Wikis and Collaborative Writing Applications as KT ......The rapid rise in the use of collaborative writing applications (eg, wikis, Google Documents, and Google Knol) has created

Wikis and Collaborative Writing Applications as KT Interventions in Health Care

Patrick Archambault MD, MSc, FRCPC

Emergency and critical care

specialist

FRQS Career Scientist

Département de médecine

familiale et médecine

d’urgence

Université Laval

CSSS Alphonse-Desjardins

Learning Objectives

• Learn about the existing evidence supporting the use of wikis and collaborative writing applications in health care • To learn about the barriers and facilitators in implementing a wiki and collaborative writing applications in health care • To learn about a theory-based approach to implement a wiki reminder system to implement best practices in trauma care

A bit of history …

• Lascaux: 15 000 BC • Rosetta stone: 196 BC • Gutenberg’s printing press:1450 • Encyclopaedia Britannica: 1768 • Berners Lee’s Internet: 1991 • Cunningham’s wiki: 1995

History of social media

• Jimmy Wales’s Wikipedia: 2001 • Zuckerberg’s Facebook 2004 • Dorsey’s Twitter 2006 • Medicine 2.0 • Since 2001 Medical wikis are exploding • HLWIKI: Top Fifty (50) Medical Wikis You Might (Want to) Know http://goo.gl/jhA6f

What is a wiki?

Wiki •  Webpage •  Content is

•  User-generated •  Edited by whoever has access •  Open access

What is a collaborative writing application (CWA)?

• Category of social media • Enables the joint and simultaneous editing • Webpage or an online document • By many end users • Wikis • Google Docs • Google Knols

• Although blogs, discussion boards, CoPs, VLEs are collaborative in nature

• More for ‘discussion’ or ‘conversation’

Kaplan et al Users of the world, unite! The challenges and opportunities of Social Media. Business Horizons 2010;53(1):59.

0

50

100

150

200

250

300

350

400

450

500

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

PubMed citations since 2001 about wikis

Archambault et al (unpublished data, JMIR Res Prot 2012 (http://goo.gl/vOSyc))

Are SoMe and wikis part of the evolution in knowledge use and dissemination?

Yes, you. You CONTROL the Information Age.

E-patient Dave: http://goo.gl/3vurj

Empowered Engaged Equiped Enabled

69% Internet access 5% online groups 7% blog 23% social networks

US MDs Intention to use social media

McGowan (2012), Meaningful use of social media, JMIR http://goo.gl/J8KeB

44%

Social media and Canadian MDs

• CMA survey (e-panel) 2010 • 647 respondents (20% participation) • 51% have a Facebook account • 17% have a LinkedIn account • 12% have a Twitter account • 9% are on another social network • 7% have a blog

Pat Rich: http://www.slideshare.net/prich

Other HCPs’ use of wikis in healthcare

• 70% of residents use Wikipedia each week for work (UK)

• 35% of pharmacists consulted Wikipedia (USA) for work-related questions

Hughes et al 2009 Brokowski et al 2009

Wait a minute… Where is the evidence ?

Many questions remain:

•  Effectiveness? •  Safety ? •  Validity ? •  Authorship? •  Legal? •  How to get

people involved?

Questions about wiki use

• What is the evidence about the potential benefit or harm of using wikis in healthcare?

• There is a need to explore their impact and potential as a KT tool

• Research program to answer these question was funded by FRQS (4-year career scientist award, 2012)

• Project A : Wikis and collaborative writing applications in health care: a scoping review

• Project B : Health professionals’ intentions to use wiki-based reminders promoting best practices in trauma (mixed methods survey)

• Project C : Development of a theory-based intervention aimed at increasing the use of wiki-based reminders to promote best practices in trauma care

• Project D : Implementation and evaluation of a theory-based intervention promoting best practices in trauma: a pilot cluster randomized controlled trial

FRQS-funded research program

Tableaux et figures 24856 ARCHAMBAULT, Patrick

1

Figure 1. The Knowledge-to-Action Process and the proposed wiki action sites

Figure 2. Theoretical framework of the Theory of Planned Behavior

From Ajzen I: Attitudes, personality and behavior. 1988, Keynes M, editor: Open University Press.

Behavior Intention Behavioral

beliefs

Attitude

Normative

beliefs

Subjective norm

Perceived behavioral

control

Control

beliefs

From Graham, ID, et al.: Lost in knowledge translation: time for a map? J Contin Educ

Health Prof 2006, 26(1): p. 13-24.

Note : Red circles identify potential wiki action sites in the KTA cycle;

29

Original Paper

Wikis and Collaborative Writing Applications in Health Care: AScoping Review Protocol

Patrick Michel Archambault1,2,3,4, MD, MSc, FRCPC; Tom H van de Belt5,6, MSc; Francisco J Grajales III7,8,BHK(Hons); Gunther Eysenbach7,9, MD, MPH; Karine Aubin1,10, MSc; Irving Gold11, MA, MCA; Marie-PierreGagnon10, PhD; Craig E Kuziemsky12, PhD; Alexis F Turgeon3,4, MD, MSc, FRCPC; Julien Poitras1,2, MD, CSPQ;Marjan J Faber13, PhD; Jan A.M Kremer5, MD, PhD; Marcel Heldoorn14, PhD; Andrea Bilodeau1, MSc; FranceLégaré2,15,16, MD, CFPC, PhD1Centre de santé et de services sociaux Alphonse-Desjardins (Centre hospitalier affilié universitaire de Lévis), Lévis, QC, Canada2Département de médecine familiale et médecine d'urgence, Université Laval, Québec, QC, Canada3Division de soins intensifs, Département d'anesthésiologie, Université Laval, Québec, QC, Canada4Axe Traumatologie – Urgence – Soins Intensifs, Centre de recherche FRQS du CHA universitaire de Québec, Québec, QC, Canada5Radboud University Nijmegen Medical Centre, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Nijmegen, Netherlands6Radboud University Nijmegen Medical Centre, Radboud REshape and Innovation Centre, Nijmegen, Netherlands7Social Media Working Group, International Medical Informatics Association, Geneva, Switzerland8eHealth Strategy Office, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada9Centre for Global eHealth Innovation, University of Toronto and University Health Network, Toronto, ON, Canada10Faculté des sciences infirmières, Université Laval, Québec, QC, Canada11Association of Faculties of Medicine of Canada, Ottawa, ON, Canada12Telfer School of Management, University of Ottawa, Ottawa, ON, Canada13Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands14Federation of Patients and Consumer Organisations in the Netherlands, Utrecht, Netherlands15Centre de recherche du Centre hospitalier universitaire de Québec (CRCHUQ), Quebec, QC, Canada16Canada Research Chair in Implementation of Shared Decision Making in Primary Care, Quebec, QC, Canada

Corresponding Author:Patrick Michel Archambault, MD, MSc, FRCPCCentre de santé et de services sociaux Alphonse-Desjardins (Centre hospitalier affilié universitaire de Lévis)143, rue WolfeLévis, QC, G6V3Z1CanadaPhone: 1 418 835 7121 ext 3905Fax: 1 418 835 7276Email: [email protected]

AbstractThe rapid rise in the use of collaborative writing applications (eg, wikis, Google Documents, and Google Knol) has created theneed for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector andfor an inventory of the factors that affect their use. While researchers have conducted systematic reviews on a range ofsoftware-based information and communication technologies as well as other social media (eg, virtual communities of practice,virtual peer-to-peer communities, and electronic support groups), none have reviewed collaborative writing applications in themedical sector. The overarching goal of this project is to explore the depth and breadth of evidence for the use of collaborativewriting applications in health care. Thus, the purposes of this scoping review will be to (1) map the literature on collaborativewriting applications; (2) compare the applications’ features; (3) describe the evidence of each application’s positive and negativeeffects as a KT intervention in health care; (4) inventory and describe the barriers and facilitators that affect the applications’ use;and (5) produce an action plan and a research agenda. A six-stage framework for scoping reviews will be used: (1) identifyingthe research question; (2) identifying relevant studies within the selected databases (using the EPPI-Reviewer software to classifythe studies); (3) selecting studies (an iterative process in which two reviewers search the literature, refine the search strategy, and

JMIR Res Protoc 2012 | vol. 1 | iss. 1 | e1 | p.1http://www.researchprotocols.org/2012/1/e1/(page number not for citation purposes)

Archambault et alJMIR RESEARCH PROTOCOLS

XSL•FORenderX

Original Paper

Wikis and Collaborative Writing Applications in Health Care: AScoping Review Protocol

Patrick Michel Archambault1,2,3,4, MD, MSc, FRCPC; Tom H van de Belt5,6, MSc; Francisco J Grajales III7,8,BHK(Hons); Gunther Eysenbach7,9, MD, MPH; Karine Aubin1,10, MSc; Irving Gold11, MA, MCA; Marie-PierreGagnon10, PhD; Craig E Kuziemsky12, PhD; Alexis F Turgeon3,4, MD, MSc, FRCPC; Julien Poitras1,2, MD, CSPQ;Marjan J Faber13, PhD; Jan A.M Kremer5, MD, PhD; Marcel Heldoorn14, PhD; Andrea Bilodeau1, MSc; FranceLégaré2,15,16, MD, CFPC, PhD1Centre de santé et de services sociaux Alphonse-Desjardins (Centre hospitalier affilié universitaire de Lévis), Lévis, QC, Canada2Département de médecine familiale et médecine d'urgence, Université Laval, Québec, QC, Canada3Division de soins intensifs, Département d'anesthésiologie, Université Laval, Québec, QC, Canada4Axe Traumatologie – Urgence – Soins Intensifs, Centre de recherche FRQS du CHA universitaire de Québec, Québec, QC, Canada5Radboud University Nijmegen Medical Centre, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine, Nijmegen, Netherlands6Radboud University Nijmegen Medical Centre, Radboud REshape and Innovation Centre, Nijmegen, Netherlands7Social Media Working Group, International Medical Informatics Association, Geneva, Switzerland8eHealth Strategy Office, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada9Centre for Global eHealth Innovation, University of Toronto and University Health Network, Toronto, ON, Canada10Faculté des sciences infirmières, Université Laval, Québec, QC, Canada11Association of Faculties of Medicine of Canada, Ottawa, ON, Canada12Telfer School of Management, University of Ottawa, Ottawa, ON, Canada13Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands14Federation of Patients and Consumer Organisations in the Netherlands, Utrecht, Netherlands15Centre de recherche du Centre hospitalier universitaire de Québec (CRCHUQ), Quebec, QC, Canada16Canada Research Chair in Implementation of Shared Decision Making in Primary Care, Quebec, QC, Canada

Corresponding Author:Patrick Michel Archambault, MD, MSc, FRCPCCentre de santé et de services sociaux Alphonse-Desjardins (Centre hospitalier affilié universitaire de Lévis)143, rue WolfeLévis, QC, G6V3Z1CanadaPhone: 1 418 835 7121 ext 3905Fax: 1 418 835 7276Email: [email protected]

AbstractThe rapid rise in the use of collaborative writing applications (eg, wikis, Google Documents, and Google Knol) has created theneed for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector andfor an inventory of the factors that affect their use. While researchers have conducted systematic reviews on a range ofsoftware-based information and communication technologies as well as other social media (eg, virtual communities of practice,virtual peer-to-peer communities, and electronic support groups), none have reviewed collaborative writing applications in themedical sector. The overarching goal of this project is to explore the depth and breadth of evidence for the use of collaborativewriting applications in health care. Thus, the purposes of this scoping review will be to (1) map the literature on collaborativewriting applications; (2) compare the applications’ features; (3) describe the evidence of each application’s positive and negativeeffects as a KT intervention in health care; (4) inventory and describe the barriers and facilitators that affect the applications’ use;and (5) produce an action plan and a research agenda. A six-stage framework for scoping reviews will be used: (1) identifyingthe research question; (2) identifying relevant studies within the selected databases (using the EPPI-Reviewer software to classifythe studies); (3) selecting studies (an iterative process in which two reviewers search the literature, refine the search strategy, and

JMIR Res Protoc 2012 | vol. 1 | iss. 1 | e1 | p.1http://www.researchprotocols.org/2012/1/e1/(page number not for citation purposes)

Archambault et alJMIR RESEARCH PROTOCOLS

XSL•FORenderX

http://www.researchprotocols.org/2012/1/e1/

Project A

Scoping review questions

• What is the evidence about the impact of CWAs and wikis in health care? • What is their potential role in KT? • What are the reported barriers and facilitators? • Where are the areas that need further systematic reviews? • What are the gaps in knowledge that needs more primary research?

Methods

• PubMed, Embase, Cochrane, CINAHL, PsychInfo, Eric and ProQuest Dissertations & Theses. • “wiki”, “wikis”, “web 2.0”, “social media”, “Google Knol”, “Google Docs” and “collaborative writing applications” •  Included if : • 1) Wikis, Google Docs, Google Knol, CWAs • 2) Health care • 3) Qualitative or quantitative empirical results

• Qualitative and qualitative content analysis

!

Grey%literature%excluded!Duplicates+(n=257)!Broken'link'(n=91)!Not$healthcare$field$(n=625)!Not$mentioning$wikis$or!!!!online&collaboration&tools!!!!(n=660)!No#results#(n=245)!Published*paper*already*!!!!Considered)(n=14)!

Total&(n=1892)!

Group&1:&Patterns&of&use&of&online&!collaborative+writing+applications*!

(n=25)!

Group&3:&Collaborative&writing&applications&used%as%knowledge%translation%intervention*%!

(n=73)!

Group&2:&Quality&of&information&in&different!collaborative!writing'applications*!

(n=25)!

Grey%literature%included!(n=30)!

Studies!identified'and'screened'for'!retrieval!(n=5808)!

Studies(excluded!Duplicates+(n=1372)!

Studies(screened(on(title(and(abstract!(n=4436)!

Studies(excluded!or#not#considered!Not$mentioning$wiki,$knol$or$online$!! collaboration*tools*(n=2853)!Not$healthcare$field$(n=1059)!Protocol'(n=7)!Conceptual+framework+(n=6)!Conference(proceedings((n=4)!Editorial)or)opinion)(n=106)!Literature(review((n=33)!

Total!(n=4068)!Studies(screened(on#full#text!

(n=368)!Studies(excluded!or#not#considered!

Wikipedia(used(only(as(a(reference((n=6)!Genetics/Genomics+(n=87)!Biology'(n=32)!Chemistry*(n=5)!Library'Science'(Medical'or'Health)'(n=14)!Neural'network'modeling'(n=1)!Medical(informatics((n=12)!Clinical&trials&and&wikis&(n=11)!Psychology)of)wiki)users)(n=5)!No#results#(n=119)!

Total!(n=292)!

Studies(analysed!(n=111)!

Papers'added!Grey%literature%(n=30)!Suggestions*by*authors*contacted**!!!!(n=2)!Abstract(from(conference((n=3)!

Total!(n=35)!

Studies!retrieved'from'targeted'!databases!(n=18&640)! Studies(excluded!

Exclusion*of*databases*(n=11*406)!Author'with'“Wiki”'in'name'(n=541)!Written'before'2001'(n=885)!

Total&(n=12&832)!

Grey%literature!Google/Bing/Yahoo-(n=1200)!Mednar'(n=400)!HTAi%vortal'(n=319)!Other&sources&(n=2)!

Total&(n=1921)!

*10$papers$are$classified$in$two$groups,$and$1$is$classified$in$all$three$groups!

Studies(considered!(n=76)!

47%

20%

21%

4% 4% 4%

Study design

case study/ case report

Descrip;ve quality assessment of wiki content

survey

randomised controlled trial

cohort/ cross-‐sec;onal/ case-‐control study

controlled before-‐and-‐aGer trial

46%

34%

1% 8%

4% 3% 3% 1%

Fields studied

educa;on

medicine

nursing

pharmacy

psychology-‐psychiatry

den;stry/maxillofacial

librarians and informa;cs

research/epidemiology

Barriers Facilitators Perceived beneficial effects

Perceived nega8ve effects

Unfamiliarity with informa;on and communica;on technologies (ICT) in general

Training Effects on psychological domains

Unfavorable effects on efficiency

Time constraints and workload

Scien;fic quality of the informa;on resources

Learning improvements Unfavorable effects on quality

Lack of self-‐efficacy (belief in one’s competence to use the ICT)

Ease of use/ease of content edi;ng

Communica;on Impedes collabora;on

Material resources – access to ICT

Triability Collabora;on Informa;on overload

Poor validity/scien;fic quality of the informa;on resources

Presence of a community of prac;ce or a community of learners

Knowledge management Fast dissemina;on of poorly validated informa;on

Presence of a closed wiki protected by a password

Integrated support tools within wiki (i.e. toolbox, FAQ, forum, policies)

Efficiency Dele;ng of poten;ally important medica;on informa;on on Wikipedia by pharmaceu;cal companies

Presence of a moderator Quality improvements

Use of incen;ves Disease preven;on

Experimental studies

• 4 experimental studies found •  Ioannis et al, 2011 (abstract only) • 80 Patients and their physicians • Shared Google Docs vs standard care • Online diary of patients physical activity and BP measurements • Better BP control, cholesterol levels, smoking status • No difference in physical activity

European Journal of Cardiovascular Prevention & Rehabilitation 2011 18: S4


• Stutsky, 2009 (dissertation only) • 51 Nurse educators enrolled in a course to teach leadership skills • Moderated wiki vs non-moderated • Self-efficacy, leadership skills increased in both groups • Teaching presence increased in the moderated group

Stutsky (2009) Empowerment and Leadership Development in an Online Story-Based Learning Community, Nova Southeastern University, PhD dissertation


• Moeller et al, 2010 • Medical students in PBL course • Wikis vs Chat vs Interactive Diagnostic application vs classical PBL • Student self-reported evaluations • Overall satifaction • Better perceived knowledge acquisition • Better communication • Better completion of the 7 steps of PBL • No difference in collaboration • Worse perceived diagnostic skills

Medical Teacher, 2010; 32: e328–e346


• Phadtare et al, 2009 • Teaching scientific writing skills to undergraduate health science students • Online teaching facilitated with Google Docs vs standard teaching • Better scientific writing skills evaluated by teachers (blinded to intervention) • Better communication in Google Docs • Better overall satisfaction

BMC Med Educ. 2009; 9: 27.

Some other interesting examples

• CWAs involving different stakeholders • Patients • Wikibreathe (Gupta et al) • FreyaWIKI (van de Belt et al)

• Scientists/Researchers • CADTH/Open Medicine/Asynchronous telehealth scoping review project (Bender) • WhatisKT wiki (McKibbon et al)

• Healthcare professionals • Google Docs and ED residents • Wiki-reminders in trauma

•  effective collaborative design of content and format aspects of an AAP

•  minimized logistical requirements •  maximized geographical representation •  mitigated hierarchical group dynamics

http://www.jmir.org/2011/4/e108/

•  298 unique visitors •  289 recommendations •  21 recommendations were ranked as the top 5 or

top 3 for their eligibility for being integrated into the clinical practice guideline

•  Challenges: ease of use, website content and layout, and characteristics of the wiki tool


•  120 pages. •  Traffic: 1700 visits per month •  Short term accesses (40 sec. per visit) •  Discussion of consolidation and

solidifying terminology was absent Implementation Science 2013, 8:13

•  Wikis provide: •  easy-to-use •  free and powerful means to edit

information •  Fewer than 1% of visitors contributed

content to the wiki

Conclusions scoping review

• Remains areas for further systematic review: • 4 experimental studies that show interesting potential • Is there publication bias? • Will better inform future prospective trials

• Remains areas that need further study • How to address different barriers? • How to stimulate participation? • With different stakeholders

• How to limit potential negative impacts?

Project B – Wiki survey

•  Title : Health professionals’ intentions to use wiki-based reminders promoting best practices in trauma

•  Objective: To identify the theory-based determinants (TPB) of emergency and critical care professionals’ use of collaborative writing applications in the context of their critical care practice

•  Phase I : Identification of salient beliefs •  Phase II : Construction of TPB questionnaire •  Phase III : Validation of questionnaire •  Phase IV: Survey

Protocol in Implementation Science

www.implementationscience.com/content/5/1/45

Background

• EDs and ICUs are hostile environments to the implementation of best practices in trauma care

• Significant regional variation in the treatment and outcomes of common injuries

Schuster M, McGlynn E, Brook R, 1998 Rhodes M, et al. 1990 Nayduch D, et al. 1994 Copes WS, et al.1995 Cryer HG, et al. 1996,

O'Keefe GE, Jurkovich GJ, Maier RV, 1999 Gruen RL, et al., 2006

The situation in Quebec

•  More than half of all injured patients spend more than the recommended 4 hours in the ED

•  Less than 10% of patients transferred from the ED to the OR or the ICU in less than 60 minutes

•  More than 30% of patients with a GCS less than 9 are intubated as recommended

Performance d’un continuum de services en traumatologie, Lavoie et al, 2010

Computer-based Reminders

• A range of decision aids that support decision making • Order sets • Care protocols • Clinical pathways • Clinical Decision Support Systems

• Computer-based reminders are moderately effective cognitive aids for fostering best practices

Sahota et al 2011 Shojania et al 2009

Barriers to the use of Computer-based Reminders

• Acute care professionals have rejected computer-based reminders because they are: • Slow • Incompatible with work processes • Unable to adapt to local practices • Difficult to access • Very costly to implement • Difficult and costly to update

Weingart et al 2003 Stiell et al 2007 Chan et al 2011 Wright et al 2010

Lang et al 2007 Black et al 2011 Holroyd et al 2011

Our overarching research question

• Can wikis help increase the use of computer-based reminders and improve care in the acute trauma care setting ?

Self-efficacy/empowerment

• Belief in an individual’s competence to perform a behavior • Most important cognitive human factor in the adoption of a new behavior • Wikis could improve our self-efficacy in the implementation of computer-based reminders

How could a wiki help empower clinicians?

• Create, share, and update their own reminders •  Allow local adaptation of external reminders •  Increase interprofessional collaboration •  Increase collaboration between academic centers and the community hospitals and rural hospitals •  Share tacit knowledge about best practices • Decrease the cost of producing reminders • Decrease the time to updating reminders

Berner 2009

Theory of planned behaviour

Adapted from Ajzen, 1988

Behaviour studied

• To use a wiki-based reminder promoting best practices in trauma during the care of a severe TBI victim

Methods •  25 MDs (emergency physicians) and 25 allied health professionnals (RNs, RTs, pharmacists)

•  EDs in 3 trauma centers in Quebec : Level I (n=20), II (n=20), III (n=10)

• Before each interview a 6-min video was presented: • Wiki concept • Presented a HCP using a wiki-based reminder on a computer screen at the bedside of a patient

Methods

Analysis of beliefs • Each interview was transcribed verbatim • 2 researchers independently performed qualitative content analysis to identify the beliefs, then consensus was achieved • Top 75% of beliefs were identified as salient


Control Beliefs for ED physicians

Control Beliefs for AHPs

MDs: behavioral beliefs

AHPs: behavioral beliefs

MDs : normatives beliefs

AHPs: normative beliefs

Methods (Phase 2 and 3)

• Phase 2: questionnaire • Salient beliefs were selected and items were developed for questionnaire

• Phase 3: Focus group with 5 MDs and 5 AHPs to assess readability

58

Methods phase 4

• Test-retest (2 week interval) with 25 emergency physicians and 25 AHPs in 3 trauma centers in Quebec. • Assess construct validity (Cronbach’s alpha) • Assess stabilty of constructs over time (Kendall tau) •  Item reduction • Internal consistency Cronbach’s alpha > 0.7 • stability over time Kendall Tau > 0.3

59

60

Internal consistency of direct constructs

Beliefs Cronbach’s alpha: Test

Cronbach’s alpha : re-test

Intention to use a wiki 0,94 (3 items) 0,98 (3 items)

PBC 0,65 (3 items) 0,86 (2 items)

0,67 (3 items) 0,85 (2 items)

Attitude 0,74 (4 items) 0,89 (3 items)

0,72 (4 items) 0,91 (3 items)

Subjective norm

0,79 (3 items) 0,78 (3 items)

61

Internal consistency of indirect constructs (after item reduction)

Beliefs Cronbach’s alpha: Test

Cronbach’s alpha: re-test

Normative beliefs 0.88 0.89

Control beliefs: facilitators 0.96 0.82

Control beliefs: barriers 0.72 0.77

Behavioral beliefs 0.96 0.90

Discussion • Many new specific beliefs concerning the use of wikis

•  Standardizes care •  Supports teamwork •  A new teaching tool • Gives access to up-to-date protocols •  Information that might change too fast • MDs and RNs name themselves as important referent •  The younger generation is another referent •  Isolated centers and rural hospital

Limitations of this study

• Limited number of AHPs per profession • New and complex behaviour: • Does not evaluate the behavior of contributing to a wiki

• Video addressed some of the potential barriers to using a wiki (e.g authorship) • The participants did not use a real wiki-based reminder

Strengths of the study

• First study about the beliefs of HCPs to use a wiki-based reminder • Theory-based (will help inform our future implementation) • Use of a video to study a complex behaviour •  Interprofessional • Valid and reliable questionnaire

Summary and steps to come

• We have created a valid questionnaire for emergency physicians • We still have to finish validating AHP questionnaire • Translate questionnaire to use survey with English-speaking participants across Canada • Conduct a survey of HCP across Canada about their intention to use a wiki-based reminder •  Identify most important beliefs for the adoption of a wiki-based reminder •  Inform a theory-based intervention

65

Project C: Theory-based intervention to increase use of wiki-based reminders

• Develop a wiki-based reminder system based on results from project A and B

• Develop a theory-based intervention aimed at increasing health professionals’ use of wiki-based reminder system to promote best trauma care.

• Michie et al. framework linking determinants of behavior among healthcare professionals to theory-based behavior modifying intervention

Michie S et al.: From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychology 2008, 57(4):660-80

Project D: IMPLEMENTATION AND EVALUATION OF A THEORY-BASED INTERVENTION (pilot cRCT)

• Assess feasibility of delivering theory-based intervention developed in project C • Evaluate clinician’s participation and evaluation of their experience with the theory-based intervention • To determine the impact of the theory-based intervention on the use of wiki-based reminders in trauma care • To obtain a first estimate of wikis’ effect on health professionals’ adoption of best practices in trauma care.

Acknowledgements •  KT Canada and my mentors

•  France Légaré •  Marie-Pierre Gagnon

•  Collaborators •  Tom van de Belt, M. Faber, J. Kremer •  Francisco Grajales and IMIA SoMe WG •  Gunther Eysenbach •  André Lavoie •  Lévis: Jean Lapointe, Julien Poitras •  Sylvain Croteau •  Craig Kuziemsky •  CCCTG: A. Turgeon, F. Lauzier, F. Lamontagne •  CCCTG KT: T. Sinuff and J. Muscedere •  Irving Gold (AFMC), Marcel Heldoorn

•  Colleagues at Lévis ED and ICU •  Research team

•  Susie, Simon, Cynthia, Jasmine, Azadeh •  Andrea, Catherine, Mathieu

•  My parents, wife and children