Electronic Dissemination of Canadian Clinical Practice Guidelines to Health Care Professionals and the Public

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EXECUTIVE SUMMARY

Background: The Canadian Task Force on Preventive Health Care (CTFPHC) is mandated "to determine how the periodic health examination might enhance or protect the health of Canadians and to recommend a plan for a lifetime program of periodic health assessments for all persons living in Canada". To complement its more traditional dissemination activities, the CTFPHC has developed and recently "launched" its World Wide Web site (http://www.ctfphc.org).

Purpose of Project: The broad purpose of this project was to find out how best to use the Internet to make evidence-based preventive health care guidelines available to physicians and consumers by an Internet website. Specific goals were to:

• determine facilitators and barriers for the dissemination of evidence-based preventive clinical practice guidelines (CPG) to Canadian health care professionals on the World Wide Web;
• determine issues related to the public's needs for evidence-based preventive health care information on the World Wide Web;
• develop an online evaluation tool to evaluate the website; 
• develop a process for converting CPGs into consumer versions, including a sample of what consumer web pages would look like.

Methods: Focus groups were held with physicians and consumers to examine their information needs and to determine how we can make CTFPHC information available, convenient and usable. Key-informant interviews were conducted with consumer advocates and a public health professional to gain their insights into producing consumer health information. As a supplement, individuals from organizations involved in producing evidence-based consumer health information in the United States and Great Britain were also interviewed.

Results:

Physician Focus Groups: A common theme to all physician focus groups were the barriers that time and technology posed to accessing information from the Internet. Physician participants felt a good index system would be the easiest way to find the answer to their specific questions to help them search for information by disease, organ system or screening test. If they were looking for patient-specific information they would search based on age, gender and family history. Physicians wanted simple design with text-based information and minimal graphics. They wanted quick access to the summary of the recommendations with internal hypertext links to more detailed information, including the date and grade of recommendation. Participants also wanted links to external web sites and information that they could print and give to their patients. They also recommended strategies for increasing physician use of the site.

Consumer Focus Groups: Consumers wanted to know what they could personally do to prevent disease as well as what their doctor could do. They gave a number of suggestions for the content and design of a consumer web site. Other discussion points included issues of trust on the Internet, marketing our web site, and how they used health information from the Internet.  Consumers wanted a site that included information they could understand in lay language. It was important to include evidence to support the recommendations made. When evidence was unclear, they wanted the facts clearly stated so that they could come to their own decision. Some participants suggested that hearing about other people's experiences would be extremely helpful. Participants wanted a site that could be navigated easily by novice computer users, including access by an index system, search features, and an alphabetical list of topics. Graphics, colour, and text should capture their interest. Participants also recommended linking to other web sites.  Participants strongly advocated marketing the CTFPHC web site in physician offices and health care facilities, and via the mass media. These consumers often printed health information from the Internet to take to their physician. Internet information also helped them to become more informed and know what questions they should ask their doctor.

Key-Informant Interviews: We discussed with key informants the process of developing patient information materials, with a focus on how they obtained input from consumers. They reported gathering this input at different stages in the process, both before the materials were developed, in order to understand what the consumer/patient issues and information needs were, and to later test the materials. Preparing targeted print information was a challenge for all organizations, and each had developed different strategies to meet this challenge. The key-informants felt the Internet would play a significant role in the dissemination of consumer health information in the future, although there was debate over what should be included on the Internet (print materials or interactive materials) and if there should be additional ways of disseminating information to the public. All organizations were interested in the information produced by the CTFPHC.

Organizational Interviews: All organizations interviewed had been involved in developing consumer health information from evidence-based reports. The main impetus for this was to have informed consumers. All interviewees reported that the development of consumer information materials was a highly iterative, complex and lengthy process requiring multiple drafts and feedback mechanisms from a variety of experts and consumers. Consultations with consumers were a central part of the development process.

Discussion: This project has given the CTFPHC many insights into the enhancement of our physician web site and a number of issues to consider for the development of a consumer area for the site. It is apparent that the Task Force has a large body of useful and credible information.  High quality information is the most expensive component of developing a quality web site.  Many of the design and format suggestions from the physician focus groups can be incorporated into the current CTFPHC web site. This will create a site that can provide quick and easy access to information so physicians can get the answers they need. Developing consumer health information in simple and understandable forms, however, would represent a significant initiative for the CTFPHC. Based on the findings from the focus groups and interviews, consumers want basic health information written in understandable language. There would also be challenges in balancing consumer information needs with the available research evidence.  Prior to developing these consumer health information materials, some basic decisions will need to be made about the (1) intended aims; (2) proposed audience; and (3) the intended context of use of this information. The current research provides a strong foundation for further development and exploration of these issues.