Four levels of outcomes of information‐seeking: A mixed methods study in primary health care

Abstract

Primary health care practitioners routinely search for information within electronic knowledge resources. We proposed four levels of outcomes of informationseeking: situational relevance, cognitive impact, information use, and patient health outcomes. Our objective was to produce clinical vignettes for describing and testing these levels. We conducted a mixed methods study combining a quantitative longitudinal study and a qualitative multiple case study. Participants were 10 nurses, 10 medical residents, and 10 pharmacists. They had access to an online resource, and did 793 searches for treatment recommendations. Using the Information Assessment Method (IAM), participants rated their searches for each of the four levels. Rated searches were examined in interviews guided by log reports and a think-aloud protocol. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described the four levels of outcomes. Quantitative and qualitative data were merged into clinical vignettes. We produced 130 clinical vignettes. Specifically, 46 vignettes (35.4%) corresponded to clinical situations where information use was associated with one or more than one type of positive patient health outcome: increased patient knowledge (n = 28), avoidance of unnecessary or inappropriate intervention (n = 25), prevention of disease or health deterioration (n = 9), health improvement (n = 6), and increased patient satisfaction (n = 3). Results suggested information use was associated with perceived benefits for patients. This may encourage clinicians to search for information more often when they feel the need. Results supported the four proposed levels of outcomes, which can be transferable to other information-seeking contexts.

Patient-Oriented Evidence that Matters (POEMs) Suggest Potential Clinical Topics for the Choosing Wisely Campaign

“…8 The ACA-LO model extends a previous model of human-information interaction for research on the value of informa-tion, 9 and it explicates this notion of "value" from the user's perspective ( Figure 1). For example, in the context of E-mail alerts, clinicians receive a passage of text (acquisition) that they read and understand (cognition).…”

Number Needed to Benefit From Information (NNBI): Proposal From a Mixed Methods Research Study With Practicing Family Physicians

“…This study is based on a theoretical model called the acquisition-cognition-application/levels-of-outcomes model (hereinafter the ACA-LO model), 13 which can be summarized as follows. Clinicians may find one or more information objects to fulfill a search objective, eg, a Web page for addressing a clinical question (acquisition/level 1).…”

“…In a concomitant study with similar mixed methods, we documented searches for treatment recommendations (summaries) conducted by 30 primary health care professionals (10 nurse practitioners, 10 family health team pharmacists, and 10 family medicine residents), using another resource (e-Therapeutics+) on a desktop computer: the NNBI was lower (NNBI = 7), ie, expected benefits were more frequently reported. 13 In our pilot study involving family medicine residents, the NNBI was also 7.…”

Perceived outcomes of online parenting information according to self‐selected participants from a population of website users

“…Method (IAM) for assessing and improving the N&G website and newsletter. Developed at McGill, the IAM allows people to rate specific information content (e.g., a N&G web page) (www.mcgill.ca/iam) (Pluye et al, 2013). Specifically, the four levels of outcomes reflect how information is valuable from the user viewpoint, and are derived from the 3-stage iterative 'Acquisition-Cognition-Application' process proposed by Saracevic and Kantor for assessing the value of information and information services (Saracevic & Kantor, 1997): people receive or retrieve information (Acquisition), understand and integrate it (Cognition), and possibly use it (Application).…”