Emergency Physicians’ Beliefs About Their Intention to Use Wiki-based Reminders to Promote Evidence-based Trauma Care
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Abstract
Background
Wikis are knowledge translation (KT) tools that could help emergency physicians collaborate asynchronously in the updating and sharing of reminders. Reminders (e.g. care protocols) help physicians make decisions based on evidence. However, no study has determined the factors influencing emergency physicians’ intentions to use a wiki-based reminder.
This study aimed to identify physicians’ salient beliefs regarding their intended use of wiki-based reminders promoting evidence-based trauma care.
Methods
Using the Theory of Planned Behavior, we conducted semi-structured interviews to identify these salient beliefs. Based on previous work by Godin and Kok, a sample size of 25 participants was determined sufficient to elicit these beliefs. Among the 61 eligible physicians working in three trauma centers in Quebec (Canada), we contacted 30 physicians and five were not available. To elicit a wide variety of beliefs, we purposefully selected a sample of 10 physicians from a level I trauma center, 10 physicians from a level II trauma center and 5 physicians from a level III trauma center. We also included older and more experienced physicians who might have different beliefs. Before the interview, all participants were presented a video that explained wiki characteristics and featured a physician using a wiki-based reminder. Two independent coders analyzed the content of the verbatim interview transcripts to identify participants’ attitudinal, normative and control beliefs. Conflicts between coders were resolved through discussion. They classified responses into themes (salient beliefs). Themes that expressed the same idea were grouped and their frequency calculated.
Results
A majority of participants were male (92%), had a median age of 38 years (ranging from 28 to 58 years) and had a median of 11 years of clinical work experience (ranging from 1 to 34 years). We identified 19 attitudinal, 16 normative and 33 control beliefs. The top two attitudinal beliefs were that using a wiki-based reminder would: reduce errors (n=14, 56%) and save time in developing a reminder (n=13, 52%). Only two disadvantages were reported: the fear of reproducing an existing resource like UpToDateTM (n=1, 4%) and the added stress of using a wiki-based reminder while treating a trauma victim (n=1, 4%). The three most influential normative beliefs (people who would approve or disapprove the use of wiki-based reminders) were: 1) nurses (n=17, 68%); 2) physicians (n=14, 56%); and 3) trainees (n=12, 48%). Finally, the top three control beliefs were facilitators of the use of a wiki-based reminder: 1) access without passwords (n=21, 84%); 2) mobile access (n=20, 80%; and 3) peer-reviewed information (n=19, 76%). The top negative control beliefs (barriers) were : 1) the lack of internet access (n=8, 32%); 2) immediate decision making in trauma (n=7, 28%); and 3) rapidly changing wiki-based reminders (n=6, 24%).
Conclusion
This is the first study to identify the salient beliefs influencing physicians’ intentions to use a wiki-based reminder to promote evidence-based trauma care. These beliefs will be used to construct a questionnaire that will measure the influence of each of these beliefs in a broader population of emergency physicians.
Wikis are knowledge translation (KT) tools that could help emergency physicians collaborate asynchronously in the updating and sharing of reminders. Reminders (e.g. care protocols) help physicians make decisions based on evidence. However, no study has determined the factors influencing emergency physicians’ intentions to use a wiki-based reminder.
This study aimed to identify physicians’ salient beliefs regarding their intended use of wiki-based reminders promoting evidence-based trauma care.
Methods
Using the Theory of Planned Behavior, we conducted semi-structured interviews to identify these salient beliefs. Based on previous work by Godin and Kok, a sample size of 25 participants was determined sufficient to elicit these beliefs. Among the 61 eligible physicians working in three trauma centers in Quebec (Canada), we contacted 30 physicians and five were not available. To elicit a wide variety of beliefs, we purposefully selected a sample of 10 physicians from a level I trauma center, 10 physicians from a level II trauma center and 5 physicians from a level III trauma center. We also included older and more experienced physicians who might have different beliefs. Before the interview, all participants were presented a video that explained wiki characteristics and featured a physician using a wiki-based reminder. Two independent coders analyzed the content of the verbatim interview transcripts to identify participants’ attitudinal, normative and control beliefs. Conflicts between coders were resolved through discussion. They classified responses into themes (salient beliefs). Themes that expressed the same idea were grouped and their frequency calculated.
Results
A majority of participants were male (92%), had a median age of 38 years (ranging from 28 to 58 years) and had a median of 11 years of clinical work experience (ranging from 1 to 34 years). We identified 19 attitudinal, 16 normative and 33 control beliefs. The top two attitudinal beliefs were that using a wiki-based reminder would: reduce errors (n=14, 56%) and save time in developing a reminder (n=13, 52%). Only two disadvantages were reported: the fear of reproducing an existing resource like UpToDateTM (n=1, 4%) and the added stress of using a wiki-based reminder while treating a trauma victim (n=1, 4%). The three most influential normative beliefs (people who would approve or disapprove the use of wiki-based reminders) were: 1) nurses (n=17, 68%); 2) physicians (n=14, 56%); and 3) trainees (n=12, 48%). Finally, the top three control beliefs were facilitators of the use of a wiki-based reminder: 1) access without passwords (n=21, 84%); 2) mobile access (n=20, 80%; and 3) peer-reviewed information (n=19, 76%). The top negative control beliefs (barriers) were : 1) the lack of internet access (n=8, 32%); 2) immediate decision making in trauma (n=7, 28%); and 3) rapidly changing wiki-based reminders (n=6, 24%).
Conclusion
This is the first study to identify the salient beliefs influencing physicians’ intentions to use a wiki-based reminder to promote evidence-based trauma care. These beliefs will be used to construct a questionnaire that will measure the influence of each of these beliefs in a broader population of emergency physicians.
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