What is knowledge and when should it be implemented?

A primary purpose of research is to generate new knowledge. Scientific advances have progressively identified optimal ways to achieve this purpose. Included in this evolution are the notions of evidence-based medicine, decision aids, shared decision making, measurement and evaluation as well as implementation. The importance of including qualitative and quantitative methods in our research is now understood. We have debated the meaning of evidence and how to implement it. However, we have yet to consider how to include in our study findings other types of information such as tacit and experiential knowledge. This key consideration needs to take place before we translate new findings or 'knowledge' into clinical practice. This article critiques assumptions regarding the nature of knowledge and suggests a framework for implementing research findings into practice.

The use of tags and tag clouds to discern credible content in online health message forums.

BACKGROUND: Web sites with health-oriented content are potentially harmful if inaccurate or inappropriate medical information is used to make health-related decisions. Checklists, rating systems and guidelines have been developed to help people determine what is credible, but recent Internet technologies emphasize applications that are collaborative in nature, including tags and tag clouds, where site users 'tag' or label online content, each using their own labelling system. Concepts such as the date, reference, author, testimonial and quotations are considered predictors of credible content. An understanding of these descriptive tools, how they relate to the depiction of credibility and how this relates to overall efforts to label data in relation to the semantic web has yet to emerge. PURPOSE: This study investigates how structured (pre-determined) and unstructured (user-generated) tags and tag clouds with a multiple word search feature are used by participants to assess credibility of messages posted in online message forums. The targeted respondents were those using web sites message forums for disease self-management. We also explored the relevancy of our findings to the labelling or indexing of data in the context of the semantic web. METHOD: Diabetes was chosen as the content area in this study, since (a) this is a condition with increasing prevalence and (b) diabetics have been shown to actively use the Internet to manage their condition. From January to March 2010 participants were recruited using purposive sampling techniques. A screening instrument was used to determine eligibility. The study consisted of a demographic and computer usage survey, a series of usability tests and an interview. We tested participants (N=22) on two scenarios, each involving tasks that assessed their ability to tag content and search using a tag cloud that included six structured credibility terms (statistics, date, reference, author, testimonial and quotations). MORAE Usability software (version 3.1) was employed to record participants' use of the study environment. The surveys were analyzed using SPSS version 17. Interviews with participants were transcribed, coded and analyzed using thematic text analysis with the aid of NVivo8. FINDINGS: Most participants had experience with Internet resources. However, less than one quarter of this sample had seen or used tags or a tag clouds. The ways in which participants used tags to label the content posted in the message forums varied. Some participants were tagging the information for their own subsequent use, whereas others viewed this process from the perspective of others: they tagged the content in ways that they thought other users would find beneficial. Many participants did not use the structured credibility tags when asked to search for credible content. The interviews corroborated these findings by confirming participants were not considering credibility foremost when tagging. CONCLUSION: Many participants in this study focused on assessing whether the information was relevant to their current circumstances, after which they would proceed to determine its credibility by corroborating with other sources. The use of structured tags to label information may not be a useful way to encourage the use of tagging, or to indicate credibility in this context. Current applications used in the semantic web automate this process. Therefore it may be useful to engage consumers of online content, in particular health-related content, to be more directly involved in the annotation of this content.

Collaborative authoring: a case study of the use of a wiki as a tool to keep systematic reviews up to date.

BACKGROUND: Systematic reviews are recognized as the most effective means of summarizing research evidence. However, they are limited by the time and effort required to keep them up to date. Wikis present a unique opportunity to facilitate collaboration among many authors. The purpose of this study was to examine the use of a wiki as an online collaborative tool for the updating of a type of systematic review known as a scoping review. METHODS: An existing peer-reviewed scoping review on asynchronous telehealth was previously published on an open, publicly available wiki. Log file analysis, user questionnaires and content analysis were used to collect descriptive and evaluative data on the use of the site from 9 June 2009 to 10 April 2010. Blog postings from referring sites were also analyzed. RESULTS: During the 10-month study period, there were a total of 1222 visits to the site, 3996 page views and 875 unique visitors from around the globe. Five unique visitors (0.6% of the total number of visitors) submitted a total of 6 contributions to the site: 3 contributions were made to the article itself, and 3 to the discussion pages. None of the contributions enhanced the evidence base of the scoping review. The commentary about the project in the blogosphere was positive, tempered with some skepticism. INTERPRETATIONS: Despite the fact that wikis provide an easy-to-use, free and powerful means to edit information, fewer than 1% of visitors contributed content to the wiki. These results may be a function of limited interest in the topic area, the review methodology itself, lack of familiarity with the wiki, and the incentive structure of academic publishing. Controversial and timely topics in addition to incentives and organizational support for Web 2.0 impact metrics might motivate greater participation in online collaborative efforts to keep scientific knowledge up to date.

Measuring the impact of a moving target: towards a dynamic framework for evaluating collaborative adaptive interactive technologies.

BACKGROUND: Website evaluation is a key issue for researchers, organizations, and others responsible for designing, maintaining, endorsing, approving, and/or assessing the use and impact of interventions designed to influence health and health services. Traditionally, these evaluations have included elements such as content credibility, interface usability, and overall design aesthetics. With the emergence of collaborative, adaptive, and interactive ("Web 2.0") technologies such as wikis and other forms of social networking applications, these metrics may no longer be sufficient to adequately assess the quality, use or impact of a health website. Collaborative, adaptive, interactive applications support different ways for people to interact with health information on the Web, including the potential for increased user participation in the design, creation, and maintenance of such sites. OBJECTIVE: We propose a framework that addresses how to evaluate collaborative, adaptive, and interactive applications. METHODS: In this paper, we conducted a comprehensive review of a variety of databases using terminology related to this area. RESULTS: We present a review of evaluation frameworks and also propose a framework that incorporates collaborative, adaptive, and interactive technologies, grounded in evaluation theory. CONCLUSION: This framework can be applied by researchers who wish to compare Web-based interventions, non-profit organizations, and clinical groups who aim to provide health information and support about a particular health concern via the Web, and decisions about funding grants by agencies interested in the role of social networks and collaborative, adaptive, and interactive technologies technologies to improve health and the health system.

Meeting health information needs of people with HIV/AIDS: sources and means of collaboration.

BACKGROUND: Internet-based applications, in particular those that allow communication, have great potential to meet information needs. Limited research has indicated that people with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS; PHAs) use these technologies, but it has not yet been examined how resources are used collaboratively and in conjunction with offline sources. OBJECTIVES: The purpose of this study was to determine in what ways PHAs collaborate to meet treatment information needs and what role Internet-based computer-mediated communication (CMC) played in meeting this goal. METHODS: This exploratory study was implemented using surveys and focus groups with 23 participants in Toronto, Canada. The purposive sample included men and women. RESULTS: A variety of both off- and online resources were used to learn about HIV/AIDS treatment information, including web-based and print. All participants were communicating with others, primarily in person, and most desired anecdotal treatment information. However, few reported using CMC to accomplish this goal. Harris and Dewdney's Principles of Information Seeking was used to frame the findings. CONCLUSIONS: Despite technical proficiency with CMC, few participants in this study reported use of this communication tool. Information professionals need to ensure access to HIV health information including those in remote areas who have fewer resources.

The experiential health information processing model: supporting collaborative web-based patient education.

BACKGROUND: First generation Internet technologies such as mailing lists or newsgroups afforded unprecedented levels of information exchange within a variety of interest groups, including those who seek health information. With emergence of the World Wide Web many communication applications were ported to web browsers. One of the driving factors in this phenomenon has been the exchange of experiential or anecdotal knowledge that patients share online, and there is emerging evidence that participation in these forums may be having an impact on people's health decision making. Theoretical frameworks supporting this form of information seeking and learning have yet to be proposed. RESULTS: In this article, we propose an adaptation of Kolb's experiential learning theory to begin to formulate an experiential health information processing model that may contribute to our understanding of online health information seeking behaviour in this context. CONCLUSION: An experiential health information processing model is proposed that can be used as a research framework. Future research directions include investigating the utility of this model in the online health information seeking context, studying the impact of collaborating in these online environments on patient decision making and on health outcomes are provided.

Consumer e-health education in HIV/AIDS: a pilot study of a web-based video workshop.

BACKGROUND: Members of the HIV/AIDS community are known to use web-based tools to support learning about treatment issues. Initial research indicated components such as message forums or web-based documentation were effectively used by persons with HIV/AIDS. Video has also shown promise as a technology to aid consumer health education. However, no research has been published thus far investigating the impact of web-based environments combining these components in an educational workshop format. METHODS: In this qualitative study HIV/AIDS community members provided feedback on an integrated web-based consumer health education environment. Participants were recruited through organizations that serve the HIV/AIDS community located in Toronto, Canada. Demographics, data on Internet use, including messages exchanged in the study environment were collected. A group interview provided feedback on usability of the study environment, preferences for information formats, use of the message forum, and other sources for learning about treatment information. RESULTS: In this pilot study analysis of the posted messages did not demonstrate use for learning of the workshop content. Participants did not generally find the environment of value for learning about treatment information. However, participants did share how they were meeting these needs. It was indicated that a combination of resources are being used to find and discuss treatment information, including in-person sources. CONCLUSION: More research on the ways in which treatment information needs are being met by HIV/AIDS community members and how technology fits in this process is necessary before investing large amounts of money into web-based interventions. Although this study had a limited number of participants, the findings were unexpected and, therefore, of interest to those who intend to implement online consumer health education initiatives or interventions.

Future directions for depicting credibility in health care web sites.

OBJECTIVES: The purpose of the paper was to determine appropriate terminology, criteria, implementation, and develop a theoretical framework by which credibility in health care web sites can be depicted. Future research directions for evaluating credibility in health care web sites was also discussed. METHOD: A comprehensive literature review of published articles, policy papers, and grey literature using relevant search terms was conducted. Sources for articles reviewed included MEDLINE (from 1966 to present), PsycINFO (from 1840 to present), ERIC (from 1966 to present), and the Association for Computing Machinery (ACM) databases. The Web of Science citation service was continuously searched using a subscription service from 2002 to 2004. The search engine Google was also implemented. RESULTS: A common term, credibility, was purposed for use in this context. A comprehensive set of credibility criteria, presented within a theoretical framework was also developed. Implementation by means of a browser-based graphic icon was purposed. CONCLUSIONS: Relevancy and readiness of the purposed common terminology, criteria, and implementation within the theoretical framework must be further researched. More knowledge of consumers' behaviour regarding use of online health content and collaboration with others when implementing such information should be considered in future research.

Accessibility compliance rates of consumer-oriented Canadian health care Web sites.

Vast amounts of consumer-based health care information are widely available on the World Wide Web. However, for some this material is inaccessible due to reliance on specialized computer equipment or software known as assistive technology. These tools, designed for people with sensory, physical, or learning disabilities, act as a median to interpret Web pages in accessible ways. Unfortunately, many websites, including those with health-related content are not designed to accommodate this equipment. No research has yet been published examining the extent of this problem in Canadian consumer-oriented health care sites. The purpose of this study was to investigate the percentage of accessible consumer-based health care websites of Canadian origin. A listing of such sites was randomly sampled for study inclusion. Each was assessed for accessibility based on the World Wide Web Consortium (W3C) Web Accessibility Initiative (WAI) Web Content Accessibility Guidelines (WCAG) 1.0 using the validation software Bobby. The results indicated that only about 40% of pages investigated were free of errors in accordance with WCAG 1.0 Priority 1 level. Websites should be constructed in compliance with these standards to better accommodate those using assistive devices.