Laval University, Pavillon Ferdinand-Vandry, Room 2881, 1050 avenue de la Médecine, Quebec, QC, G1V 0A6, Canada.
CISSS de la Gaspésie - Service externe de gériatrie ambulatoire, 455 rue Mgr Ross Est, Chandler, QC, G0C 1K0, Canada.
BMC Med Inform Decis Mak. 2021 Feb 17;21(1):59. doi: 10.1186/s12911-021-01396-y.
We know little about the best approaches to design training for healthcare professionals. We thus studied how user-centered and theory-based design contribute to the development of a distance learning program for professionals, to increase their shared decision-making (SDM) with older adults living with neurocognitive disorders and their caregivers.
In this mixed-methods study, healthcare professionals who worked in family medicine clinics and homecare services evaluated a training program in a user-centered approach with several iterative phases of quantitative and qualitative evaluation, each followed by modifications. The program comprised an e-learning activity and five evidence summaries. A subsample assessed the e-learning activity during semi-structured think-aloud sessions. A second subsample assessed the evidence summaries they received by email. All participants completed a theory-based questionnaire to assess their intention to adopt SDM. Descriptive statistical analyses and qualitative thematic analyses were integrated at each round to prioritize training improvements with regard to the determinants most likely to influence participants' intention.
Of 106 participants, 98 completed their evaluations of either the e-learning activity or evidence summary (93%). The professions most represented were physicians (60%) and nurses (15%). Professionals valued the e-learning component to gain knowledge on the theory and practice of SDM, and the evidence summaries to apply the knowledge gained through the e-learning activity to diverse clinical contexts. The iterative design process allowed addressing most weaknesses reported. Participants' intentions to adopt SDM and to use the summaries were high at baseline and remained positive as the rounds progressed. Attitude and social influence significantly influenced participants' intention to use the evidence summaries (P < 0.0001). Despite strong intention and the tailoring of tools to users, certain factors external to the training program can still influence the effective use of these tools and the adoption of SDM in practice.
A theory-based and user-centered design approach for continuing professional development interventions on SDM with older adults living with neurocognitive disorders and their caregivers appeared useful to identify the most important determinants of learners' intentions to use SDM in their practice, and validate our initial interpretations of learners' assessments during the subsequent evaluation round.
我们对设计医疗专业人员培训的最佳方法知之甚少。因此，我们研究了以用户为中心和基于理论的设计如何有助于为专业人员开发远程学习计划，以增加他们与患有神经认知障碍的老年人及其照顾者的共同决策（SDM）。
在这项混合方法研究中，在家庭医学诊所和家庭护理服务工作的医疗保健专业人员在用户为中心的方法中评估了培训计划，该计划经历了几个迭代阶段的定量和定性评估，每次评估后都进行了修改。该计划包括一个电子学习活动和五个证据摘要。一个子样本在半结构化的思考 aloud 会议期间评估了电子学习活动。另一个子样本通过电子邮件评估了他们收到的证据摘要。所有参与者都完成了基于理论的问卷，以评估他们采用 SDM 的意愿。在每一轮中都整合了描述性统计分析和定性主题分析，以根据最有可能影响参与者意图的决定因素确定培训改进的优先级。
在 106 名参与者中，有 98 名完成了对电子学习活动或证据摘要的评估（93%）。最具代表性的专业是医生（60%）和护士（15%）。专业人员重视电子学习部分，以获取关于 SDM 理论和实践的知识，以及证据摘要，以便将通过电子学习活动获得的知识应用于不同的临床环境。迭代设计过程允许解决报告的大多数弱点。参与者采用 SDM 和使用摘要的意图在基线时较高，并且随着轮次的进展保持积极。态度和社会影响对参与者使用证据摘要的意图有重大影响（P<0.0001）。尽管意图强烈且工具针对用户进行了定制，但培训计划之外的某些因素仍会影响这些工具的有效使用以及在实践中采用 SDM。
针对患有神经认知障碍的老年人及其照顾者的共同决策的继续专业发展干预措施的基于理论和以用户为中心的设计方法似乎有助于确定学习者在实践中采用 SDM 的最重要决定因素，并验证我们在随后的评估轮次中对学习者评估的初步解释。
