Improving healthcare consumer effectiveness: an Animated, Self-serve, Web-based Research Tool (ANSWER) for people with early rheumatoid arthritis.
BACKGROUND
People with rheumatoid arthritis (RA) should use DMARDs (disease-modifying anti-rheumatic drugs) within the first three months of symptoms in order to prevent irreversible joint damage. However, recent studies report the delay in DMARD use ranges from 6.5 months to 11.5 months in Canada. While most health service delivery interventions are designed to improve the family physician's ability to refer to a rheumatologist and prescribe treatments, relatively little has been done to improve the delivery of credible, relevant, and user-friendly information for individuals to make treatment decisions. To address this care gap, the Animated, Self-serve, Web-based Research Tool (ANSWER) will be developed and evaluated to assist people in making decisions about the use of methotrexate, a type of DMARD. The objectives of this project are: 1) to develop ANSWER for people with early RA; and 2) to assess the extent to which ANSWER reduces people's decisional conflict about the use of methotrexate, improves their knowledge about RA, and improves their skills of being 'effective healthcare consumers'.


METHODS
Consistent with the International Patient Decision Aid Standards, the development process of ANSWER will involve: 1.) creating a storyline and scripts based on the best evidence on the use of methotrexate and other management options in RA, and the contextual factors that affect a patient's decision to use a treatment as found in ERAHSE; 2.) using an interactive design methodology to create, test, analyze and refine the ANSWER prototype; 3.) testing the content and user interface with health professionals and patients; and 4.) conducting a pilot study with 51 patients, who are diagnosed with RA in the past 12 months, to assess the extent to which ANSWER improves the quality of their decisions, knowledge and skills in being effective consumers.


CONCLUSIONS
We envision that the ANSWER will help accelerate the dissemination of knowledge and skills necessary for people with early RA to make informed choices about treatment and to manage their health. The latest in animation and online technology will ensure ANSWER fills a knowledge translation gap, focusing on the next generation of people living with RA.
Li
Linda C
LC
Department of Physical Therapy, University of British Columbia, Vancouver, Canada. lli@arthritisresearch.ca
Adam
Paul
P
Townsend
Anne F
AF
Stacey
Dawn
D
Lacaille
Diane
D
Cox
Susan
S
McGowan
Jessie
J
Tugwell
Peter
P
Sinclair
Gerri
G
Ho
Kendall
K
Backman
Catherine L
CL
D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001955:British Columbia; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D010865:Pilot Projects; D011446:Prospective Studies; D020377:Self Efficacy; D012984:Software; D011795:Surveys and Questionnaires; D014584:User-Computer Interface
Cochrane Database Syst Rev. 2003;(1):CD002047
12535423
J Rheumatol. 2000 Mar;27(3):623-9
10743799
Rheumatology (Oxford). 2000 Jan;39(1):34-42
10662871
J Cancer Educ. 2006 Fall;21(3):133-9
17371175
Ann Rheum Dis. 1998 Feb;57(2):88-93
9613337
J Genet Couns. 1999 Aug;8(4):217-33
26142262
Curr Opin Rheumatol. 2001 May;13(3):193-201
11333348
Lancet. 2004 Oct 23-29;364(9444):1523-37
15500899
J Contin Educ Health Prof. 2006 Winter;26(1):13-24
16557505
Patient Educ Couns. 1998 Mar;33(3):267-79
9731164
Ann Intern Med. 1999 Nov 16;131(10):768-74
10577301
J Rheumatol. 1993 Feb;20(2):243-7
8474059
J Rheumatol. 2005 Jan;32(1):137-42
15630739
J Rheumatol. 2007 Jun;34(6):1392-400
17552066
Ann Rheum Dis. 2003 Feb;62(2):159-61
12525386
Arthritis Rheum. 2002 Apr;46(4):894-8
11953964
Arthritis Rheum. 1998 Jul;41(7):1190-5
9663474
Ann Rheum Dis. 2009 Jul;68(7):1086-93
19033291
BMJ. 2006 Aug 26;333(7565):417
16908462
Cochrane Database Syst Rev. 2000;(4):CD001157
11034702
Am J Med. 2001 Oct 15;111(6):446-51
11690569
J Rheumatol. 2005 Nov;32(11):2257-61
16265713
Arthritis Rheum. 2005 Apr 15;53(2):241-8
15818655
J Rheumatol. 1997 Apr;24(4):647-53
9101496
J Rheumatol. 1995 Dec;22(12):2208-13
8835550
Rheumatology (Oxford). 2003 Jun;42(6):763-8
12730536
Phys Ther. 2007 Dec;87(12):1728-38
17906288
Ann Rheum Dis. 2009 Jul;68(7):1094-9
19033290
Rheumatology (Oxford). 2000 Jun;39 Suppl 1:30-5
11001377
Arthritis Rheum. 1996 Apr;39(4):616-22
8630111
Ann Intern Med. 1996 Apr 15;124(8):699-707
8633829