title: If you build it, will they come? A qualitative evaluation of the use of video-based decision aids in primary care.
abstract: OBJECTIVE
  Given the growing presence of Patient-centered Medical Home practices and the need for patient participation, it is concerning that tools to improve patient participation are not widely used in primary care. Despite demonstrated effect on decision quality and patient satisfaction, decision aids (DAs) are not broadly utilized. We conducted focus groups to examine the use of DAs and uncovered barriers to greater DA utilization in primary care.
  
  
  METHODS
  The University of California, San Diego family medicine clinics use an integrated process to prescribe DA videos. We conducted provider and patient focus groups to explore use of DAs in three clinics. Using a qualitative phenomenological design, we analyzed thematic content using immersion techniques.
  
  
  RESULTS
  Focus group discussions identified six categories: patient benefits, physician benefits, process improvements needed, reasons DAs are prescribed, barriers to watching DAs, and the role of the DA. These categories encompassed 21 themes. Four themes were salient for improving DA utilization: follow-up process needs improvement, prescribing process needs improvement, patients were unclear regarding each DA's purpose, and patient benefits.
  
  
  CONCLUSIONS
  While previous studies have described expected barriers to hypothetical DA distribution, our analysis reveals barriers reported by physicians, staff, and patients based on actual experience in practice. Decision aids can improve patient participation in health decisions. However, physicians and patients have to recognize a need for these tools before they will be adopted in practice.
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, USA. amnewsome@ucsd.edu
authors.forename: Alita
authors.initials: A
authors.lastname: Newsome
authors.forename: William
authors.initials: W
authors.lastname: Sieber
authors.forename: Michele
authors.initials: M
authors.lastname: Smith
authors.forename: Dustin
authors.initials: D
authors.lastname: Lillie
mesh_terms: D001291:Attitude of Health Personnel; D002140:California; D003657:Decision Making; D003661:Decision Support Techniques; D017144:Focus Groups; D006801:Humans; D010358:Patient Participation / Q000523:psychology / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000379:methods; D010361:Patients / Q000523:psychology; D010820:Physicians / Q000523:psychology; D011320:Primary Health Care / Q000379:methods