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BackgroundTypically, web-based consumer health information is considered more beneficial for people with high levels of education and income. No evidence shows that equity-oriented information offers equal benefits to all. This is important for parents of low socioeconomic status (SES; low levels of education and income and usually a low level of literacy). ObjectiveThis study is based on a conceptual framework of information outcomes. In light of this, it aims to compare the perception of the outcomes of web-based parenting information in low-SES mothers with that of other mothers and explore the perspective of low-SES mothers on contextual factors and information needs and behavior associated with these outcomes. MethodsA participatory mixed methods research was conducted in partnership with academic researchers and Naître et grandir (N&G) editors. N&G is a magazine, website, and newsletter that offers trustworthy parenting information on child development, education, health, and well-being in a format that is easy to read, listen, or watch. Quantitative component (QUAN) included a 3-year longitudinal observational web survey; participants were mothers of 0- to 8-year-old children. For each N&G newsletter, the participants’ perception regarding the outcomes of specific N&G webpages was gathered using a content-validated Information Assessment Method (IAM) questionnaire. Differences between participants of low SES versus others were estimated. Qualitative component (QUAL) was interpretive; participants were low-SES mothers. The thematic analysis of interview transcripts identified participants’ characteristics and different sources of information depending on information needs. Findings from the two components were integrated (QUAN+QUAL integration) through the conceptual framework and assimilated into the description of an ideal-typical mother of low SES (Kate). A narrative describes Kate’s perception of the outcomes of web-based parenting information and her perspective on contextual factors, information needs, and behavior associated with these outcomes. ResultsQUAN—a total of 1889 participants completed 2447 IAM responses (50 from mothers of low SES and 2397 from other mothers). N&G information was more likely to help low-SES participants to better understand something, decrease worries, and increase self-confidence in decision making. QUAL—the 40 participants (21 N&G users and 19 nonusers) used 4 information sources in an iterative manner: websites, forums, relatives, and professionals. The integration of QUAN and QUAL findings provides a short narrative, Kate, which summarizes the main findings. ConclusionsThis is the first study comparing perceptions of information outcomes in low-SES mothers with those of other mothers. Findings suggest that equity-oriented, web-based parenting information can offer equal benefits to all, including low-SES mothers. The short narrative, Kate, can be quickly read by decision policy makers, for example, web editors, and might encourage them to reach the underserved and provide and assess trustworthy web-based consumer health information in a format that is easy to read, listen, or watch.

BackgroundChronic diseases are the leading cause of death (63%) worldwide. A key behavioral risk factor is unhealthy eating. New strategies must be identified and evaluated to improve dietary habits. Social media, such as blogs, represent a unique opportunity for improving knowledge translation in health care through interactive communication between health consumers and health professionals. Despite the proliferation of food and lifestyle blogs, no research has been devoted to understanding potential blog readers’ perceptions of healthy eating blogs written by dietitians. ObjectiveTo identify women’s salient beliefs and perceptions regarding the use of healthy eating blogs written by dietitians promoting the improvement of their dietary habits. MethodsWe conducted a qualitative study with female Internet users living in the Quebec City, QC, area with suboptimal dietary habits. First, the women explored 4 existing healthy eating blogs written in French by qualified dietitians. At a focus group 2-4 weeks later, they were asked to discuss their experience and perceptions. Focus group participants were grouped by age (18-34, 35-54, and 55-75 years) and by their use of social media (users/nonusers). Using a questionnaire based on the Theory of Planned Behavior, participants were asked to identify salient beliefs underlying their attitudes (advantages/disadvantages), subjective norms (what people important to them would think), and perceptions of control (facilitators/barriers) regarding the use of a healthy eating blog written by a dietitian to improve dietary habits. Discussion groups were audiotaped, transcribed verbatim, coded, and a deductive content analysis was performed independently by 2 individuals using the NVivo software (version 10). ResultsAll participants (N=33) were Caucasian women aged between 22 to 73 year. Main advantages perceived of using healthy eating blogs written by a dietitian were that they provided useful recipe ideas, improved lifestyle, were a credible source of information, and allowed interaction with a dietitian. Disadvantages included increased time spent on the Internet and guilt if recommendations were not followed. Important people who would approve were family, colleagues, and friends. Important people who could disapprove were family and doctors. Main facilitators were visually attractive blogs, receiving an email notification about new posts, and finding new information on the blog. Main barriers were too much text, advertising on the blog, and lack of time. ConclusionsThe women in this study valued the credibility of healthy eating blogs written by dietitians and the contact with dietitians they provided. Identifying salient beliefs underlying women’s perceptions of using such blogs provides an empirically supported basis for the design of knowledge translation interventions to help prevent chronic diseases.

BackgroundElectronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. ObjectiveThe purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians’ knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants’ suggestions to improve email alert services for CME. MethodsWe conducted a qualitative descriptive study using the “Knowledge, Attitude, Behavior” model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. ResultsAll 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. ConclusionsThe advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts.

BackgroundOnline consumer health information addresses health problems, self-care, disease prevention, and health care services and is intended for the general public. Using this information, people can improve their knowledge, participation in health decision-making, and health. However, there are no comprehensive instruments to evaluate the value of health information from a consumer perspective. ObjectiveWe collaborated with information providers to develop and validate the Information Assessment Method for all (IAM4all) that can be used to collect feedback from information consumers (including patients), and to enable a two-way knowledge translation between information providers and consumers. MethodsContent validation steps were followed to develop the IAM4all questionnaire. The first version was based on a theoretical framework from information science, a critical literature review and prior work. Then, 16 laypersons were interviewed on their experience with online health information and specifically their impression of the IAM4all questionnaire. Based on the summaries and interpretations of interviews, questionnaire items were revised, added, and excluded, thus creating the second version of the questionnaire. Subsequently, a panel of 12 information specialists and 8 health researchers participated in an online survey to rate each questionnaire item for relevance, clarity, representativeness, and specificity. The result of this expert panel contributed to the third, current, version of the questionnaire. ResultsThe current version of the IAM4all questionnaire is structured by four levels of outcomes of information seeking/receiving: situational relevance, cognitive impact, information use, and health benefits. Following the interviews and the expert panel survey, 9 questionnaire items were confirmed as relevant, clear, representative, and specific. To improve readability and accessibility for users with a lower level of literacy, 19 items were reworded and all inconsistencies in using a passive or active voice have been solved. One item was removed due to redundancy. The current version of the IAM4all questionnaire contains 28 items. ConclusionsWe developed and content validated the IAM4all in partnership with information providers, information specialists, researchers and representatives of information consumers. This questionnaire can be integrated within electronic knowledge resources to stimulate users’ reflection (eg, their intention to use information). We claim that any organization (eg, publishers, community organizations, or patient associations), can evaluate and improve their online consumer health information from a consumers’ perspective using this method.

BackgroundA synopsis of new clinical research highlights important aspects of one study in a brief structured format. When delivered as email alerts, synopses enable clinicians to become aware of new developments relevant for practice. Once read, a synopsis can become a known item of clinical information. In time-pressured situations, remembering a known item may facilitate information retrieval by the clinician. However, exactly how synopses first delivered as email alerts influence retrieval at some later time is not known. ObjectivesWe examined searches for clinical information in which a synopsis previously read as an email alert was retrieved (defined as a dyad). Our study objectives were to (1) examine whether family physicians retrieved synopses they previously read as email alerts and then to (2) explore whether family physicians purposefully retrieved these synopses. MethodsWe conducted a mixed-methods study in which a qualitative multiple case study explored the retrieval of email alerts within a prospective longitudinal cohort of practicing family physicians. Reading of research-based synopses was tracked in two contexts: (1) push, meaning to read on email and (2) pull, meaning to read after retrieval from one electronic knowledge resource. Dyads, defined as synopses first read as email alerts and subsequently retrieved in a search of a knowledge resource, were prospectively identified. Participants were interviewed about all of their dyads. Outcomes were the total number of dyads and their type. ResultsOver a period of 341 days, 194 unique synopses delivered to 41 participants resulted in 4937 synopsis readings. In all, 1205 synopses were retrieved over an average of 320 days. Of the 1205 retrieved synopses, 21 (1.7%) were dyads made by 17 family physicians. Of the 1205 retrieved synopses, 6 (0.5%) were known item type dyads. However, dyads also occurred serendipitously. ConclusionIn the single knowledge resource we studied, email alerts containing research-based synopses were rarely retrieved. Our findings help us to better understand the effect of push on pull and to improve the integration of research-based information within electronic resources for clinicians.

Collaborative information monitoring (CIM) involves intentional information monitoring activities pursued by a group and could help researchers keep up to date. This paper reports findings of a cross‐case analysis aimed to explore the perceived factors and outcomes of CIM. Seven cases were included in the study, representing 11 members of patient‐oriented research communities (i.e., researchers, trainees, clinicians, research professionals, managers), who have implemented projects in a dedicated CIM system called eSRAP. Data were collected with semistructured interviews, verified with system logs and CIM project documents. Data were analyzed using a deductive/inductive thematic analysis. Cross‐case analysis revealed four types of cases, those that engaged in CIM with eSRAP, without eSRAP, used eSRAP individually (i.e., did not collaborate), or did not collaborate and did not use eSRAP. Analysis confirmed theory‐based types of factors (personal, group, organizational, environmental, information sources, system, task) and outcomes (performance, behavioral, cognitive, affective, relational) and generated new subtypes. The factor specific to cases that engaged in CIM (with or without eSRAP) was group leadership. Specific outcomes were motivation and discussion. Our findings contribute to conceptualizing CIM and can inform practice by providing actionable recommendations for supporting and sustaining CIM projects. [ABSTRACT FROM AUTHOR]

Mixed methods (MM) involve combining qualitative (QUAL) and quantitative (QUAN) methods in program evaluation, primary research, and literature reviews. MM are being increasingly used in health and social sciences (in multiple fields and in an inter-field manner). Over the years, several strategies to integrate QUAL and QUAN phases, results, and data have been proposed. For MM teachers, one of the challenges is to explain specific MM strategies and their combinations, find current illustrative examples for trainees, and identify emerging innovative MM strategies. Our project is aimed at identifying and measuring the importance of facilitators and barriers associated with the implementation of an innovative cross-disciplinary monitoring of the research literature: the Collaborative eBibliography on Mixed Methods (CeBoMM). Results will facilitate CeBoMM implementation, and can contribute to MM teaching and learning, thereby, helping MM teachers and their trainees worldwide. Ultimately, CeBoMM can be adapted to be used by teachers in other academic areas and those interested in collaborative information monitoring.

In this commentary, we will describe our study and report results that will be of interest to information and education professionals and researchers. Evidence-based medicine requires health professionals to keep up to date with new research-based knowledge. Canadian physicians must now participate in Continuing Medical Education (CME) activities. CME strives to improve clinician performance as well as patient health outcomes. Our study was aimed to assess whether physicians who participated in a CME program and expected health benefits for their patients following an elearning activity were more likely to have higher participation in the program in subsequent years. Weekly treatment Highlights were delivered by email to practicing family physicians across Canada, who rated them using the Information Assessment Method (IAM). The number of expected benefits for patients reported by participants during 2016 was plotted against the number of instances of participation in 2017. Results show that the number of expected benefits in 2016 was correlated with the number of IAM ratings in 2017.

Spaced education (SE) is a learning strategy that can improve long-term knowledge retention. Inspired by the concept of SE, we conducted a mixed methods study of a smartphone application (app) as a platform of SE. Objectives were to: (phase 1 quantitative) estimate the extent to which weekly alerts on the app can stimulate medical residents to visit the app, (connection of phases) identify participants for a second qualitative phase, and (phase 2 qualitative) describe factors, from the resident perspective, which influence sustainable participation in SE, and describe strategies for improvement of the app. Methodology and methods: phase-1 design was pre-experimental, phase-2 design was qualitative descriptive (deductive-inductive thematic analysis). Results: We observed a stimulating effect of weekly alerts for the first two months of the one-year study. Per participant, alert visits varied from 0 to 34 (mean = 1.7, SD = 4.5) and total page visits varied from 1 to 442 (mean = 28.3, SD = 61.4). Barriers and facilitators to sustainable participation in SE fell into five dimensions: user-related factors, information content factors, mobile app design factors, alert system factors, and service factors. Four strategies for app improvement were described. In conclusion, we propose five dimensions pertaining to potential predictors of sustainable participation in SE to deliver clinical information.

Information monitoring and keeping abreast of research trends is essential for researchers. However, as the volume of information and the number of tools for staying up to date continue to grow, researchers struggle to continuously monitor and filter scholarly articles. This is particularly true for researchers working in complex multidisciplinary fields like Patient Oriented Research, who need to cast their nets wide to identify relevant high-quality studies. The proposed multiple case study will explore and analyze the use and user perceptions regarding a collaborative research trend monitoring system, called eSRAP. This research will advance knowledge on processes and outcomes of collaborative monitoring of research publications. The findings will be significant to those providing monitoring services, studying collaborative information behaviour, training future researchers and information professionals, as well as to system designers.

The Information Assessment Method (IAM) is unique, theory-driven, and validated by and for different audiences. Based on a theoretical model of information outcomes, the IAM questionnaire is organized in four levels: situational relevance, cognitive impact, use, and health outcomes of information. To evaluate health information, the IAM questionnaire has been used as an outcome measure providing feedback from the viewpoint of information users, who are clinicians, managers, patients or the public. The IAM stimulates the user to rate specific health information content online (e.g., on a webpage), thereby capturing their reflection (e.g., reflective learning) and feedback. Subsequently, ratings and comments can be used by information providers to improve their content.

Mixed studies reviews include empirical studies with diverse designs (qualitative, quantitative and mixed methods). To make the process of identifying relevant empirical studies for such reviews more efficient, we developed a mixed filter that included different keywords and subject headings for quantitative (e.g., cohort study), qualitative (e.g., focus group), and mixed methods studies. It was tested for six journals from three disciplines. We measured precision (proportion of retrieved documents being relevant), sensitivity (proportion of relevant documents retrieved), and specificity (proportion of non-relevant documents not retrieved). Records were coded before applying the filter and compared with retrieved records, and descriptive statistics were performed, suggesting the mixed filter has high sensitivity, but lower precision and specificity (close to 50%). Next, based on the success of the filter, we developed an automated text classification system that can automatically select empirical studies in order to facilitate systematic mixed studies reviews. Several algorithms were trained and validated with 8,050 database records that were previously manually categorized. Decision trees had the best results and surpassed the accuracy of the filter by 30% when using full-text documents. This algorithm was then adapted into an online format that can be used by researchers to analyze their bibliography and categorize records into "empirical" and "nonempirical".

The questionnaires' origin (sources from which elements of the questionnaire are derived) and initial development (process of making a questionnaire from elements) should be assessed before their measurement properties. There is no Critical Appraisal Tool (CAT) that comprehensively assesses the origin and initial development of questionnaires therefore, our objective was to develop one. To develop the Questionnaire Origin and Development Appraisal (QODA) tool, we first developed QODA version-one from psychometric tool development guidelines, and pilot tested it, resulting in QODA version-two. Second, we performed a review that identified six CATs that evaluate origin and initial development. A pool of items was derived from these six CATs and QODA version-two. Using a nominal group method, this item pool was reduced and QODA version-three (20 items) was developed. The QODA may be useful to academic librarians who assist researchers and students from various disciplines. Information professionals including research trainees can learn how to use QODA and ensure sound questionnaire origin and initial development. This will improve the accuracy of data collected in research and professional practice (e.g., information service evaluation). Future research will study the QODA's measurement properties.

With an increasing volume of health information online, it becomes critical for consumers to improve their search and evaluation skills to retrieve reliable information. The Patient Information Aid (PIA) program is aimed to facilitate information seeking, potentially leading to positive outcomes of online consumer health information and the reduction of negative outcomes. This program consists of an educational website based on findings from a systematic literature review and a qualitative research. By teaching information evaluation skills at-the-point-of-search, the general objective of the PIA website is to improve users' e-health information literacy. Adopting user-centered design methods, we ran two focus groups with users having various literacy levels. We applied usability heuristics and information architecture strategies to design the PIA website, and developed "personas" and task scenarios to inform the wireframing. In this paper, we share our experience and insights on designing an educational information literacy program, which can be useful for information professionals working in all areas.

Online consumer health information (OCHI) is being used at an unprecedented rate, and this trend is expected to continue. Most people have used OCHI, and many may have seen the outcomes of this use (either positive or negative or both). Education and income, as indicators of socioeconomic status, are important contextual factors influencing OCHI outcomes. Much of the literature states that individuals with higher income and education are more likely to access OCHI and with this, experience better health outcomes. On the other hand, our research shows that when OCHI websites offer high-quality information that is accessible to those with low literacy levels, individuals with low socioeconomic status report as many benefits as those with higher income and education. In this commentary, we will describe the context of our research and present our findings. This work is relevant to information professionals (librarians) working with health professionals and the public, those teaching information literacy and health literacy, as well as researchers interested in information literacy and information use.

Context: Proxy online health information seekers informally seek online health information on behalf of or because of others without necessarily being asked to do so. Proxy information seekers in a person's social circle may help this person overcome information-seeking barriers (e.g., low level of e-health literacy) and illness challenges (e.g., when they are too physically weak to search themselves). However, little is known of the context, use, and reported outcomes of proxy online health information seeking. Objective: To explore the outcomes of proxy online health information seeking behaviour. Study Design: Mixed studies literature review with framework synthesis, then a convergent mixed methods study. Setting: In partnership with Naitre et Grandir (an online parenting resource). Population: Members of the entourage of parents of 0- to 8-year-old children (grandparents, family members, friends, neighbours, or professionals working with children). Instrument: Validated 'Information Assessment Method' (IAM) questionnaire. Results: An initial theoretical model was developed using findings from the mixed studies review. IAM questionnaire responses showed that entourage members who actively seek online information were more likely to report that the information can help them be less worried, handle a problem, and decide what to do with someone else. In the interviews, entourage members reported proxy-seeking for reassurance, out of personal curiosity, as part of their professional role, or following an explicit request from the parents. They used the information to provide informational support (either by sharing the webpage directly or discussing its content), or to provide material support for a child in their care (e.g., playing games with a child), or to provide emotional support. In some cases, they did not share the information to avoid tensions with the parents in question. Positive outcomes included improvement in the relationship with others, and negative outcomes included interpersonal tensions when information was unsolicited. The initial model was revised to incorporate findings from the mixed methods study. Expected Outcomes: Findings from this study advance knowledge on proxy online health information seeking behaviour and outcomes. Health care practitioners can target patients' entourage with information for dissemination and use. Patients can be encouraged to turn to their entourage for support using online health information., Presenters Reem El Sherif, PhD, MBChB, Roland Grad, MD, MSc, FCFP, Pierre Pluye, MD, [...]

Context: Almost all parents search web-based information for their children. This study focuses on parents with low socioeconomic status (SES), a correlate of health literacy (determinants of child education/health); specifically, their experience of seeking information on the Naitre et Grandir (N&G) website (trustworthy information on child development, education and health in clear language). Objectives: To measure the influence of a health literacy intervention on (a) the frequency of the utilization of a questionnaire to understand the perceived outcomes of N&G information, and (b) parents' expected benefits of this information. Study Design and Analysis: A 4-year prospective time series. Statistical analyses were descriptive and inferential. Setting: For each N&G webpage, parents are invited to complete a questionnaire (Information Assessment Method, IAM) to report their intention to use and expected benefits of the webpage information. Population studied: Quebec parents of 0-8-year-old children who completed at least one IAM questionnaire. Intervention: An improved version of the IAM, the IAM+ was developed with low SES parents and implemented in January 2019. Main outcome measures: IAM data were collected in the pre-intervention (2017-2018) and the post-intervention (2019-2020) periods. Results: Participants completed 10,362 IAM questionnaires. The proportion of responses and reported benefits from low SES participants increased post-intervention. Low SES participants and particularly low SES fathers expected greater benefits from the accessed web information compared to other participants and mothers. Conclusions: Results suggest (a) family physicians recommend trustworthy easy-to-read information resources to all patients when needed, including patients with a low literacy level; (b) web content that incorporates international health literacy standards is associated with greater expected benefits among low SES parents; (c) increasing father awareness and father-inclusive content can lead to greater expected benefits; and (d) the IAM questionnaire that is accessible on all devices, including smartphones, can help low SES parents provide feedback to web editors regarding the outcomes of their content., Presenters Pierre Pluye, MD, PhD, Albina Tskhay, Roland Grad, MD, MSc, FCFP, Melanie Barwick, PhD, CPsych, Genevieve Doray, Gillian Bartlett-Esquilant, PhD, Christine Loignon, PhD, Araceli Gonzalez Reyes, MSc, Reem El [...]

Objective: Identify the most performant automated text classification method (eg, algorithm) for differentiating empirical studies from nonempirical works in order to facilitate systematic mixed studies reviews. Methods: The algorithms were trained and validated with 8050 database records, which had previously been manually categorized as empirical or nonempirical. A Boolean mixed filter developed for filtering MEDLINE records (title, abstract, keywords, and full texts) was used as a baseline. The set of features (eg, characteristics from the data) included observable terms and concepts extracted from a metathesaurus. The efficiency of the approaches was measured using sensitivity, precision, specificity, and accuracy. Results: The decision trees algorithm demonstrated the highest performance, surpassing the accuracy of the Boolean mixed filter by 30%. The use of full texts did not result in significant gains compared with title, abstract, keywords, and records. Results also showed that mixing concepts with observable terms can improve the classification. Significance: Screening of records, identified in bibliographic databases, for relevant studies to include in systematic reviews can be accelerated with automated text classification.

PURPOSE Case management (CM) is a promising intervention for frequent users of health care services. Our research question was how and under what circumstances does CM in primary care work to improve outcomes among frequent users with chronic conditions? METHODS We conducted a realist synthesis, searching MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) for articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Academic and gray literature were evaluated for relevance and robustness. Independent reviewers extracted data to identify context, mechanism, and outcome (CMO) configurations. Analysis of CMO configurations allowed for the modification of an initial program theory toward a refined program theory. RESULTS Of the 9,295 records retrieved, 21 peer-reviewed articles and an additional 89 documents were retained. We evaluated 19 CM interventions and identified 11 CMO configurations. The development of a trusting relationship fostering patient and clinician engagement in the CM intervention was recurrent in many CMO configurations. CONCLUSION Our refined program theory proposes that in the context of easy access to an experienced and trusted case manager who provides comprehensive care while maintaining positive interactions with patients, the development of this relationship fosters the engagement of both individuals and yields positive outcomes when the following mechanisms are triggered: patients and clinicians feel supported, respected, accepted, engaged, and committed; and patients feel less anxious, more secure, and empowered to self-manage., INTRODUCTION Frequent users of health care services are a small proportion of the population who account for a disproportionate number of visits to emergency departments, thereby placing a heavy strain [...]

Introduction: Appraising the quality of studies included in systematic reviews combining qualitative and quantitative evidence is challenging. To address this challenge, a critical appraisal tool was developed: the Mixed Methods Appraisal Tool (MMAT). The aim of this paper is to present the enhancements made to the MMAT. Development: The MMAT was initially developed in 2006 based on a literature review on systematic reviews combining qualitative and quantitative evidence. It was subject to pilot and interrater reliability testing. A revised version of the MMAT was developed in 2018 based on the results from usefulness testing, a literature review on critical appraisal tools and a modified e-Delphi study with methodological experts to identify core criteria. Tool Description: The MMAT assesses the quality of qualitative, quantitative, and mixed methods studies. It focuses on methodological criteria and includes five core quality criteria for each of the following five categories of study designs: (a) qualitative, (b) randomized controlled, (c) nonrandomized, (d) quantitative descriptive, and (e) mixed methods. Conclusion: The MMAT is a unique tool that can be used to appraise the quality of different study designs. Also, by limiting to core criteria, the MMAT can provide a more efficient appraisal.

A mixed studies review (MSR) is a type of literature review that includes qualitative, quantitative, and mixed methods studies. This form of literature review is popular since it can provide a rich understanding of complex health interventions and programs. However, conducting a MSR can be challenging since it combines several study designs. A wiki toolkit was developed to provide MSR-specific guidance and suggest tips and tools for planning, conducting and reporting MSR. The toolkit is structured according to eight stages for conducting a systematic review: (1) formulate a review question, (2) define eligibility criteria, (3) select sources of information, (4) identify potentially relevant studies, (5) select relevant studies, (6) appraise the quality of studies, (7) extract data, and (8) synthesize included studies. The toolkit includes examples, tips for searching studies with diverse designs, existing tools for searching, selecting and appraising, synthesis designs, and a template for proposals and reports. This toolkit is presented as a wiki, which allows users to collaboratively modify the content and provides continuous updates on the science of MSR. It is hoped that this wiki toolkit will be useful to all users and contribute to creating a network of people interested in MSR.

Systematic reviews (SR) typically focus on well-defined topics and homogeneous populations. In contrast, conducting a SR on patients with complex care needs (PCCN) presents two main challenges: a novel ill-defined topic and a heterogeneous population. This commentary summarizes the lessons learned from our experience using crowdsourcing to meet these challenges. PCCN often suffer from combinations of multiple issues (medical, interactional, sociocultural, psychological, related to healthcare services use), which can lead to difficult decision-making involving different stakeholders (themselves, caregivers, practitioners). The objective of our SR was to systematically assess decisional needs of PCCN reported in the literature. With the collaboration of librarians, we identified 8616 potentially relevant studies in five databases. A team of 20 crowdreviewers were trained and participated in the selection of 156 relevant studies, using specialised online software. The main benefit of crowdsourcing was the diversity of crowdreviewers' viewpoints which helped us establish an intersubjective knowledge classification of idiosyncratic concepts related to PCCN and their decisional needs. In line with other crowdsourced reviews, our experience confirms that crowdsourcing can be useful in SR with a large number of studies on ill-defined domains and with heterogeneous populations

Literature reviews, and more particularly systematic reviews, are increasingly being produced and published. The past 40 years have been marked by considerable development of methodologies and methods in literature reviews. This paper aims to provide a brief historical overview of systematic reviews which will help to have a better understanding of what, why, when, and how they were developed. The paper is structured in three parts. The first part will provide a definition of systematic reviews and their main characteristics. The second part will present three main periods of the evolution of systematic reviews: foundation period (1970-1989), institutionalization period (1990-2000), and diversification period (2001-). These periods can be distinguished by the users of scientific evidence, the methodological influence, and the technological development. The last part will summarize the main elements in the history of the systematic reviews and present some direction for future research.

PURPOSE Case management (CM) interventions are effective for frequent users of health care services, but little is known about which intervention characteristics lead to positive outcomes. We sought to identify characteristics of CM that yield positive outcomes among frequent users with chronic disease in primary care. METHODS For this systematic review of both quantitative and qualitative studies, we searched MEDLINE, CINAHL, Embase, and PsycINFO (1996 to September 2017) and included articles meeting the following criteria: (1) population: adult frequent users with chronic disease, (2) intervention: CM in a primary care setting with a postintervention evaluation, and (3) primary outcomes: integration of services, health care system use, cost, and patient outcome measures. Independent reviewers screened abstracts, read full texts, appraised methodologic quality (Mixed Methods Appraisal Tool), and extracted data from the included studies. Sufficient and necessary CM intervention characteristics were identified using configurational comparative methods. RESULTS Of the 10,687 records retrieved, 20 studies were included; 17 quantitative, 2 qualitative, and 1 mixed methods study. Analyses revealed that it is necessary to identify patients most likely to benefit from a CM intervention for CM to produce positive outcomes. High-intensity intervention or the presence of a multidisciplinary/interorganizational care plan was also associated with positive outcomes. CONCLUSIONS Policy makers and clinicians should focus on their case-finding processes because this is the essential characteristic of CM effectiveness. In addition, value should be placed on high-intensity CM interventions and developing care plans with multiple types of care providers to help improve patient outcomes. Key words: case management; frequent users; primary health care; systematic review, INTRODUCTION In developed countries, the bulk of health care system expenses is attributable to a small proportion of the population. Specifically, frequent users of health care services account for approximately [...]

Abstract Background Participatory Research (PR) entails the co-governance of research by academic researchers and end-users. End-users are those who are affected by issues under study (e.g., community groups or populations affected by illness), or those positioned to act on the knowledge generated by research (e.g., clinicians, community leaders, health managers, patients, and policy makers). Systematic reviews assessing the generalizable benefits of PR must address: the diversity of research topics, methods, and intervention designs that involve a PR approach; varying degrees of end-user involvement in research co-governance, both within and between projects; and the complexity of outcomes arising from long-term partnerships. Methods We addressed the above mentioned challenges by adapting realist review methodology to PR assessment, specifically by developing inductively-driven identification, selection, appraisal, and synthesis procedures. This approach allowed us to address the non-uniformity and complexity of the PR literature. Each stage of the review involved two independent reviewers and followed a reproducible, systematic coding and retention procedure. Retained studies were completed participatory health interventions, demonstrated high levels of participation by non-academic stakeholders (i.e., excluding studies in which end-users were not involved in co-governing throughout the stages of research) and contained detailed descriptions of the participatory process and context. Retained sets are being mapped and analyzed using realist review methods. Results The librarian-guided search string yielded 7,167 citations. A total of 594 citations were retained after the identification process. Eighty-three papers remained after selection. Principle Investigators (PIs) were contacted to solicit all companion papers. Twenty-three sets of papers (23 PR studies), comprising 276 publications, passed appraisal and are being synthesized using realist review methods. Discussion The systematic and stage-based procedure addressed challenges to PR assessment and generated our robust understanding of complex and heterogeneous PR practices. To date, realist reviews have focussed on evaluations of relatively uniform interventions. In contrast our PR search yielded a wide diversity of partnerships and research topics. We therefore developed tools to achieve conceptual clarity on the PR field, as a beneficial precursor to our theoretically-driven synthesis using realist methods. Findings from the ongoing review will be provided in forthcoming publications.