Cultural adaptation of a patient decision-aid for insulin therapy

Tan, Ngiap Chuan; Leng, Agnes Koong Ying; Yun, Ian Phoon Kwong; Zhen, Sinead Wang; Muthulakshmi, Paulpandi; Lee, Yew Kong; Furler, John; Car, Josip; Ng, Chirk Jenn

doi:10.1136/bmjopen-2019-033791

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…The same degree of respect for cultural differences should be extended to the development of the DA. This is similar to the finding in a study by Tan et al [ 34 ] in their cultural adaptation of a DA on insulin therapy, in which Muslim patients’ concern about the non-halal source of insulin was addressed.…”

Section: Discussionsupporting

confidence: 88%

Development of a decision aid to support colorectal cancer screening: perspectives of Asians in an endemic urban community—a qualitative research study

Yuen

Tay

Gao

et al. 2021

BMC Med Inform Decis Mak

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Background Colorectal cancer (CRC) is a common malignancy worldwide. Despite being the most common cancer in Singapore, CRC screening rate remains low due to knowledge deficits, social reasons such as inconvenience and a lack of reminder or recommendation. A decision aid (DA) may facilitate an individual’s decision-making to undertake CRC screening by addressing misconceptions and barriers. We postulate that a more person-centred and culturally adapted DA will better serve the local population. The views of the target users are thus needed to develop such a DA. A CRC screening DA prototype has been adapted from an American DA to cater to the Asian users. This study aimed to explore user perspectives on an adapted CRC screening DA-prototype in terms of the design, content and perceived utility. Methods The study used in-depth interviews (IDIs) and focus group discussions (FGDs) to gather qualitative data from English-literate multi-ethnic Asian adults aged 50 years old and above. They had yet to screen for CRC before they were recruited from a public primary care clinic in Singapore. The interviews were audio-recorded, transcribed and analysed to identify emergent themes via thematic analysis. Results This study included 27 participants involved in 5 IDI and 5 FGDs. Participants found the DA easily comprehensible and of appropriate length. They appreciated information about the options and proposed having multi-lingual DAs. The design, in terms of the layout, size and font, was well-accepted but there were suggestions to digitalize the DA. Participants felt that the visuals were useful but there were concerns about modesty due to the realism of the illustration. They would use the DA for information-sharing with their family and for discussion with their doctor for decision making. They preferred the doctor’s recommendation for CRC screening and initiating the use of the DA. Conclusions Participants generally had favourable perceptions of the DA-prototype. A revised DA will be developed based on their feedback. Further input from doctors on the revised DA will be obtained before assessing its effectiveness to increase CRC screening rate in a randomized controlled trial.

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Section: Discussionsupporting

confidence: 88%

Development of a decision aid to support colorectal cancer screening: perspectives of Asians in an endemic urban community—a qualitative research study

Yuen

Tay

Gao

et al. 2021

BMC Med Inform Decis Mak

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“…They proposed that more advanced digitization features, such as customization and interactivity, would make it more engaging. Customization is necessary for better culturally adapted DAs [ 35 ] and to avoid information overload [ 36 ]. In another screening context (colorectal cancer), a computer-based DA was customizable for age and gender, and participants were asked for further customizable features such as family history and medical history [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study

Agbadjé¹,

Pilon²,

Bérubé³

et al. 2022

JMIR Pediatr Parent

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Background Mobile health tools can support shared decision-making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed, value-congruent decisions regarding prenatal screening for trisomy. Objective This study aims to assess the usability and usefulness of computer-based DA among pregnant women, clinicians, and policy makers. Methods For this mixed methods sequential explanatory study, we planned to recruit a convenience sample of 45 pregnant women, 45 clinicians from 3 clinical sites, and 15 policy makers. Eligible women were aged >18 years and >16 weeks pregnant or had recently given birth. Eligible clinicians and policy makers were involved in prenatal care. We asked the participants to navigate a computer-based DA. We asked the women about the usefulness of the DA and their self-confidence in decision-making. We asked all participants about usability, quality, acceptability, satisfaction with the content of the DA, and collected sociodemographic data. We explored participants’ reactions to the computer-based DA and solicited suggestions. Our interview guide was based on the Mobile App Rating Scale. We performed descriptive analyses of the quantitative data and thematic deductive and inductive analyses of the qualitative data for each participant category. Results A total of 45 pregnant women, 14 clinicians, and 8 policy makers participated. Most pregnant women were aged between 25 and 34 years (34/45, 75%) and White (42/45, 94%). Most clinicians were aged between 35 and 44 years (5/14, 36%) and women (11/14, 79%), and all were White (14/14, 100%); the largest proportion of policy makers was aged between 45 and 54 years (4/8, 50%), women (5/8, 62%), and White (8/8, 100%). The mean usefulness score for preparing for decision-making for women was 80/100 (SD 13), and the mean self-efficacy score was 88/100 (SD 11). The mean usability score was 84/100 (SD 14) for pregnant women, 77/100 (SD 14) for clinicians, and 79/100 (SD 23) for policy makers. The mean global score for quality was 80/100 (SD 9) for pregnant women, 72/100 (SD 12) for clinicians, and 80/100 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (52/66, 79%), balanced (58/66, 88%), useful (38/66, 58%), and sufficient (50/66, 76%). The mean satisfaction score with the content was 84/100 (SD 13) for pregnant women, 73/100 (SD 16) for clinicians, and 73/100 (SD 20) for policy makers. Participants thought the DA could be more engaging (eg, more customizable) and suggested strategies for implementation, such as incorporating it into clinical guidelines. Conclusions Pregnant women, clinicians, and policy makers found the DA usable and useful. The next steps are to incorporate user suggestions for improving engagement and implementing the computer-based DA in clinical practice.

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“…Cultural optimization, in the development of this PDA, underpins the strength of the study. Cultural adaptation has been used to develop PDAs to fit local cultural contexts 49‐51 . However, cultural optimization brings this process one step further by facilitating the development of a PDA de novo.…”

Section: Discussionmentioning

confidence: 99%

Development of a novel gout treatment patient decision aid by patient and physician: A qualitative research study

Meyappan

Loh

Tan

et al. 2021

Health Expectations

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Background Gout treatment is not optimized globally, often due to therapeutic inertia by physicians or poor adherence to urate‐lowering medications by patients. A patient decision aid (PDA) to facilitate shared decision making (SDM) in gout treatment may overcome these physician‐patient barriers. Objective The study explored the views of physicians and patients on a novel locally designed gout treatment PDA prototype. Design Qualitative descriptive design was used to gather data from in‐depth‐interviews (IDI) and focus group discussions (FGD). Data analysis was via thematic analysis. Emergent themes shaped a revised version of the PDA. Setting and participants Adult Asian patients with recent acute gout exacerbations and local Primary Care Physicians (PCP) in Singapore were purposefully chosen. 15 patients with gout and 11 PCPs participated across three IDIs and six FGDs, with the investigators exploring their views of a prototype gout treatment PDA. Results Patients and physicians generally concurred with the content and design of the PDA prototype. However, while patients preferred fewer treatment details, the PCPs desired more information. Patients preferred the display of statistics, while PCPs felt that numbers were not relevant to patients. The latter were hesitant to include treatment options that were unavailable in primary care. Both stakeholders indicated that they would use the PDA during a consultation. PCPs would need further training in SDM, given a lack of understanding of it. Conclusion and patient contribution Patients will be the prime users of the PDA. While their views differed partially from the physicians, both have jointly developed the novel gout treatment PDA.

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Cultural adaptation of a patient decision-aid for insulin therapy

Cited by 10 publications

References 21 publications

Development of a decision aid to support colorectal cancer screening: perspectives of Asians in an endemic urban community—a qualitative research study

Development of a decision aid to support colorectal cancer screening: perspectives of Asians in an endemic urban community—a qualitative research study

User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study

Development of a novel gout treatment patient decision aid by patient and physician: A qualitative research study

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