An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation

Abstract

Background Whiplash is a health and economic burden worldwide. Contributing to this burden is poor guideline adherence and variable management by health care professionals (HCPs). Web-based tools that facilitate clinical pathways of care are an innovative solution to improve management. Objective The study aimed to develop, implement, and evaluate a Web-based tool to support whiplash management following a robust process. Methods This study followed the first 3 processes of a research translation framework (idea generation, feasibility, and efficacy) to inform the development, implementation, and evaluation of a website that supports HCPs in whiplash management. Development followed the idea generation and feasibility processes to inform the content, design, features, and functionality of the website. This involved stakeholder (eg, industry partners, website developers, and HCPs) consultations through face-to-face meetings, surveys, and focus group discussions. Implementation followed the feasibility process to determine the practicality of the website for clinical use and the most effective strategy to promote wider uptake. Implementation strategies included classroom education, educational meetings, educational outreach, reminders, and direct phone contact. The analysis of website use and practicality of implementation involved collection of website metrics. Evaluation followed the feasibility and efficacy processes to investigate the acceptability and extent to which the website assisted HCPs in gaining knowledge about whiplash management. Surveys were conducted among student, primary, and specialist HCPs to explore ease of access, use, and satisfaction with the website, as well as self-rated improvements in knowledge of risk assessment, management, and communication between HCPs. Website logs of specialist management decisions (eg, shared care, specialist care, and referred care) were also obtained to determine actual practice. Results The development process delivered an interactive, user-friendly, and acceptable website, My Whiplash Navigator, tailored to the needs of HCPs. A total of 260 registrations were recorded from June 2016 to March 2018, including 175 student, 65 primary, and 20 specialist HCPs. The most effective implementation strategies were classroom education for students (81% uptake, 175/215) and educational meetings for primary HCPs (43% uptake, 47/110). Popular pages visited included advice and exercises and risk assessment. Most HCPs agreed that their knowledge about risk management (79/97, 81%) and exercises (85/97, 88%) improved. The specialists’ most common management decision was shared care, an improvement from a previous cohort. Areas to improve were navigation and access to outcome measures. Conclusions A robust process resulted in an innovative, interactive, user-friendly, and acceptable website, the My Whiplash Navigator. Implementation with HCPs was best achieved through classroom education and educational meetings. Evaluation of the website showed improved knowledge and practice to be more consistent with a risk-based clinical care pathway for whiplash. The positive results provide sufficient evidence to scale implementation nationally and involve other target markets such as people with whiplash, insurers, and insurance regulators.

Health care personnel’s perception of guideline implementation for musculoskeletal imaging: a process evaluation

“…Our findings demonstrate that the informational meetings were the most successful part of the implementation, because they created an awareness of the guidelines' existence and their potential to make good decisions with respect to examinations, and to confirm that GPs and radiologists' practice was mostly correct. This is in accordance with the literature, in which informational meetings have been seen to have great potential for change in guideline adherence [29][30][31]. Studies have reported increases in guideline adherence between 9 and 82% when applying informational meetings in different forms [11,12,29,31,32].…”

“…This is in accordance with the literature, in which informational meetings have been seen to have great potential for change in guideline adherence [29][30][31]. Studies have reported increases in guideline adherence between 9 and 82% when applying informational meetings in different forms [11,12,29,31,32]. The participants were also mostly happy with the contents of the informational meetings, which may also have contributed to the experience that this was the most successful part of the implementation.…”

“…Our study indicates that in the Norwegian context the implementation was unable to reduce the existing barriers to guideline use and adherence. The context of primary care and radiology may also have influenced the findings, since providing educational material, and educational meetings has been found more effective in other contexts [29][30][31]. Had the implementation been changed to either be a digital reminder message, or just have a repeat of the meetings this may also have shown a different outcome.…”

Implementation of a novel stratified PAthway of CarE for common musculoskeletal (MSK) conditions in primary care: protocol for a multicentre pragmatic randomised controlled trial (the PACE MSK trial)

“…Care typically involves interventions targeted to identified risk factors, comprising active approaches of exercise within a psychologically informed cognitive behavioural framework. Based on pilot feasibility studies,32 53 this pathway was used when the participant’s presentation is more complex or when the primary HCP is less confident in management. Example scenarios are when participants have widespread pain sensitivity, dominant psychosocial factors, or when complex differential diagnosis is needed (eg, neck pain, headache, dizziness).…”

“…Patients with a favourable prognosis should do well with care delivered by a primary healthcare professional (HCP), supported by high quality and credible self-management information resources 24 28 32 33. One of the barriers for implementation is the volume of options of internet-based resources, many of which have low credibility standards and contain inaccurate information 34.…”