Department of Research, SingHealth Polyclinics, Singapore, Singapore
Duke-NUS, Singapore, Singapore.
BMJ Open. 2020 Mar 8;10(3):e033791. doi: 10.1136/bmjopen-2019-033791.
Patient decision-aids (PDAs) support patients in selecting evidence-based treatment options. PDA is useful only if the user understands the content to make personalised decisions. Cultural adaptation is a process of adjusting health messages so that the information is accurate, relevant and understandable to users from a different population. A PDA has been developed to assist Malaysian patients with secondary drug failure to initiate insulin therapy to control their type 2 diabetes mellitus (T2DM). Likewise, patients with T2DM in neighbouring Singapore face similar barriers in commencing insulin treatment, which a PDA may facilitate decision-making in selecting personalised therapy.
The study aimed to explore the views and perceptions of Singaporean primary care providers on the Malaysia PDA to initiate insulin therapy and described the cultural adaptation process used in the design and development of a new PDA, which would be trialled in a Singapore primary healthcare institution.
Qualitative research method was deployed to conduct one-to-one in-depth interviews of the healthcare providers at the trial site (SingHealth Polyclinics-SHP), including six primary care physicians and four nurses to gather their views and feedbacks on the Malaysian PDA. The interviews were transcribed, audited and analysed (standard content analysis) to identify themes relating to the content, layout, concerns of the original PDA and suggestions to the design of the new SHP PDA.
Cultural adaptation of the new PDA includes change to the overall design, graphics (including pictograms), presentation styles, additional contextualised content (personalisation, subheadings, cost and treatment option), modified phrasing of the subtitles and concerns (choice of words) relevant to the new users.
A PDA on insulin therapy underwent cultural adaptation before its implementation in another population in a neighbouring country. Its relevance and effectiveness will be evaluated in future research.
患者决策辅助工具（PDAs）支持患者选择基于证据的治疗方案。只有当用户理解内容以做出个性化决策时，PDAs 才有用。文化适应性调整是一个调整健康信息的过程，以使来自不同人群的用户获得准确、相关和易懂的信息。已经开发了一种 PDAs 来帮助马来西亚的二线药物治疗失败的患者启动胰岛素治疗以控制他们的 2 型糖尿病（T2DM）。同样，新加坡的 T2DM 患者在开始胰岛素治疗方面也面临类似的障碍，PDAs 可能有助于他们在选择个性化治疗方面做出决策。
本研究旨在探讨新加坡初级保健提供者对启动胰岛素治疗的马来西亚 PDAs 的看法和看法，并描述了在设计和开发新 PDAs 中使用的文化适应性调整过程，该 PDAs 将在新加坡的一家初级保健机构进行试验。
采用定性研究方法，对试验现场（SingHealth Polyclinics-SHP）的医疗保健提供者进行一对一深入访谈，包括六名初级保健医生和四名护士，以收集他们对马来西亚 PDAs 的意见和反馈。访谈内容进行了转录、审核和分析（标准内容分析），以确定与原始 PDAs 的内容、布局、关注点以及对新 SHP PDAs 的设计建议相关的主题。
新 PDAs 的文化适应性调整包括整体设计、图形（包括象形图）、演示风格、额外的情境内容（个性化、副标题、成本和治疗选择）、副标题和关注点的措辞修改（用词选择）与新用户相关。
在另一个国家的另一个人群中实施之前，对胰岛素治疗的 PDAs 进行了文化适应性调整。未来的研究将评估其相关性和有效性。
