Supporting Parents to Choose Wisely: A Multi-Method Study to Increase Knowledge and Manage Expectations for Common Acute Childhood Conditions
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 174
- 试验地点
- 2
- 主要终点
- Knowledge - Quantitative true/false
研究概览
简要总结
The goal of this multi-method study including a randomized control trial and qualitative interviews is to see how useful blogshots (an image that summarizes information) are at helping parents increase their knowledge and manage their expectations for common acute childhood conditions (e.g. sore throat, ear infection) with respect to Choosing Wisely Canada recommendations.
Participants will be randomly assigned to Group A or Group B in this study. Group A will receive three of six blogshots over a 4-week period (a different blogshot will be sent by email to them each week for three weeks, then in the final week they will receive the same three blogshots in one summary email to review). Group B will receive the other three of six blogshots, following the same email sequence and timing. All participants from both groups will be asked to complete one baseline questionnaire at the start of the study and a follow-up questionnaire at week 5, month 3 and month 6 about different common acute childhood conditions, the blogshots and their content. All participants also have the option to participate in an optional semi-structured interview to give their thoughts on the blogshots and their experience in the study.
Researchers will compared each participant's baseline score to their follow up scores to see if there was a change in their knowledge and expectations.
By developing and evaluating evidence-based Choosing Wisely Canada resources, the researchers aim to make it easier for parents to choose wisely. Empowering parents to be part of conversations with their child's healthcare provider can improve health decision-making and reduce health system costs.
详细描述
Purpose and Justification
A key driver of inappropriate care is patient expectations; that is, patients want something done when they seek care, whether that be a diagnostic test or some form of intervention such as a prescription.There is a growing body of literature providing evidence that increasing knowledge and awareness among patients can influence their behaviours in terms of deciding to seek care or expectations of healthcare professionals if they do seek care. Moreover, behaviour theory indicates that precursors to behaviour change are awareness, knowledge, and intentions. Knowledge translation (KT) is concerned with the communication of evidence to improve such outcomes.
In the context of pediatric healthcare, connecting parents and legal guardians to research evidence has the power to improve health decision-making and reduce health system costs. The heaviest users of unscheduled healthcare are children, who also make up a large proportion of emergency department (ED) attendances that may have been treatable elsewhere (e.g. primary care or home). There are multiple complex factors and circumstances that can influence parents' decision-making regarding where, when and why they seek unscheduled healthcare for their children. A recent systematic review highlighted that pressure to be seen as 'doing the right thing' as a parent was related to care seeking. However, fear of wasting a doctor's time for a minor illness was perceived as a barrier for seeking care. Subsequently, parents and caregivers should be the target of efforts to promote empowerment. Parent empowerment can be defined as the "process through which parents are able to increase the control they have over decisions and actions affecting their child's health". One mechanism for supporting and empowering parents could be through KT of the Choosing Wisely Canada (CWC) recommendations.
It has become increasingly clear that parents need knowledge and confidence to be involved in healthcare decisions. CWC is a national movement launched in 2014 in partnership with the Canadian Medical Association. The campaign aims to help physicians, patients and families engage in conversations around unnecessary tests, treatments and procedures, which often do more harm than good and result in significant waste in the Canadian healthcare system. The central tenant to the movement is specialty-specific lists of "Things Physicians and Patients Should Question" aimed to assist physicians and patients in making informed health choices. Further, parents often seek care for these conditions either from their primary care provider or through the ED, representing a large burden on healthcare resources. While there are a number of pediatric specific CWC recommendations, there is currently no outward facing CWC campaign that targets parents in the community.
In the pediatric context, conditions such as ear infections, the common cold, sore throat, bronchiolitis and asthma are extremely common among children in Canada. These are conditions in which antibiotic treatment is usually unnecessary, however antibiotics are often prescribed. The goal of this research team is to co-design with parents an intervention and evaluation of CWC recommendations that align with common childhood conditions. The investigators have previously evaluated different means of sharing health information with parents and found that blogshots compared to plain language summaries and Wikipedia pages showed significant differences in terms of parent preferences, knowledge and usability. This study will include all four elements of the CWC patient engagement framework. The investigators will partner and engage with parent stakeholders to design and create blogshots that are tailored to parents. The investigators will then assess the effectiveness of the blogshots http://s.nooro.com/choosingwisely at informing and educating parents on CWC recommendations and empowering them to make educated, evidence-based choices for their child's health. To the investigators' knowledge, this study will be the first of its kind in Canada, and has the potential for widespread scale and implementation.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Over the age of 18 years
- •Parent or legal guardian of a child under 5 years of age
- •Live in Canada
- •Able to complete the questionnaire and interview in English (speak/read)
- •Access to an electronic device (e.g. computer, tablet or smart phone), Internet and email.
排除标准
- •Under the age of 18 years
- •Does not identify as a parent or legal guardian of a child under 5 years of age
- •Does not live in Canada
- •Unable to complete the interview and questionnaire in English (speak/read)
- •No access to an electronic device (e.g. computer, tablet or smart phone), Internet and email.
结局指标
主要结局
Knowledge - Quantitative true/false
时间窗: baseline (week 0), follow-up 1 (week 5), follow-up 2 (month 3), follow-up 3 (month 6)
Primary outcome will be knowledge. Change will be compared from baseline between groups (i.e. average change in knowledge scores specific to Choosing Wisely recommendations, expecting that knowledge will improve with respect to the content received). There will be 8 'true/false' questions to assess knowledge. Each question is worth 2 points. Knowledge will be assessed by comparing participant's scores on baseline to follow-up 1 (knowledge change) and comparing scores to follow-up 2 and 3 (knowledge retention).
Knowledge - Quantitative Multiple Choice
时间窗: baseline (week 0), follow-up 1 (week 5), follow-up 2 (month 3), follow-up 3 (month 6)
Primary outcome will be knowledge. Change will be compared from baseline between groups (i.e. average change in knowledge scores specific to Choosing Wisely recommendations, expecting that knowledge will improve with respect to the content received). There will be 7 'multiple choice' questions to assess knowledge. Each question is worth 2 points. Knowledge will be assessed by comparing participant's scores on baseline to follow-up 1 (knowledge change) and comparing scores to follow-up 2 and 3 (knowledge retention).
Knowledge - Quantitative Select all that apply
时间窗: baseline (week 0), follow-up 1 (week 5), follow-up 2 (month 3), follow-up 3 (month 6)
Primary outcome will be knowledge. Change will be compared from baseline between groups (i.e. average change in knowledge scores specific to Choosing Wisely recommendations, expecting that knowledge will improve with respect to the content received). There will be 6 'select all that apply' questions to assess knowledge. Each question is worth 2 points. Knowledge will be assessed by comparing participant's scores on baseline to follow-up 1 (knowledge change) and comparing scores to follow-up 2 and 3 (knowledge retention).
Knowledge - Qualitative
时间窗: interviews will be conducted between week 5 - month 3
Interviews will be used to clarify, expand on and provide to context to the questionnaire responses - two open-ended questions addressing knowledge and will undergo thematic analysis.
Knowledge - Quantitative
时间窗: baseline (week 0), follow-up 1 (week 5), follow-up 2 (month 3), follow-up 3 (month 6)
Primary outcome will be knowledge. Change will be compared from baseline between groups (i.e. average change in knowledge scores specific to Choosing Wisely recommendations, expecting that knowledge will improve with respect to the content received). The outcome will be assessed two ways: 1\. Quantitatively via questionnaires: 21 knowledge questions with about 8 'true/false', 7 'multiple choice' and 6 'select all that apply' in each questionnaire (baseline, follow-up 1, 2 \& 3). Each question is worth 2 points, total score per questionnaire ranging from 0-42 pts. Knowledge will be assessed by comparing participant's scores on baseline to follow-up 1 (knowledge change) and comparing scores to follow-up 2 and 3 (knowledge retention).
次要结局
- Intentions - Quantitative Likert(week 0 (baseline), week 5 (follow-up 1))
- Intentions - Quantitative Multiple Choice(week 0 (baseline), week 5 (follow-up 1))
- Intentions - Qualitative(interviews will be conducted between week 5 - month 3)
- Expectations of care - quantitative(week 0 (baseline), week 5 (follow-up 1))
- Expectations of care - qualitative(interviews will be conducted between week 5 - month 3)
- Usability of the blogshots - Likert(week 5 (follow-up 1))
- Usability of the blogshots - open ended questions(week 5 (follow-up 1))
- Usability of the blogshots - qualitative(interviews will be conducted between week 5 - month 3)