Effectiveness of e-learning material on essential components of evidence-based medicine among laypersons: a randomized controlled trial.

Evidence-based medicine (EBM) is helpful for laypersons' decision-making. This study aimed to evaluate the effectiveness of e-learning materials on the essential components of EBM for laypersons. We conducted a web-based, open-label, randomized controlled trial with laypersons in Japan aged ≥20 years who used the internet. Participants were randomly assigned to the intervention group with the e-learning material and the control group with only the 'Introduction' section of the same material. The primary and secondary outcomes were the self-created acquirement test scores (responding correctly with confidence) immediately after using the material and after 4 weeks. A multiple linear regression analysis was conducted. Of the 122 participants, 62 were randomly assigned to the intervention group and 59 to the control group; finally, 59 and 58, respectively, were included in the full analysis set. The mean (standard deviation) of the acquirement test score immediately after learning was 14.11 and (3.11) and 11.07 (3.88) in the intervention and control groups, respectively, indicating statistical significance (multivariable P < 0.001). The secondary long-term outcome was also statistically significant. The results showed that the e-learning material was effective for laypersons in acquiring the essential components of EBM. The material may increase laypersons' confidence in appraising health information, which can be used in decision-making.

E-Learning Material of Evidence-Based Medicine for Laypersons.

BACKGROUND: There is a need for evidence-based medicine (EBM) education for laypersons. However, there are few materials or opportunities to learn EBM for Japanese laypersons. OBJECTIVE: The aim of this study was to develop and test the usability of e-learning material on EBM for health-conscious laypersons in Japan. METHODS: This study was conducted in two steps. First, content elements for the material were identified using purposive evaluation and a prototype of the e-learning material was developed. Following this, usability testing of the material was conducted. A questionnaire survey and qualitative semi-structured focus group interviews were conducted with health-conscious laypersons. Subsequently, the material was refined and finalized. KEY RESULTS: A total of 217 descriptions related to EBM were extracted from 12 materials and were integrated into 56 major elements. Each element was rated from the viewpoint of usefulness for laypersons and reviewed by four expert panelists, and finally 18 elements were confirmed, most of which were critical appraisal skills related to critical health literacy. For the usability testing after constructing the material, 25 laypersons participated, and 19 (76%) felt very/rather much interest in the contents of the material in the questionnaire. The results of five focus group interviews showed that the effectiveness of the e-learning material was influenced by the story and characters, and whether the contents of the material were consistent with interviewees' daily interests. CONCLUSIONS: The e-learning material on EBM was found to be of interest to health-conscious laypersons and appeared to be useful in participants' daily lives. This study successfully developed novel e-learning material on the essential components of EBM for laypersons in Japan. [HLRP: Health Literacy Research and Practice. 2022;6(4):e290-e299.] Plain Language Summary: This study developed and tested the usability of e-learning material to encourage health-conscious laypersons in Japan to learn the fundamentals of evidence-based medicine. Most of the contents of the material are related to critical health literacy. The usability testing showed that the material was of interest to non-health professionals and useful for dealing with health information in their daily lives.

Healthcare use and RT-PCR testing during the first wave of the COVID-19 pandemic in Japan.

BACKGROUND: Rapid testing, tracing, and isolation among symptomatic patients are the standard for controlling the COVID-19. However, during spring 2020, Japan employed a RT-PCR test policy by using a guideline, which was used for the public to visit hospitals or clinics when they had mild symptoms for 4 days or longer ("4-day rule") among low-risk patients. It is unknown of patients' experience of healthcare use and testing during the period under the guideline. Thus, we investigated the healthcare visiting and testing among patients who developed cold-like symptoms during the period. METHODS: Our survey was conducted online in September 2020 to a nationally representative sample of adults throughout Japan. We investigated the public's understanding of the guideline. In addition, we asked their experience with healthcare use and testing if they had noticed new-onset cold-like symptoms. RESULTS: Of 2,137 people surveyed, 1,698 (79.5%) recognized the guidelines, but 422 people (19.7%) misunderstood. There were 144 (6.7% of 2,137 people) who developed cold-like symptoms, and many of them experienced difficulties in getting through telephone calls to a public health center, and 25 (17% of 144 people) visited healthcare institutions. Of these 25 symptomatic patients, 15 (60%) could not receive testing because of decisions by physicians (14 patients) or a local public health center (1 patient). CONCLUSION: There was a low use of healthcare and testing among symptomatic patients during the first wave of the pandemic in Japan. Testing capacity should be increased to provide effective care for patients with suspected COVID-19 in Japan.

Health-care-seeking behaviours of the Japanese lay public during the COVID-19 pandemic: a cross-sectional study.

INTRODUCTION Owing to a decrease in visits to health-care facilities due to the coronavirus disease 2019 (COVID-19) pandemic, the health-care-seeking behaviour of the Japanese lay public has yet to be adequately clarified. AIM To explore health-care-seeking behaviour of the Japanese lay public during the COVID-19 pandemic in 2020. METHODS We conducted a web-based questionnaire survey in September 2020 to enquire about visits to health-care facilities for disease treatment and preventive services (health check-ups or cancer screening tests) during two periods: mid-February to May 2020 and from June to September 2020. Survey respondents were selected from people who voluntarily registered with a Japanese consumer research company, excluding health-care workers. Respondents' residence and sex were adjusted to represent the Japanese population. Survey results were aggregated after anonymizing respondents' personal information. RESULTS In total, 2137 people responded to the survey. The proportion of respondents who avoided new and follow-up visits to health-care facilities were 31.1% and 25.0%, respectively, in the first period and 19.1% and 12.5%, respectively, in the second period. In both periods, dentistry and general medicine were the most avoided health-care sites. Trying to avoid infection was the main motivation for this behaviour. Nearly half of respondents stated that they would not visit health facilities after the COVID-19 infection became controlled. DISCUSSION During the COVID-19 pandemic, the Japanese lay public indicated that they would avoid new and follow-up visits to health-care facilities. The highlighted changes in health-care-seeking behaviour may be long-term, even after COVID-19 is under control.

Updates to and quality of clinical practice guidelines for high-priority diseases in Japan.

PURPOSE: To examine the update status of clinical practice guidelines (CPGs) for 24 main diseases in Japan, and to clarify the quality of and issues pertaining to the most recent versions of CPGs for each disease. DATA SOURCES: CPGs were searched in two Japanese guideline databases. STUDY SELECTION: All relevant Japanese CPGs published between January 1999 and July 2016 were selected. DATA EXTRACTION: The developer and issue date were extracted for all target CPGs. The most recent CPGs were assessed using the Appraisal of Guidelines for Research and Evaluation-II (AGREE II) instrument. RESULTS OF DATA SYNTHESIS: Among 106 target CPGs, 24 most recent CPGs were subjected to assessment using the AGREE II instrument. CPGs for 11 diseases (46%) had a mean time interval for update of ≥5 years. Among the 24 CPGs subjected to AGREE II assessment, median domain scores were 74% for "Domain 1: Scope and Purpose," 43% for "Domain 2: Stakeholder Involvement," 46% for "Domain 3: Rigor of Development," 69% for "Domain 4: Clarity of Presentation," 24% for "Domain 5: Applicability" and 27% for "Domain 6: Editorial Independence." CONCLUSIONS: The systematic assessment of CPGs for 24 major diseases in Japan revealed a trend for a delay in timing of update for many CPGs. Moreover, the 24 most recent CPGs had low domain scores for domains 2, 3, 5 and 6. In the future, concrete measures will need to be considered in order to improve the quality of CPGs.

["Choosing Wisely" Improves Shared Decision Making].

"Choosing Wisely" is a campaign activity promoting awareness of the dangers of providing medical tests, drugs, and procedures that are not supported by firm scientific evidence and that may harm patients. The American Society of Health-System Pharmacists has released a recommendation on polypharmacy. Stakeholders such as patients, health professionals, hospital executives, industry, and mass media may all contribute to treatment decision making. The patient-centric "five questions you need to ask your doctor" are a useful trigger for better dialogue between patients and health professionals and could contribute to appropriate drug prescription in which benefit always exceeds the potential for harm.

[Status of Evidence-based Medicine Education in Undergraduate Pharmacy Curricula].

　This research aimed to clarify the present status and challenges of evidence-based medicine (EBM) education in schools of pharmacy. We sent a questionnaire to 268 faculty members in August 2015, and a total of 192 were completed. The educational contents by respondents differed considerably. Only about 30% of respondents self-assessed the current EBM courses they taught as "fulfilling". Challenges such as "time deficits", "lack of exercise lessons and practical training", "limited awareness and skills of teachers", "lack of appropriate educational tools", and "insufficient academic ability of students" were mentioned.

[Drug safety--from patients' perspective].

Patients expect drugs are 100% effective and safe. Unfortunately, however, most drugs are not. Continuous efforts by healthcare professionals and industry should be made to maximize efficacy and safety. Here, four challenges are shown from a viewpoint of laypersons. 1) Develop better drugs: Continuous efforts to develop drugs for 'neglected' diseases should be enhanced to meet unmet medical needs. 2) Deliver right drugs: Medication errors caused by similar names and shapes have been repeatedly reported. Communication with patients and their families may be helpful to decrease errors. 3) Improve the quality of drug information: How health professionals provide drug information to patients should be routinely monitored to improve the quality. Rephrasing to plain expressions may sometimes be useful for better communication. 4) Promote personalized medicine: Each patient wants to know whether this drug would work to him/herself as well as statistical data. Pharmacogenomics and pharmacokinetics/pharmacodynamics (PK/PD) research should be encouraged in order to develop personalized medicine.