Outcomes of Equity-Oriented, Web-Based Parenting Information in Mothers of Low Socioeconomic Status Compared to Other Mothers: Participatory Mixed Methods Study.

BACKGROUND: Typically, web-based consumer health information is considered more beneficial for people with high levels of education and income. No evidence shows that equity-oriented information offers equal benefits to all. This is important for parents of low socioeconomic status (SES; low levels of education and income and usually a low level of literacy). OBJECTIVE: This study is based on a conceptual framework of information outcomes. In light of this, it aims to compare the perception of the outcomes of web-based parenting information in low-SES mothers with that of other mothers and explore the perspective of low-SES mothers on contextual factors and information needs and behavior associated with these outcomes. METHODS: A participatory mixed methods research was conducted in partnership with academic researchers and Naître et grandir (N&G) editors. N&G is a magazine, website, and newsletter that offers trustworthy parenting information on child development, education, health, and well-being in a format that is easy to read, listen, or watch. Quantitative component (QUAN) included a 3-year longitudinal observational web survey; participants were mothers of 0- to 8-year-old children. For each N&G newsletter, the participants' perception regarding the outcomes of specific N&G webpages was gathered using a content-validated Information Assessment Method (IAM) questionnaire. Differences between participants of low SES versus others were estimated. Qualitative component (QUAL) was interpretive; participants were low-SES mothers. The thematic analysis of interview transcripts identified participants' characteristics and different sources of information depending on information needs. Findings from the two components were integrated (QUAN+QUAL integration) through the conceptual framework and assimilated into the description of an ideal-typical mother of low SES (Kate). A narrative describes Kate's perception of the outcomes of web-based parenting information and her perspective on contextual factors, information needs, and behavior associated with these outcomes. RESULTS: QUAN-a total of 1889 participants completed 2447 IAM responses (50 from mothers of low SES and 2397 from other mothers). N&G information was more likely to help low-SES participants to better understand something, decrease worries, and increase self-confidence in decision making. QUAL-the 40 participants (21 N&G users and 19 nonusers) used 4 information sources in an iterative manner: websites, forums, relatives, and professionals. The integration of QUAN and QUAL findings provides a short narrative, Kate, which summarizes the main findings. CONCLUSIONS: This is the first study comparing perceptions of information outcomes in low-SES mothers with those of other mothers. Findings suggest that equity-oriented, web-based parenting information can offer equal benefits to all, including low-SES mothers. The short narrative, Kate, can be quickly read by decision policy makers, for example, web editors, and might encourage them to reach the underserved and provide and assess trustworthy web-based consumer health information in a format that is easy to read, listen, or watch.

Patients' perspective of barriers and facilitators to taking long-term controller medication for asthma: a novel taxonomy.

BACKGROUND: Although asthma morbidity can be prevented through long-term controller medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. The objective of this study was to gather patients' insights into barriers and facilitators to taking long-term daily inhaled corticosteroids as basis for future knowledge translation interventions. METHODS: We conducted a collective qualitative case study. We interviewed 24 adults, adolescents, or parents of children, with asthma who had received a prescription of long-term inhaled corticosteroids in the previous year. The one-hour face-to-face interviews revolved around patients' perceptions of asthma, use of asthma medications, current self-management, prior changes in self-management, as well as patient-physician relationship. We sought barriers and facilitators to optimal asthma management. Interviews were transcribed verbatim and transcripts were analyzed using a thematic approach. RESULTS: Patients were aged 2-76 years old and 58% were female. Nine patients were followed by an asthma specialist (pulmonologist or allergist), 13 patients by family doctors or pediatricians, and two patients had no regular follow-up. Barriers and facilitators to long-term daily inhaled corticosteroids were classified into the following loci of responsibility and its corresponding domains: (1) patient (cognition; motivation, attitudes and preferences; practical implementation; and parental support); (2) patient-physician interaction (communication and patient-physician relationship); and (3) health care system (resources and services). Patients recognized that several barriers and facilitators fell within their own responsibility. They also underlined the crucial impact (positive or negative) on their adherence of the quality of patient-physician interaction and health care system accessibility. CONCLUSIONS: We identified a close relationship between reported barriers and facilitators to adherence to long-term daily controller medication for asthma within three loci of responsibility. As such, patients' adherence must be approached as a multi-level phenomenon; moreover, interventions targeting the patient, the patient-physician interaction, and the health care system are recommended. The present study offers a potential taxonomy of barriers and facilitators to adherence to long-term daily inhaled corticosteroids therapy that, once validated, may be used for planning a knowledge translation intervention and may be applicable to other chronic conditions.

Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper.

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.

L'asthme fait souvent son apparition avant l'âge de six ans. Cependant, il subsiste des incertitudes relativement à quand et comment un enfant d'âge préscolaire ayant des symptômes de type asthmatique peut être diagnostiqué avec cette condition. Ceci retarde le traitement et contribue à la morbidité à court et à long terme. L'Assemblée clinique sur l'asthme de la Société canadienne de thoracologie s'est associée à la Société canadienne de pédiatrie pour créer un groupe de travail conjoint afin de préparer un document de principes sur le diagnostic et la prise en charge de l'asthme chez les enfants d'âge préscolaire. En l'absence de mesures de la fonction pulmonaire, le diagnostic d'asthme devrait être envisagé chez les enfants de un à cinq ans ayant des symptômes de type asthmatique fréquents (≥8 jours/mois) ou des exacerbations récurrentes (≥2) (épisodes accompagnés de signes compatibles). Le diagnostic nécessite une documentation objective des signes cliniques ou un compte rendu parental convaincant de symptômes d'obstruction des voies respiratoires et de réversibilité de l' obstruction (amélioration suite à un traitement pour l'asthme), ainsi que l'absence de suspicion clinique de tout autre diagnostic. La respiration sifflante, souvent accompagnée de difficultés respiratoires et de toux, est le signe cardinal de l'obstruction des voies respiratoires. La réversibilité à la suite de la prise de médicaments pour l'asthme se définie par l'observation directe par un professionnel de la santé compétent, d'une amélioration après l'administration de ß2-agonistes à courte durée d'action (BACA) (accompagnés ou non de corticostéroïdes par voie orale) pendant une exacerbation aigue (méthode diagnostique privilégiée). Cependant, chez les enfants qui n'ont pas à l'examen une respiration sifflante (ni d'autres signes d'obstruction des voies respiratoires), la réversibilité peut être déterminée par un compte rendu parental convaincant d'une réponse symptomatique à un essai thérapeutique de trois mois de corticostéroïdes inhalés, à dose moyenne, avec un BACA au besoin (méthode diagnostique alternative), ou avec seulement un BACA au besoin (méthode diagnostique alternative moins certaine) est recommandé. Les auteurs présentent des messages clés quant aux enfants chez lesquels on doit envisager le diagnostic, quant aux termes désuets à abandonner, quant aux situations pour lesquelles on doit orienter l'enfant vers un spécialiste de l'asthme et quant à la stratégie de prise en charge initiale. Enfin, ils décrivent la stratégie de diffusion de ces messages et identifient les domaines de recherche prioritaires.

Number needed to benefit from information (NNBI): proposal from a mixed methods research study with practicing family physicians.

PURPOSE: We wanted to describe family physicians' use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. METHODS: We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008-2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. RESULTS: In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). CONCLUSION: The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported.

The Clinical Relevance of Information Index (CRII): assessing the relevance of health information to the clinical practice.

BACKGROUND: The high volume of health information creates a need for processes and tools to select, evaluate and disseminate relevant information to health professionals in clinical practice. OBJECTIVES: To introduce an index of the clinical relevance of information and to show that it is different from existing measures. METHODS: A conceptual model of knowledge translation was developed to explain the need for a new index, whose application was verified by an exploratory study with two (quantitative and qualitative) phases. The Clinical Relevance of Information Index (CRII) was defined employing descriptive statistical analyses of assessments performed by health professionals. The model and the CRII were applied in a primary healthcare context. RESULTS: The CRII was applied to 4574 relevance assessments of 194 evidence synopses. The assessments were performed by 41 family physicians in 2008. The CRII value of each synopsis was compared with the number of citations received by its corresponding research paper and with the level of evidence of the study, presenting weak correlation with both. CONCLUSION: The CRII captures aspects of information not considered by other indices. It can be a parameter for information providers, institutions, editors, as well as health and information professionals targeting knowledge translation.

Impact of research-based synopses delivered as daily e-mail: a prospective observational study.

We conducted a prospective observational study to (1) determine usage and construct validity of a method to gauge the cognitive impact of information derived from daily e-mail, and (2) describe self-reported impacts of research-based synopses (InfoPOEMs) delivered as e-mail. Ratings of InfoPOEMs using an Impact assessment scale provided (a) data on usage of the impact assessment method, (b) reports of impact by InfoPOEM and by doctor and (c) data for analysis of construct validity of the scale. PARTICIPANTS were family physicians or general practitioners who rated at least five InfoPOEMs delivered on e-mail. For each InfoPOEM rated, 0.1 continuing education credit was awarded by the College of Family Physicians of Canada. Use of the impact assessment scale linked to a daily InfoPOEM was sustained during the 150-day study period. 1,007 participants submitted 61,493 reports of 'cognitive impact' by rating on average 61 InfoPOEMs (range 5-111). 'I learned something new' was most frequently reported. 'I was frustrated as there was not enough information or nothing useful' was the most frequently reported negative type of impact. The proportion of reports of 'No Impact' varied substantially across individual InfoPOEMs. Impact patterns suggested an 8 or 9-factor solution. Our Impact assessment method facilitates knowledge transfer by promoting two-way exchange between providers of health information and family doctors. Providers of health information can use this method to better understand the impact of research-based synopses. Sustaining current practice and increasing knowledge about new developments in medicine are important outcomes arising from research-based synopses delivered as e-mail, in addition to practice change.

Systematically assessing the situational relevance of electronic knowledge resources: a mixed methods study.

UNLABELLED: Electronic Knowledge Resources (EKRs) are increasingly used by physicians, but their situational relevance has not been systematically examined. OBJECTIVE: Systematically scrutinize the situational relevance of EKR-derived information items in and outside clinical settings. BACKGROUND: Physicians use EKRs to accomplish four cognitive objectives (C1-4), and three organizational objectives (O1-3): (C1) Answer questions/solve problems/support decision-making in a clinical context; (C2) fulfill educational-research objectives; (C3) search for personal interest or curiosity; (C4) overcome limits of human memory; (O1) share information with patients, families, or caregivers; (O2) exchange information with other health professionals; (O3) plan-manage-monitor tasks with other health professionals. METHODS: Longitudinal mixed methods multiple case study: Cases were 17 residents' critical searches for information, using a commercial EKR, during a 2-month block of family practice. Usage data were automatically recorded. Each "opened" item of information was linked to an impact assessment questionnaire, and 1,981 evaluations of items were documented. Interviews with residents were guided by log files, which tracked use and impact of EKR-derived information items. Thematic analysis identified 156 critical searches linked to 877 information items. For each case, qualitative data were assigned to one of the seven proposed objectives. RESULTS: Residents achieved their search objectives in 85.9% of cases (situational relevance). Additional sources of information were sought in 52.6% of cases. Results support the seven proposed objectives, levels of comparative relevance (less, equally, more), and levels of stimulation of learning and knowledge (individual, organizational). CONCLUSION: Our method of systematic assessment may contribute to user-based evaluation of EKRs.

Seven reasons why health professionals search clinical information-retrieval technology (CIRT): toward an organizational model.

RATIONALE AND AIM: Clinical Information-Retrieval Technology (CIRT) is increasingly used, for example in accessing drug databases. However, no comprehensive framework exists to understand why health professionals search for information using CIRT. The present article aims to propose such organizational framework. BACKGROUND: Our literature review suggests six reasons, of which three refer to cognitive objectives (C1, C2, C3) and three to organizational objectives (O1, O2, O3): (C1) to answer-solve-support a clinical question-problem-decision; (C2) to fulfil an educational-research objective; (C3) to search in general or for curiosity; (O1) to share information with patients; (O2) to exchange information with other health professionals; (O3) to plan-manage-monitor tasks with other health professionals. METHODS: The case study examined the use and impact of the InfoRetriever software on handheld computers in a Canadian family practice centre. Using the Critical Incident Technique, six family doctors were interviewed on specific events. A thematic analysis assigned extracts of interviews to reasons for use. FINDINGS AND CONCLUSION: Findings illustrate the six reasons, and suggest a seventh reason that refers to a cognitive objective, namely (C4) to overcome the limits of health professional memory. These seven reasons are interpreted according to the literature on information science and organization studies, which suggest ordering reasons at three levels of stimulation of learning and knowledge: none (objective not achieved), moderate (cognitive objective achieved), and high (organizational objective achieved). This paves the way toward a new evaluation of relevance of CIRT in everyday practice (judgement based on professionals' objective achievement) using an organizational model of information-retrieving processes.

Effect of a PDA-assisted evidence-based medicine course on knowledge of common clinical problems.

BACKGROUND AND OBJECTIVES: It is not yet known if personal digital assistant (PDA)-assisted evidence-based medicine (EBM) courses in postgraduate training enhance knowledge of common clinical problems. This study's objective was to determine if PDA-assisted EBM training would improve clinical knowledge. METHODS: In a controlled trial, intervention group residents received InfoRetriever on a PDA coupled with an EBM course integrated within clinical rotations in family medicine. The effect of the intervention and the rate of use of InfoRetriever on a written test of knowledge were evaluated after adjusting for baseline knowledge scores. The test measured knowledge of primary care management of hypertension and diabetes as well as estimation of disease probability. RESULTS: There was no effect on first posttest knowledge scores of the intervention overall or of the rate with which participants had used InfoRetriever during the intervention. However, when intervention group residents retook the test with access to InfoRetriever while taking the knowledge test, scores increased 7.4% (+2.4 correct test questions). Access to InfoRetriever Clinical Prediction Rules on a PDA, however, had an unclear effect on residents' ability to estimate disease probability. CONCLUSIONS: There was no effect of a PDA-assisted EBM course on knowledge test scores, although using the PDA during the test results in higher scores. It is unclear if using PDA Clinical Prediction Rules can improve residents' estimates of disease probability.

Assessing the impact of clinical information-retrieval technology in a family practice residency.

RATIONALE AND OBJECTIVE: Evidence-based sources of information do not integrate self-assessment tools to assess the impact of a users' search for clinical information. We present a method to evaluate evidence-based sources of information, by systematically assessing the impact of searches for clinical information in everyday practice. METHODS: We integrated an information management tool (InfoRetriever 2003) with an educational intervention in a cohort of 26 family medicine residents. An electronic impact assessment scale was used by these doctors to report the perceived impact of each item of information (each hit) retrieved on hand-held computer. We compared the types of impact associated with hits in two distinct categories: clinical decision support systems (CDSS) vs. clinical information-retrieval technology (CIRT). Information hits in CDSS were defined as any hit in the following InfoRetriever databases: Clinical Prediction Rules, History and Physical Exam diagnostic calculator and Diagnostic Test calculator. CIRT information hits were defined as any hit in: Abstracts of Cochrane Reviews, InfoPOEMs, evidence-based practice guideline summaries and the Griffith's 5 Minute Clinical Consult. RESULTS: The impact assessment questionnaire was linked to 5160 information hits. 4946 impact assessment questionnaires were answered (95.9%), and 2495 contained reports of impact (48.4%). Reports of positive impact on doctors were most frequently in the areas of learning and practice improvement. In comparison to CDSS, CIRT hits were more frequently associated with learning and recall. CDSS hits were more frequently associated with reports of practice improvement. CONCLUSIONS: Our new method permits systematic and comparative assessment of impact associated with distinct categories of information.

Impact of clinical information-retrieval technology on physicians: a literature review of quantitative, qualitative and mixed methods studies.

PURPOSE: This paper appraises empirical studies examining the impact of clinical information-retrieval technology on physicians and medical students. METHODS: The world literature was reviewed up to February 2004. Two reviewers independently identified studies by scrutinising 3368 and 3249 references from bibliographic databases. Additional studies were retrieved by hand searches, and by searching ISI Web of Science for citations of articles. Six hundred and five paper-based articles were assessed for relevance. Of those, 40 (6.6%) were independently appraised by two reviewers for relevance and methodological quality. These articles were quantitative, qualitative or of mixed methods, and 26 (4.3%) were retained for further analysis. For each retained article, two teams used content analysis to review extracted textual material (quantitative results and qualitative findings). RESULTS: Observational studies suggest that nearly one-third of searches using information-retrieval technology may have a positive impact on physicians. Two experimental and three laboratory studies do not reach consensus in support of a greater impact of this technology compared with other sources of information, notably printed educational material. Clinical information-retrieval technology may affect physicians, and further research is needed to examine its impact in everyday practice.

Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper.

Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥ 8 days/month) asthma-like symptoms or recurrent (≥ 2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.

Development and content validation of the information assessment method for patients and consumers.

BACKGROUND: Online consumer health information addresses health problems, self-care, disease prevention, and health care services and is intended for the general public. Using this information, people can improve their knowledge, participation in health decision-making, and health. However, there are no comprehensive instruments to evaluate the value of health information from a consumer perspective. OBJECTIVE: We collaborated with information providers to develop and validate the Information Assessment Method for all (IAM4all) that can be used to collect feedback from information consumers (including patients), and to enable a two-way knowledge translation between information providers and consumers. METHODS: Content validation steps were followed to develop the IAM4all questionnaire. The first version was based on a theoretical framework from information science, a critical literature review and prior work. Then, 16 laypersons were interviewed on their experience with online health information and specifically their impression of the IAM4all questionnaire. Based on the summaries and interpretations of interviews, questionnaire items were revised, added, and excluded, thus creating the second version of the questionnaire. Subsequently, a panel of 12 information specialists and 8 health researchers participated in an online survey to rate each questionnaire item for relevance, clarity, representativeness, and specificity. The result of this expert panel contributed to the third, current, version of the questionnaire. RESULTS: The current version of the IAM4all questionnaire is structured by four levels of outcomes of information seeking/receiving: situational relevance, cognitive impact, information use, and health benefits. Following the interviews and the expert panel survey, 9 questionnaire items were confirmed as relevant, clear, representative, and specific. To improve readability and accessibility for users with a lower level of literacy, 19 items were reworded and all inconsistencies in using a passive or active voice have been solved. One item was removed due to redundancy. The current version of the IAM4all questionnaire contains 28 items. CONCLUSIONS: We developed and content validated the IAM4all in partnership with information providers, information specialists, researchers and representatives of information consumers. This questionnaire can be integrated within electronic knowledge resources to stimulate users' reflection (eg, their intention to use information). We claim that any organization (eg, publishers, community organizations, or patient associations), can evaluate and improve their online consumer health information from a consumers' perspective using this method.

An online knowledge resource and questionnaires as a continuing pharmacy education tool to document reflective learning.

OBJECTIVE: To assess the use of an electronic knowledge resource to document continuing education activities and reveal educational needs of practicing pharmacists. METHODS: Over a 38-week period, 67 e-mails were sent to 6,500 Canadian Pharmacists Association (CPhA) members. Each e-mail contained a link to an e-Therapeutics+ Highlight, a factual excerpt of selected content from an online drug and therapeutic knowledge resource. Participants were then prompted to complete a pop-up questionnaire. RESULTS: Members completed 4,140 questionnaires. Participants attributed the information they learned in the Highlights to practice improvements (50.4%), learning (57.0%), and motivation to learn more (57.4%). CONCLUSIONS: Reading Highlight excerpts and completing Web-based questionnaires is an effective method of continuing education that could be easily documented and tracked, making it an effective tool for use with e-portfolios.

Evaluation of email alerts in practice: Part 1. Review of the literature on clinical emailing channels.

RATIONALE: Methods to systematically assess electronic knowledge resources by health professionals may enhance evaluation of these resources, knowledge exchange between information users and providers, and continuing professional development. We developed the Information Assessment Method (IAM) to document health professional perspectives on the relevance, cognitive impact, potential use and expected health outcomes of information delivered by (push) or retrieved from (pull) electronic knowledge resources. However, little is known about push communication in health sciences, and what we propose to call clinical emailing channels (CECs). CECs can be understood as a communication infrastructure that channels clinically relevant research knowledge, email alerts, from information providers to the inboxes of individual practitioners. AIMS: In two companion papers, our objectives are to (part 1) explore CEC evaluation in routine practice, and (part 2) examine the content validity of the cognitive component of IAM. METHODS: The present paper (part 1) critically reviews the literature in health sciences and four disciplines: communication, information studies, education and knowledge translation. Our review addresses the following questions. What are CECs? How are they assessed? RESULTS: The review contributes to better define CECs, and proposes a 'push-pull-acquisition-cognition-application' evaluation framework, which is operationalized by IAM. CONCLUSION: Compared with existing evaluation tools, our review suggests IAM is comprehensive, generic and systematic.

Evaluation of email alerts in practice: Part 2. Validation of the information assessment method.

RATIONALE AND OBJECTIVE: The information assessment method (IAM) permits health professionals to systematically document the relevance, cognitive impact, use and health outcomes of information objects delivered by or retrieved from electronic knowledge resources. The companion review paper (Part 1) critically examined the literature, and proposed a 'Push-Pull-Acquisition-Cognition-Application' evaluation framework, which is operationalized by IAM. The purpose of the present paper (Part 2) is to examine the content validity of the IAM cognitive checklist when linked to email alerts. METHODS: A qualitative component of a mixed methods study was conducted with 46 doctors reading and rating research-based synopses sent on email. The unit of analysis was a doctor's explanation of a rating of one item regarding one synopsis. Interviews with participants provided 253 units that were analysed to assess concordance with item definitions. RESULTS AND CONCLUSION: The content relevance of seven items was supported. For three items, revisions were needed. Interviews suggested one new item. This study has yielded a 2008 version of IAM.