The effects of a web-based decision aid on the intention to diagnostic self-testing for cholesterol and diabetes: a randomized controlled trial.

BACKGROUND: Diagnostic self-tests are becoming increasingly available. Since the pros and cons of self-testing are unclear and neutral information on self-testing is lacking, two decision aids (DAs) on self-testing for cholesterol and diabetes were developed to support consumers in making an informed choice that is in line with their personal values. We aimed to evaluate the effect of the DAs on the intention to self-test for cholesterol or diabetes, as well as socio-cognitive determinants of that intention. METHODS: 1137 people of an internet panel with an intention to use a diagnostic self-test for cholesterol or diabetes were enrolled in a web-based randomized controlled trial consisting of four groups: a cholesterol intervention and control group and a diabetes intervention and control group. The study was conducted in September and October 2011. The intervention groups received an interactive online DA with general information on self-testing and test-specific information on cholesterol or diabetes self-testing, whereas the control groups received a limited information sheet with general information on self-testing. The intention to use a self-test for cholesterol or diabetes and perceived susceptibility, perceived severity, cues to action, perceived benefits, perceived barriers, self-efficacy and ambivalence towards self-testing were assessed directly after being exposed to the intervention or control information. RESULTS: Follow-up measurement was completed by 922 people. Analyses showed a significant group by intention at baseline interaction effect within the diabetes condition. Further exploration of this interaction showed that a main group-effect was only observed among maybe-intenders; intention of participants in the intervention group did not change between baseline and follow-up, while intention slightly increased in the control group. We observed a significant main effect of group on cues to action in the cholesterol condition. CONCLUSIONS: We found limited effects of the DAs on intention and its determinants. Although the time spent on the DAs was limited, we might assume that our DAs contain neutral information on self-testing for cholesterol and diabetes. By implementing our DAs in real life among people who probably or definitely intend to use a self-test and by assessing weblog files, we might be able to determine the effectiveness of our DAs on self-test behaviour. DUTCH TRIAL REGISTER: NTR3149.

Quality and use of consumer information provided with home test kits: room for improvement.

BACKGROUND: Diagnostic self-tests (tests on body materials that are initiated by consumers with the aim of diagnosing a disorder or risk factor) are becoming increasingly available. Although the pros and cons of self-testing are currently not clear, it is an existing phenomenon that is likely to gain further popularity. OBJECTIVE: To examine consumers' use of and needs for information about self-testing, and to assess the quality of consumer information provided with home test kits, as perceived by consumers and as assessed using a checklist of quality criteria. METHODS: A cross-sectional Internet survey among 305 self-testers assessed their use of and needs for information and their perception of the quality of consumer information provided with self-test kits. A meta-search engine was used to identify Dutch and English consumer information for home diagnostic tests available online at the time of the study. The quality of this consumer information was evaluated using a checklist of quality criteria. RESULTS: The consumers' information needs were in line with the most frequently used information, and the information was perceived as being of moderate to good quality. The information was mostly in agreement with clinical practice guidelines, although information on reliability and follow-up behaviour was limited. Approximately half of the instruction leaflets did not include information on the target group of the test. CONCLUSIONS: Although generally of moderate to good quality, some aspects of the information provided were in many cases insufficient. European legislation concerning self-tests and accompanying information needs to be adapted and adhered to more closely.

Motivation and experiences of self-testers regarding tests for cardiovascular risk factors.

BACKGROUND: In recent years, self-tests have become increasingly available to the general public, though their value is still being debated. Because these tests are available, consumers should have access to clear information about self-testing. Examining experiences of self-testers could contribute to the development of consumer information. OBJECTIVE: Detailed exploration of consumers' experiences with self-testing for cardiovascular risk factors. METHODS: Semi-structured interviews with 20 consumers who had performed a self-test for glucose, cholesterol or albuminuria. The main topics of the interviews were reasons for self-testing, performing the self-test, follow-up behaviour and perceived need for information on self-testing. Data were analysed using thematic content analysis. RESULTS: Regarding the reason for self-testing, three types of users were distinguished: those who engaged in self-testing when a test was offered, either with or without previous knowledge about the disease or risk factor, and those who had actively decided to test and had searched for a self-test themselves. Self-testers had generally experienced no problems performing the test or interpreting the result and had considerable confidence in the result. They were easily reassured by a normal result, while an abnormal result did not automatically mean they consulted a doctor. Most participants did not feel the need for more information. CONCLUSIONS: Self-testers often perform tests for reassurance, without considering the disadvantages, such as the absence of professional counselling and the risk of false-positive or false-negative results. Consumer information should promote more informed and deliberate choices for self-testing.

A single-blind randomised controlled trial of the effects of a web-based decision aid on self-testing for cholesterol and diabetes. Study protocol.

BACKGROUND: Self-tests, tests on body materials to detect medical conditions, are widely available to the general public. Self-testing does have advantages as well as disadvantages, and the debate on whether self-testing should be encouraged or rather discouraged is still ongoing. One of the concerns is whether consumers have sufficient knowledge to perform the test and interpret the results. An online decision aid (DA) with information on self-testing in general, and test specific information on cholesterol and diabetes self-testing was developed. The DA aims to provide objective information on these self-tests as well as a decision support tool to weigh the pros and cons of self-testing. The aim of this study is to evaluate the effect of the online decision aid on knowledge on self-testing, informed choice, ambivalence and psychosocial determinants. METHODS/DESIGN: A single blind randomised controlled trial in which the online decision aid 'zelftestwijzer' is compared to short, non-interactive information on self-testing in general. The entire trial will be conducted online. Participants will be selected from an existing Internet panel. Consumers who are considering doing a cholesterol or diabetes self-test in the future will be included. Outcome measures will be assessed directly after participants have viewed either the DA or the control condition. Weblog files will be used to record participants' use of the decision aid. DISCUSSION: Self-testing does have important pros and cons, and it is important that consumers base their decision whether they want to do a self-test or not on knowledge and personal values. This study is the first to evaluate the effect of an online decision aid for self-testing. TRIAL REGISTRATION: Dutch Trial Register: NTR3149.

Effectiveness of testing for genetic susceptibility to smoking-related diseases on smoking cessation outcomes: a systematic review and meta-analysis.

OBJECTIVE: To examine whether genetic testing for smoking-related diseases benefits smoking cessation. DATA SOURCES: PubMed, EMBASE, ERIC, PsycINFO, PsychArticles, CiNAHL and socINDEX databases, the search engine Google Scholar, and key-author and reference list searches. Study selection Randomised controlled smoking cessation interventions using genetic testing for smoking-related diseases. DATA EXTRACTION: Consistent with the Cochrane guidelines, two reviewers completed the review process (initial n=139) in three phases, title selection (n=56), abstract selection (n=28) and whole paper selection (n=9). From these nine studies, each reviewer extracted information about outcome measures and statistical and methodological quality. Data synthesis Relevant data were abstracted from included papers and were subsequently subjected to meta-analysis. RESULTS: Interest in genetic testing was relatively high with 60-80% of smokers reporting to be interested. The authors observed positive short-term effects on risk perception, motivation to quit smoking and smoking cessation, but these effects fade at longer follow-ups. Importantly, the authors did not find any evidence of adverse effect of testing negative on the risk-predisposing gene. CONCLUSIONS: This systematic review does not provide solid evidence for the proposed beneficial effects of genetic testing for smoking-related diseases on smoking cessation, but does suggest the presence of an immediate motivational effect, such that genetic testing resulted in higher risk perception and more motivation to quit smoking.

To test or not to test: a cross-sectional survey of the psychosocial determinants of self-testing for cholesterol, glucose, and HIV.

BACKGROUND: Although self-tests are increasingly available and widely used, it is not clear whether their use is beneficial to the users, and little is known concerning the determinants of self-test use. The aim of this study was to identify the determinants of self-test use for cholesterol, glucose, and HIV, and to examine whether these are similar across these tests. Self-testing was defined as using in-vitro tests on body materials, initiated by consumers with the aim of diagnosing a particular disorder, condition, or risk factor for disease. METHODS: A cross-sectional Internet survey was conducted among 513 self-testers and 600 non-testers, assessing possible determinants of self-test use. The structured questionnaire was based on the Health Belief Model, Theory of Planned Behavior, and Protection Motivation Theory. Data were analyzed by means of logistic regression. RESULTS: The results revealed that perceived benefits and self-efficacy were significantly associated with self-testing for all three conditions. Other psychosocial determinants, e.g. gender, cues to action, perceived barriers, subjective norm, and moral obligation, seemed to be more test-specific. CONCLUSIONS: Psychosocial determinants of self-testing are not identical for all tests and therefore information about self-testing needs to be tailored to a specific test. The general public should not only be informed about advantages of self-test use but also about the disadvantages. Designers of information about self-testing should address all aspects related to self-testing to stimulate informed decision making which, in turn, will result in more effective self-test use.

How do people respond to self-test results? A cross-sectional survey.

BACKGROUND: Self-tests, tests on medical conditions that can be performed by consumers without consulting a doctor first, are frequently used. Nevertheless, there are concerns about the safety of self-testing, as it may delay diagnosis and appropriate treatment in the case of inappropriate use of the test, or false-negative results. It is unclear whether self-tests stimulate appropriate follow-up behaviour. Our aim was to examine the frequency of self-test use, consumers' response to self-test results in terms of their confidence in the result, reassurance by the test result, and follow-up behaviour. METHODS: A two step cross-sectional survey was designed. A random sample of 6700 Internet users in an existing Internet panel received an online questionnaire on the use of self-tests. Self-tests were defined as tests on body materials, initiated by consumers with the aim to diagnose a disease or risk factor. A second questionnaire on consumers' response to self-test results was sent to the respondents that were identified as a self-tester in the first questionnaire (n = 703). RESULTS: 18.1% (799/4416) of the respondents had ever performed a self-test, the most frequently used tests being those for diabetes (5.3%), kidney disease (4.9%), cholesterol (4.5%), urinary tract infection (1.9%) and HIV/AIDS and Chlamydia (both 1.6%). A total of 78.1% of the testers with a normal test result and 81.4% of those with an abnormal result reported confidence in this result. Almost all (95.6%) of the testers with a normal result felt reassured. After a normal result, 78.1% did not take any further action and 5.8% consulted a doctor. The corresponding figures after an abnormal test result were 9.3% and 72.2%, respectively. CONCLUSIONS: Respondents who had performed a self-test seemed to base their follow-up behaviour on the result of the test. They had confidence in the test result, and were often reassured by a normal result. After an abnormal result, most self-testers sought medical care. Because consumers seem to trust the self-test results, further research should focus on the development of consumer information addressing indications for performing a self-test, the validity of self-tests and appropriate interpretation of and management after a test.

Improving behaviour in self-testing (IBIS): Study on frequency of use, consequences, information needs and use, and quality of currently available consumer information (protocol).

BACKGROUND: Self-tests are available to consumers for more than 25 conditions, ranging from infectious diseases to cardiovascular risk factors. Self-tests are defined as in-vitro tests on body materials such as blood, urine, faeces, or saliva that are initiated by consumers to diagnose a particular disorder or risk factor without involving a medical professional. In 2006, 16% of a sample of Dutch Internet users had ever used at least one self-test and 17% intended to use a self-test in the future. The objectives of this study are to determine (1) the frequency of self-test use, (2) the consumers' reasons for using or not using a self-test, (3) the information that is used by self-testers in the different self-test stages and the consumers' interpretation of the quality of this information, (4) the consumers' response to self-test results in terms of their confidence in the result, reassurance by the test result, and follow-up behaviour, (5) the information consumers report to need in the decision making process of using or not using a self-test, and in further management on the basis of the self-test result, and (6) the quality of the currently available consumer information on a selected set of self-tests. METHODS: Mixed methods study with (1) a cross-sectional study consisting of a two-phase Internet-questionnaire, (2) semi-structured interviews with self-testers and consumers who intend to use a self-test, and (3) the assessment of the quality of consumer information of self-tests. The Health Belief Model and the Theory of Planned Behaviour will serve as the theoretical basis for the questionnaires and the interview topic guides. CONCLUSIONS: The self-testing area is still in a state of flux and therefore it is expected that self-test use will increase in the future. To the best of our knowledge, this is the first study which combines quantitative and qualitative research to identify consumers' information needs and use concerning self-testing, and the consumers' actual follow-up behaviour based on the self-test result, and simultaneously investigates the quality of the currently available consumer information. The results of this study will be used as an input in developing consumer information on self-testing.