quality of health care (OR = 3.4; 95% CI, 1.1-10.9), or health outcomes (OR = 5.6; 95% CI, 1.7-18.7). Thirty-eight percent of physicians believed that the patient bringing in information made the visit less time efficient, particularly if the patient wanted something inappropriate (OR = 2.5; 95% CI, 1.5-4.4), or the physician felt challenged (OR = 3.6; 95% CI, 1.8-7.2). Conclusions: The quality of information on the Internet is paramount: accurate relevant information is beneficial, while inaccurate information is harmful. Physicians appear to acquiesce to clinically-inappropriate requests generated by information from the Internet, either for fear of damaging the physician-patient relationship or because of the negative effect on time efficiency of not doing so. A minority of physicians feels challenged by patients bringing health information to the visit; reasons for this require further research. UR - http://www.jmir.org/2003/3/e17/ UR - http://dx.doi.org/10.2196/jmir.5.3.e17 UR - http://www.ncbi.nlm.nih.gov/pubmed/14517108 ID - info:doi/10.2196/jmir.5.3.e17 ER - TY - JOUR AU - Bader, L. Judith AU - Strickman-Stein, Nancy PY - 2003/8/29 TI - Evaluation of New Multimedia Formats for Cancer Communications JO - J Med Internet Res SP - e16 VL - 5 IS - 3 KW - Lung cancer KW - Internet KW - multimedia KW - patient education KW - audio N2 - Background: Providing quality, current cancer information to cancer patients and their families is a key function of the National Cancer Institute (NCI) Web site. This information is now provided in predominantly-text format, but could be provided in formats using multimedia, including animation and sound. Since users have many choices about where to get their information, it is important to provide the information in a format that is helpful and that they prefer. Objective: To pilot and evaluate multimedia strategies for future cancer-information program formats for lay users, the National Cancer Institute created new multimedia versions of existing text programs. We sought to evaluate user performance and preference on these 3 new formats and on the 2 existing text formats. Methods: The National Cancer Institute's "What You Need to Know About Lung Cancer" program was the test vehicle. There were 5 testing sessions, 1 dedicated to each format. Each session lasted about 1 hour, with 9 participants per session and 45 users overall. Users were exposed to the assigned cancer program from beginning to end in 1 of 5 formats: text paperback booklet, paperback booklet formatted in HTML on the Web, spoken audio alone, spoken audio synchronized with a text Web page, and Flash multimedia (animation, spoken audio, and text). Immediately thereafter, the features and design of the 4 alternative formats were demonstrated in detail. A multiple-choice pre-test and post-test quiz on the cancer content was used to assess user learning (performance) before and after experiencing the assigned program. The quiz was administered using an Authorware software interface writing to an Access database. Users were asked to rank from 1 to 5 their preference for the 5 program formats, and provide structured and open-ended comments about usability of the 5 formats. Results: Significant improvement in scores from pre-test to post-test was seen for the total study population. Average scores for users in each of the 5 format groups improved significantly. Increments in improvement, however, were not statistically different between any of the format groups. Significant improvements in quiz scores were seen irrespective of age group or education level. Of the users, 71.1% ranked the Flash program first among the 5 formats, and 84.4% rated Flash as their first or second choice. Audio was the least-preferred format, ranking fifth among 46.7% of users and first among none. Flash was ranked first among users regardless of education level, age group, or format group to which the user was assigned. Conclusions: Under the pilot study conditions, users overwhelmingly preferred the Flash format to the other 4 formats. Learning occurred equally in all formats. Use of multimedia should be considered as communication strategies are developed for updating cancer content and attracting new users. UR - http://www.jmir.org/2003/3/e16/ UR - http://dx.doi.org/10.2196/jmir.5.3.e16 UR - http://www.ncbi.nlm.nih.gov/pubmed/14517107 ID - info:doi/10.2196/jmir.5.3.e16 ER - TY - JOUR AU - Satterlund, J. Melisa AU - McCaul, D. Kevin AU - Sandgren, K. Ann PY - 2003/8/27 TI - Information Gathering Over Time by Breast Cancer Patients JO - J Med Internet Res SP - e15 VL - 5 IS - 3 KW - Breast cancer KW - Internet KW - Internet use KW - Internet search N2 - Background: Unlike many patients of the past, today's health-care users want to become more informed about their illnesses, and they want the most current information. The Internet has become a popular way to access current information, and since its introduction more people are turning to it to find medical information. Studies report that anywhere from 36% to 55% of the American population that use the Internet is using the Internet to research medical information, and these percentages have been rising. Cancer is 1 of the top 2 diseases about which people seek information on the Internet. Some studies have specifically asked whether breast cancer patients access the Internet for medical information; estimates range from 10% to 43% of breast cancer patients who use the Internet, with higher usage being associated with more education, greater income, and younger age. Objective: To identify where breast cancer patients find medical information about their illness and to track changes over time, from active treatment to survivorship status. Methods: Participants were 224 women who had been recently diagnosed with Stage I, Stage II, or Stage III breast cancer. Each woman was contacted approximately 8 months and 16 months after diagnosis and was asked about 10 different information sources they could have used to obtain information or support about their breast cancer. Results: Eight months after diagnosis, the top 3 information sources used by women were books (64%), the Internet (49%), and videos (41%). However, at follow-up (16 months after diagnosis), the most frequently cited information source was the Internet (40%), followed by books (33%), and the American Cancer Society (17%). We found that women continued to use the Internet as a means of gathering information even after their treatment ended. Significant unique predictors of Internet use were more years of formal education and younger ages. Cancer stage was not a significant predictor of Internet use. Conclusions: Previous research has been mixed about the percentage of cancer patients who use the Internet to gather information about their illnesses. The results of the present study corroborate 2 other data sets of breast cancer patients, as just over 44% of the women reported using the Internet after diagnosis. Sixteen months after diagnosis, the percentage of women using the Internet dropped slightly, but other chief sources dropped sharply at that time. The Internet continues to play an important role for cancer survivors after medical treatment has ended, and health professionals can use this knowledge to provide their patients with Internet advice. UR - http://www.jmir.org/2003/3/e15/ UR - http://dx.doi.org/10.2196/jmir.5.3.e15 UR - http://www.ncbi.nlm.nih.gov/pubmed/14517106 ID - info:doi/10.2196/jmir.5.3.e15 ER - TY - JOUR AU - Casebeer, L. Linda AU - Strasser, M. Sheryl AU - Spettell, M. Claire AU - Wall, C. Terry AU - Weissman, Norman AU - Ray, N. Midge AU - Allison, J. Jeroan PY - 2003/9/24 TI - Designing Tailored Web-Based Instruction to Improve Practicing Physicians' Preventive Practices JO - J Med Internet Res SP - e20 VL - 5 IS - 3 KW - Internet KW - World Wide Web KW - online KW - continuing medical education KW - continuing health care education KW - education theory KW - cognitive theory KW - Web site design KW - chlamydia screening N2 - Background: The World Wide Web has led to the rapid growth of medical information and continuing medical educational offerings. Ease of access and availability at any time are advantages of the World Wide Web. Existing physician-education sites have often been designed and developed without systematic application of evidence and cognitive-educational theories; little rigorous evaluation has been conducted to determine which design factors are most effective in facilitating improvements in physician performance and patient-health outcomes that might occur as a result of physician participation in Web-based education. Theory and evidence-based Web design principles include the use of: needs assessment, multimodal strategies, interactivity, clinical cases, tailoring, credible evidence-based content, audit and feedback, and patient-education materials. Ease of use and design to support the lowest common technology denominator are also important. Objective: Using these principles, design and develop a Web site including multimodal strategies for improving chlamydial-screening rates among primary care physicians. Methods: We used office-practice data in needs assessment and as an audit/feedback tool. In the intervention introduced in 4 phases over 11 months, we provided a series of interactive, tailored, case vignettes with feedback on peer answers. We included a quality-improvement toolbox including clinical practice guidelines and printable patient education materials. Results: In the formative evaluation of the first 2 chlamydia modules, data regarding the recruitment, enrollment, participation, and reminders have been examined. Preliminary evaluation data from a randomized, controlled trial has tested the effectiveness of this intervention in improving chlamydia screening rates with a significant increase in intervention physicians' chlamydia knowledge, attitude, and skills compared to those of a control group. Conclusions: The application of theory in the development and evaluation of a Web-based continuing medical education intervention offers valuable insight into World Wide Web technology's influence on physician performance and the quality of medical care. UR - http://www.jmir.org/2003/3/e20/ UR - http://dx.doi.org/10.2196/jmir.5.3.e20 UR - http://www.ncbi.nlm.nih.gov/pubmed/14517111 ID - info:doi/10.2196/jmir.5.3.e20 ER - TY - JOUR AU - Embi, J. Peter AU - Desai, Sima AU - Cooney, G. Thomas PY - 2003/9/25 TI - Use and Utility of Web-Based Residency Program Information: A Survey of Residency Applicants JO - J Med Internet Res SP - e22 VL - 5 IS - 3 KW - Internship and residency KW - Internet KW - education KW - medical KW - graduate KW - job application KW - career choice KW - pamphlets N2 - Background: The Internet has become essential to the residency application process. In recent years, applicants and residency programs have used the Internet-based tools of the National Residency Matching Program (NRMP, the Match) and the Electronic Residency Application Service (ERAS) to process and manage application and Match information. In addition, many residency programs have moved their recruitment information from printed brochures to Web sites. Despite this change, little is known about how applicants use residency program Web sites and what constitutes optimal residency Web site content, information that is critical to developing and maintaining such sites. Objective: To study the use and perceived utility of Web-based residency program information by surveying applicants to an internal medicine program. Methods: Our sample population was the applicants to the Oregon Health & Science University Internal Medicine Residency Program who were invited for an interview. We solicited participation using the group e-mail feature available through the Electronic Residency Application Service Post-Office application. To minimize the possibility for biased responses, the study was confined to the period between submission of National Residency Matching Program rank-order lists and release of Match results. Applicants could respond using an anonymous Web-based form or by reply to the e-mail solicitation. We tabulated responses, calculated percentages for each, and performed a qualitative analysis of comments. Results: Of the 431 potential participants, 218 responded (51%) during the study period. Ninety-nine percent reported comfort browsing the Web; 52% accessed the Web primarily from home. Sixty-nine percent learned about residency Web sites primarily from residency-specific directories while 19% relied on general directories. Eighty percent found these sites helpful when deciding where to apply, 69% when deciding where to interview, and 36% when deciding how to rank order programs for the Match. Forty-nine percent found sites most useful in deciding where to apply, while 40% found them most useful while preparing for their interviews. Seventy-two percent felt that a "complete" Web site could substitute for a mailed printed brochure. Qualitative analysis identified additional important information needs. Conclusions: Applicants are turning to residency Web sites for information during critical phases of the application process. Though usually helpful, many of these sites are felt to be incomplete and may not be meeting important applicant information needs. These findings should be useful to those involved in residency recruitment efforts and in counseling applicants. UR - http://www.jmir.org/2003/3/e22/ UR - http://dx.doi.org/10.2196/jmir.5.3.e22 UR - http://www.ncbi.nlm.nih.gov/pubmed/14517113 ID - info:doi/10.2196/jmir.5.3.e22 ER - TY - JOUR AU - Dutta-Bergman, Mohan PY - 2003/9/25 TI - Trusted Online Sources of Health Information: Differences in Demographics, Health Beliefs, and Health-Information Orientation JO - J Med Internet Res SP - e21 VL - 5 IS - 3 KW - Internet KW - source credibility KW - demographics KW - beliefs KW - health beliefs KW - health consciousness KW - consumer N2 - Background: The recent surge in online health information and consumer use of such information has led to expert speculations and prescriptions about the credibility of health information on the World Wide Web. In spite of the growing concern over online health information sources, existing research reveals a lacuna in the realm of consumer evaluations of trustworthiness of different health information sources on the Internet. Objective: This study examines consumer evaluation of sources of health information on the World Wide Web, comparing the demographic, attitudinal, and cognitive differences between individuals that most trust a particular source of information and individuals that do not trust the specific source of health information. Comparisons are made across a variety of sources. Methods: The Porter Novelli HealthStyles database, collected annually since 1995, is based on the results of nationally-representative postal-mail surveys. In 1999, 2636 respondents provided usable data for the HealthStyles database. Independent sample t tests were conducted to compare the respondents in the realm of demographic, attitudinal, and cognitive variables. Results: The most trusted sources of online health information included the personal doctor, medical university, and federal government. The results demonstrated significant differences in demographic and health-oriented variables when respondents who trusted a particular online source were compared with respondents that did not trust the source, suggesting the need for a segmented approach to research and application. Individuals trusting the local doctor were younger ( t2634= 4.02, P< .001) and held stronger health beliefs (F 1= 5.65, P= .018); individuals trusting the local hospital were less educated ( t2634= 3.83, P< .001), low health information oriented (F 1= 6.41, P= .011), and held weaker health beliefs (F 1= 5.56, P= .018). Respondents with greater trust in health insurance companies as online health information sources were less educated ( t2634= 1.90, P= .05) and less health information oriented (F 1= 4.30, P= .04). Trust in medical universities was positively associated with education ( t2634= 11.83, P< .001), income ( t2634= 10.19, P< .001), and health information orientation (F 1= 10.32, P<.001). Similar results were observed in the realm of federal information credibility, with individuals with greater trust in federal sources being more educated ( t2634= 7.45, P< .001) and health information oriented (F 1= 4.45, P= .04) than their counterparts. Conclusions: The results suggest systematic differences in the consumer segment based on the different sources of health information trusted by the consumer. While certain sources such as the local hospital and the health insurance company might serve as credible sources of health information for the lower socioeconomic and less health-oriented consumer segment, sources such as medical universities and federal Web sites might serve as trustworthy sources for the higher socioeconomic and more health-oriented groups. UR - http://www.jmir.org/2003/3/e21/ UR - http://dx.doi.org/10.2196/jmir.5.3.e21 UR - http://www.ncbi.nlm.nih.gov/pubmed/14517112 ID - info:doi/10.2196/jmir.5.3.e21 ER -