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Wikis are knowledge translation tools that could help health professionals implement best practices in acute care. Little is known about the factors influencing professionals’ use of wikis.
To identify and compare the beliefs of emergency physicians (EPs) and allied health professionals (AHPs) about using a wiki-based reminder that promotes evidence-based care for traumatic brain injuries.
Drawing on the theory of planned behavior, we conducted semistructured interviews to elicit EPs’ and AHPs’ beliefs about using a wiki-based reminder. Previous studies suggested a sample of 25 EPs and 25 AHPs. We purposefully selected participants from three trauma centers in Quebec, Canada, to obtain a representative sample. Using univariate analyses, we assessed whether our participants’ gender, age, and level of experience were similar to those of all eligible individuals. Participants viewed a video showing a clinician using a wiki-based reminder, and we interviewed participants about their behavioral, control, and normative beliefs—that is, what they saw as advantages, disadvantages, barriers, and facilitators to their use of a reminder, and how they felt important referents would perceive their use of a reminder. Two reviewers independently analyzed the content of the interview transcripts. We considered the 75% most frequently mentioned beliefs as salient. We retained some less frequently mentioned beliefs as well.
Of 66 eligible EPs and 444 eligible AHPs, we invited 55 EPs and 39 AHPs to participate, and 25 EPs and 25 AHPs (15 nurses, 7 respiratory therapists, and 3 pharmacists) accepted. Participating AHPs had more experience than eligible AHPs (mean 14 vs 11 years;
We identified EPs’ and AHPs’ salient beliefs about using a wiki-based reminder. We will draw on these beliefs to construct a questionnaire to measure the importance of these determinants to EPs’ and AHPs’ intention to use a wiki-based reminder promoting evidence-based care for traumatic brain injuries.
As many as half of all patients with major traumatic injuries do not receive the recommended care [
A wiki is a webpage or a collection of webpages whose content can be modified by those who access it [
Although several wikis exist in health care, a wiki containing reminders to treat trauma patients does not exist yet. These wiki-based reminders for trauma would be created by a multidisciplinary group of clinicians interested in improving the quality of trauma care by implementing care protocols to help standardize trauma care. Using a wiki to share reminders could be a potentially powerful tool to allow a multidisciplinary group of health care professionals within the same hospital or situated in different hospitals to collaborate in the creation of high-quality, evidence-based reminders. The wiki would serve as a shared online repository available for health care professionals at the point of care.
Despite preliminary surveys showing health care professionals’ interest in wikis [
The theory of planned behavior (
Intention is influenced by three constructs: attitude, subjective norm, and perceived behavioral control. Attitude toward the behavior is a person’s evaluation of the consequences of adopting the behavior. Attitude is thus determined by the actor’s behavioral beliefs about the advantages and disadvantages of adopting the behavior. Subjective norm refers to perceived social pressure to engage or not to engage in a behavior. Subjective norm thus represents the actor’s normative beliefs—that is, his or her beliefs about how people who are in some way important to the actor would like the actor to behave. Finally, perceived behavioral control is the actor’s perception of how easy or difficult it is to perform the behavior. This perception is determined by the presence of perceived barriers and facilitators: control beliefs. According to Ajzen [
Theoretical framework of the theory of planned behavior.
Our goal was to identify and compare the salient beliefs of EPs and AHPs about using a wiki-based reminder that promotes best practices in the management of patients with a severe traumatic brain injury in emergency departments in the province of Quebec, Canada.
The detailed protocol of this research project has been published elsewhere [
The study took place in three officially designated trauma centers in the province of Quebec, Canada: a level I, a level II, and a level III trauma center (see
The data collection process began by each participant meeting a researcher (AB) individually to obtain informed consent. During this meeting, the researcher, who had conducted other surveys using the theory of planned behavior, explained the study process, outlined anonymity and confidentiality issues, and stated that the participant would not be remunerated for his or her time. All meetings were conducted in French and all took place in person except one, which took place by phone. After obtaining the participant’s consent, the researcher showed the participant a video that gave a brief, simple explanation of how different health care professionals could use wikis to collaborate in creating and updating wiki-based reminders for the care of traumatic brain injury patients. The video finished with a real-life enactment of the clinician performing the behavior of interest (using a wiki-based reminder) at a patient’s bedside. A different version of the video was produced for each professional group participating in the survey (physicians, nurses, respiratory therapists, and pharmacists; see
To identify participants’ beliefs, two researchers (AB, KA) experienced with the theory of planned behavior independently analyzed the contents of the interview transcripts and the notes taken during the interviews. Using deductive content analysis [
The next step consisted of grouping the beliefs that expressed the same idea. This was done by the first researcher (AB) and validated by the second (KA). At this point, the researchers compared the beliefs with one another to remove duplicates. Dissent about grouping beliefs that expressed similar but slightly different ideas was resolved through discussion. When necessary, the principal investigator made the final decision.
Through discussion, the researchers then labeled the beliefs inductively without a predetermined taxonomy based on the ideas expressed by the participants. To better compare our results with the results of other studies of beliefs about the use of new information technology in health care, we appropriated some of the labels in the taxonomy developed by Gagnon et al [
After having classified each belief in a category, marked it as positive or negative, and given it a label, we used the options in Excel to count the frequency of mentions of each belief. Within the three belief categories, we counted the total number of times each belief was reported by participants. Using Excel, we then ordered the beliefs from the most to the least frequently mentioned and assigned each belief a rank according to its position on this list. To identify the 75% most frequently mentioned beliefs for each category (behavioral, normative, and control), we divided the cumulative total number of mentions of each belief by the total number of mentions of all beliefs in that category and retained the top three-quarters as the salient beliefs for that category as per theory of planned behavior methodology [
To determine whether our participants’ baseline demographic characteristics were statistically different from those of the general population of health care professionals from which we had recruited our sample, we performed simple univariate statistical analyses. We used a 2-tailed Fisher exact test for dichotomous variables (gender) and a 2-tailed Student
The three trauma centers comprised 66 eligible EPs and 444 eligible AHPs. To attain our target of 25 professionals per group, we invited 55 EPs and 39 AHPs to participate. Of these, 38% (25/66) of EPs and 6% (25/444) of AHPs agreed to take part. This translates to a response rate of 46% (25/55) for EPs and 64% (25/39) for AHPs. Of participating AHPs, 60% (15/25) were nurses, 28% (7/25) were respiratory therapists, and 12% (3/25) were pharmacists. These proportions are comparable with the distribution of eligible AHPs, of whom 57.7% (256/444) were nurses, 32.9% (146/444) were respiratory therapists, and 10% (42/444) were pharmacists. Our sample of EPs was composed of 10 EPs from a level I center, 10 from a level II center, and 5 from a level III center. Our sample of AHPs reproduced this distribution.
Compared with the 66 eligible EPs, the EPs who participated in this survey were similar in mean age (42 vs 43 years;
As shown in
Characteristics of participating emergency physicians (EPs) and allied health professionals (AHPs).
Variable | EPs (n = 25) | AHPs (n = 25) | |
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Mean (SD) | 42 (9) | 38 (10) | |
Median (IQR)a | 38 (35–49) | 35 (29–44) | |
Born between 1977 and 1997, n (%) | 4 (16%) | 10 (40%) | |
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Mean (SD) | 14 (10) | 14 (9) | |
Median (IQR) | 11 (6–23) | 11 (9–18) | |
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Male | 23 (92%) | 7 (28%) | |
|
Not applicable | ||
College of Family Physicians (without emergency medicine certification) | 9 (36%) | ||
College of Family Physicians (with emergency medicine certification) | 4 (16%) | ||
Royal College of Physicians of Canada or Collège des médecins du Québec | 8 (32%) | ||
|
Not applicable | ||
Nursing | 15 (60%) | ||
Respiratory therapist | 7 (28%) | ||
Pharmacist | 3 (12%) | ||
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Emergency department | 25 (100%) | 22 (88%) | |
Intensive care unit | 2 (8%) | 9 (36%) | |
Member of a local or regional trauma committee | 4 (16%) | 4 (16%) | |
Previous use of a wikib, n (%) | 20 (80%) | 15 (60%) | |
Previous use of Wikipediab, n (%) | 14 (56%) | 8 (32%) | |
Previous editing of a wikib, n (%) | 1 (4%) | 1 (4%) |
a Interquartile range.
b We did not ask whether the respondent had used wikis for personal or for professional reasons.
Emergency physicians’ salient beliefs about using a wiki-based reminder.
Ranka | Salient belief | n (%)b | Verbatim example | |
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1 | Refreshes the memory | 14 (20%) | “good revision” | |
2 | Gives access to evidence-based data | 9 (13%) | “see the best data” | |
3 | Allows information to be shared | 9 (13%) | “creates a collaborative space between hospitals” | |
4 | Standardizes practices | 8 (11%) | “consensus on the approach” | |
5 | Centralizes information and protocols | 7 (10%) | “prevents searching in different places” | |
6 | Reduces errors | 6 (8%) | “commit fewer mistakes” | |
7 | Gives access to expert opinions | 6 (8%) | “written by leaders in the field” | |
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10 | Adds stressc | 2 (3%) | “stress is added by having to search information while your patient is there” | |
Total | 61/71 (86%) | |||
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1 | Nurses | 16 (13%) | “nurses” | |
2 | Physicians | 16 (13%) | “physicians” | |
3 | Isolated/less-exposed centers | 15 (13%) | “centers less familiar with severe head injury” | |
4 | The younger generation | 14 (12%) | “the young” | |
7 | Respiratory therapists | 8 (7%) | “respiratory therapists” | |
8 | The trauma team | 7 (6%) | “the emergency team” | |
10 | Administrationc | 4 (3%) | “the department heads” | |
11 | The respondent’s patientsc | 3(3%) | “patients” | |
12 | Specialists (surgeons, intensivists)c | 3 (3%) | “specialties other than emergency” | |
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5 | People resistant to standardized care | 8 (7%) | “some people think that protocols are for robots” | |
6 | People less comfortable with computers | 8 (7%) | “people not comfortable using computers” | |
Total | 102/119 (86%) | |||
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1 | Ease of used | 19 (8%) | “if it is user friendly, easy to navigate” | |
2 | Having a bedside computer | 18 (8%) | “must be easy to access directly in the resuscitation room” | |
3 | Peer-reviewed high-quality scientific information | 18 (8%) | “control over the quality of the information” | |
5 | Rapid access to protocols | 17 (7%) | “access should not take more than 3 clicks” | |
6 | Absence of institutional control | 14 (6%) | “having 18 passwords” | |
7 | Compatibility with work processesd | 14 (6%) | “integrated into daily work tools” | |
8 | Access by handheld devices (eg, an iPhone) | 11 (5%) | “available on handheld computers” | |
9 | Locally adaptable | 8 (4%) | “able to adapt it to the local flavor” | |
10 | Trialabilityd | 8 (4%) | “you have to use it often to become familiar” | |
11 | Having Internet access | 7 (3%) | “accessible from all locations by Internet” | |
12 | Quality of visual design | 7 (3%) | “the attractiveness of the site” | |
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4 | Not being updated regularly | 18 (8%) | “if the protocol dates back and I know there are new data” | |
13 | Time constraintsd | 7(3%) | “Not having the time, having to decide on the spot” | |
14 | Frequently changing information | 7 (3%) | “wiki always changing” | |
15 | Authors not being identifiedc | 6 (3%) | “be able to know who edited” | |
18 | Undetermined legal responsibilityc | 4 (2%) | “who is ultimately legally responsible” | |
Total | 183/227 (81%) |
a The rank number corresponds to the position held in the ranking of all beliefs. The most frequently mentioned belief is ranked first. The ranking numbers do not necessarily follow each other in this table, since we grouped them as advantages, disadvantages, favorable referents, unfavorable referents, barriers, and facilitators. These rank numbers correspond to their position in
b n = the number of participants who reported the belief during their interview, and % = the number of times the belief was reported in all interviews divided by the number of times all beliefs in that category (behavioral, normative, and control beliefs) were reported in all interviews.
c This belief was not mentioned in the top 75% most frequently reported but was retained nonetheless.
d The label for this belief was taken from the Gagnon et al framework [
Allied health professionals’ salient beliefs about using a wiki-based reminder.
Ranka | Salient beliefs | n (%)b | Verbatim example | |
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1 | Gives rapid access to protocols | 16 (16%) | “immediately available” | |
2 | Improves quality of care | 15 (15%) | “enhances the quality of care” | |
3 | Gives access to a regularly updated protocol | 12 (12%) | “always up-to-date” | |
4 | Standardizes practices | 9 (9%) | “everyone uses the same procedure” | |
5 | Promotes team work | 8 (8%) | “enables a multidisciplinary approach” | |
6 | Centralizes information and protocols | 6 (6%) | “able to consolidate the information” | |
7 | Gives access to evidence-based data | 6 (6%) | “based on evidence” | |
8 | Provides a new tool for teaching | 6 (6%) | “facilitates education” | |
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None perceived | ||||
Total | 78/101 (77%) | |||
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1 | Physicians | 19 (14%) | “physicians” | |
2 | Respiratory therapists | 18 (13%) | “respiratory therapists” | |
3 | Nurses | 16 (12%) | “nurses” | |
4 | The younger generation | 13 (9%) | “young people” | |
7 | The trauma team | 9 (7%) | “any professional working in the trauma bay with a [traumatic brain injury]” | |
8 | Quality-of-care promoters | 9 (7%) | “clinical coordinator” | |
10 | Administrationc | 7(5%) | “general management” | |
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5 | People less comfortable with computers | 11 (8%) | “those with less computer skills” | |
6 | People resistant to change | 11 (8%) | “people less favorable to change” | |
Total | 113/137 (82%) | |||
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1 | Having a bedside computer | 20 (12%) | “have the computer close at hand” | |
2 | Peer-reviewed high-quality scientific information | 13 (8%) | “who ensures that the information is good” | |
3 | Trialabilityd | 12 (7%) | “must have training” | |
4 | Ease of used | 11 (7%) | “simple, instinctive system” | |
8 | Publicity about the wiki | 7 (4%) | “should be publicized” | |
9 | Secure website | 7 (4%) | “secure system” | |
12 | Having a workstation for every profession | 5 (3%) | “each having a workstation” | |
14 | Quality of visual design | 5 (3%) | “simple presentation” | |
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5 | Undetermined legal responsibility | 10 (6%) | “must know if the hospital endorses it” | |
6 | Time constraintsd | 10 (6%) | “we must act, no time to go look” | |
7 | System reliability | 7 (4%) | “if the computer crashes” | |
10 | The whole team not being up-to-date | 6 (4%) | “if people are not up-to-date, could be difficult to apply it” | |
11 | Cost of computers | 6 (4%) | “the budget” | |
13 | Mandatory use | 5 (3%) | “it’s not because one center does it that way, that everybody should adopt that practice” | |
Total | 124/162 (77%) |
a The rank number corresponds to the position held in the ranking of all beliefs. The most frequently mentioned belief is ranked first. The ranking numbers do not necessarily follow each other in this table, since we grouped them as advantages, disadvantages, favorable referents, unfavorable referents, barriers, and facilitators. These rank numbers correspond to their position in
b n = the number of participants who reported the belief during their interview, and % = the number of times the belief was reported in all interviews divided by the number of times all beliefs in that category (behavioral, normative, and control beliefs) were reported in all interviews.
c This belief was not mentioned in the top 75% most frequently reported but was retained nonetheless.
d The label for this belief was taken from the Gagnon et al framework [
Flow of participants through study.
Proportion of emergency physicians who mentioned each behavioral belief (both salient and nonsalient).
Proportion of emergency physicians who mentioned each normative belief (both salient and nonsalient).
Proportion of emergency physicians who mentioned each control belief (both salient and nonsalient).
Proportion of allied health professionals who mentioned each behavioral belief (both salient and nonsalient).
Proportion of allied health professionals who mentioned each normative belief (both salient and nonsalient).
Proportion of allied health professionals who mentioned each control belief (both salient and nonsalient).
The three behavioral beliefs about using a wiki-based reminder that EPs mentioned most frequently were, in order of frequency, that if refreshes the memory, gives access to evidence-based data, and allows information to be shared. No disadvantages figured in the top 75% of beliefs, and only one disadvantage was reported at all, with 2 EPs opining that a wiki-based reminder system would add the stress of having to look for information while the patient was there in front of them (
The three referents most cited by EPs as likely to approve or disapprove of the behavior were nursing personnel, physicians, and isolated or less-exposed trauma centers. All were seen as favorable to the respondent’s adopting the behavior (
EPs indicated that the three top facilitators were ease of use, having a computer at the bedside, and accessing information that was peer reviewed and of high scientific quality (
Among AHPs, the three most frequently mentioned facilitators were having a computer at the bedside, accessing information that was peer reviewed and of high scientific quality, and trialability (how easy it is to experiment with the tool) (
This study identified EPs’ and AHPs’ beliefs about using a wiki-based reminder to promote best practices in caring for patients with a severe traumatic brain injury. Based on the theory of planned behavior, we categorized these beliefs as behavioral, normative, and control beliefs. After analyzing the beliefs and ranking them in order of frequency of mention, we labeled the 75% most-reported beliefs as salient. We also labeled salient certain beliefs that were not among the 75% most reported. This post hoc decision was based on our knowledge of the literature (eg, “administration” as a normative belief), our experience in implementing care protocols for trauma (eg, “specialists” as a normative belief), or our fear of excluding important negative beliefs (eg, “adds stress” as a behavioral belief).
EPs and AHPs saw many of the same advantages to using a wiki-based reminder: namely, that a reminder gives access to evidence-based data, that it standardizes practices, and that it centralizes protocols. EPs and AHPs also shared similar normative beliefs about parties favorable to the use of a wiki-based reminder (nurses, physicians, respiratory therapists, the trauma team, and the younger generation), and both groups mentioned people less comfortable with computers as a negative referent. Many facilitating factors were common to EPs and AHPs: having a computer at the bedside, accessing information that was peer reviewed and of high scientific quality, ease of use, trialability, and an attractive visual design. The groups also had two obstacles in common: time constraints and undetermined legal responsibility.
Our two groups of respondents also differed in the perceived advantages to using a wiki-based reminder. While both saw the centralization of information and protocols as an advantage, only EPs saw the sharing of information as an advantage and only AHPs saw the promotion of teamwork as an advantage. Similarly, both groups saw easy access to a wiki-based reminder (eg, having a bedside computer) as a characteristic that would make using the reminder simple to use, but only EPs saw rapid access to protocols (“fewer than three clicks”) as a simplifying feature, and only AHPs saw having a workstation for every professional as such a feature. The apparent contradiction between the AHPs’ concern about having a secure website and the EPs’ desire to avoid passwords is worth exploring. Finally, AHPs felt it important to publicize and otherwise promote the wiki-based reminder to make it more visible (or in Rogers’s terms, which we explain below, “observable”). AHPs saw this as important to the innovation’s uptake, recognizing that the more people observe others using a wiki, the more likely they are to use it too.
We noted other differences. Significantly, AHPs named mandatory use as a dominant barrier. At the same time, AHPs often referred to EPs, quality-of-care promoters, and hospital administrators as important decision makers in the care of patients with a severe traumatic brain injury. Thus, if EPs, quality-of-care promoters, and hospital administrators make it mandatory to use a wiki-based reminder, the importance of this barrier might decrease. Research suggests that individuals are more likely to comply with referents’ expectations when the referents in question can reward or punish nonbehavior, as is often the case in a mandatory setting [
Many of the findings in our study confirm the findings of authors who have studied the adoption of other ICTs and of innovations in general. For instance, our participants reported compatibility with work process and trialability as important beliefs. In the diffusion of innovation theory, Rogers identifies these two characteristics in addition to three others—the innovation’s relative advantage, its complexity or simplicity, and its observability (the degree to which it is visible to users and potential users)—as influencing an individual’s decision to adopt or reject an innovation [
The findings of this survey are also consistent with the factors proposed by Davis [
Our study identified additional beliefs (aside from those similar to the beliefs identified by Rogers and by Davis) that were identical to the barriers and facilitators found in a recent systematic review of factors influencing health care professionals’ adoption of ICTs [
We also found similarities to studies on the adoption of a computerized decision support system. In these studies, clinicians most wanted such a system to remind them of what they already intended to do [
Our study of wikis also confirmed several barriers described in studies of health care professionals’ beliefs about using social media [
This overlap between study findings, notwithstanding our rigorous use of a theoretical framework, allowed us to identify new beliefs specific to our target population and related to the adoption of wiki-based reminders, beliefs that studies of the adoption of social media in health care had not identified. The importance of these new beliefs will also be important to measure in a future questionnaire. In terms of behavioral beliefs, both EPs and AHPs reported that using a wiki-based reminder could help standardize practices, promote teamwork (salient only for AHPs), and give users access to regularly updated protocols. EPs did not perceive this last factor as an advantage, but stated that having a system that was updated regularly would be a facilitating factor. Surprisingly, EPs also stated that frequently changing information would be a barrier. The importance of these apparently conflicting beliefs will be important to measure because reminders contained within a wiki could indeed change quite frequently if the literature changes frequently or if an edit war should occur. An edit war arises when a user repeatedly re-edits, undoes, or reverses a prior user’s edits in an attempt to keep visible his or her preferred version of a page [
We also identified many influential groups of people who would be favorable to health care professionals’ use of a wiki-based reminder, with EPs and AHPs naming each other as their main influence. So far, interpretations of the role of social influence on the adoption of ICTs have varied. Some authors have argued for the inclusion of normative beliefs (sources of social influence) in models of adoption and use [
Although age had been noted as a moderating factor in predicting the adoption of ICTs [
Some EPs working in the level I trauma center expressed another important normative belief. They suggested that clinicians in level II and III centers would be more likely to use a wiki-based reminder for the care of patients with a severe traumatic brain injury than would experienced clinicians working in level I centers, who would not need to refer to a reminder. This suggestion reflects the fact that many clinicians working in level I trauma centers view themselves as leaders and champions who help less-experienced clinicians better manage traumatic brain injuries. The influence of this belief must be measured quantitatively. If the experts do not intend to use wiki-based reminders themselves, future exploration must verify whether they intend to contribute their expertise to a wiki in order to help staff at level II and III centers improve their practices. It seems not unlikely that when recognized experts and strong leaders in a field add material to a wiki of evidence-based reminders promoting best practices, other health care professionals are motivated to take up the material in question. Further exploration of the intention to contribute medical information to a wiki will be particularly important because it seems that the level of sharing of medical information through social media is lower than expected for health care professionals [
In spite of its rigorous methods, our study has limitations. First, we did not perform member checking, even though member checking would have made our results more credible. However, two independent research professionals experienced with using the theory of planned behavior analyzed the contents of the interview transcripts rigorously to interpret our respondents’ beliefs as trustworthily as possible and resolved disagreements by referring scrupulously to the transcripts. Furthermore, to make it possible for readers to interpret the results for themselves, we have presented a sample transcript for each salient belief.
A second limitation is that our survey was conducted with a small group of EPs and AHPs who were recruited from a single region of the province of Quebec. Even though Godin and Kok [
Third, the video we produced to describe the behavior of study portrayed wikis positively and could have influenced interviewees’ beliefs positively as well. Using a mix of animation and actors, the 6-minute video presented wikis as a new and effective way of communicating and collaborating. We produced this video because we needed to demonstrate in a short time how a wiki-based reminder could be used to improve the care of trauma patients and because the use of a wiki-based reminder to promote best practices in trauma remains theoretical for most health care professionals. It also involves many smaller lead-in behaviors (eg, connecting to the Internet, reading the reminder, and applying its suggestions) that are hard to explain during an interview. This said, after realizing that most of the beliefs expressed by participants after viewing the video were positive, we compensated for this possible bias by including negative beliefs that did not meet our 75% most frequently mentioned criteria in our list of salient beliefs.
Finally, our behavior of study was only the use of a wiki-based reminder, not the creation and editing of the reminder. The last two behaviors are important to study in order to understand how a wiki can fulfill its potential to turn a traditionally passive consumer of knowledge into an active producer of knowledge (or
A major strength of this study was its rigorous application of the methods proposed by the authors of the theory of planned behavior to assess our target population’s perceived behavioral, normative, and control beliefs related to using a wiki-based reminder. These beliefs will be used to construct a theory-based intervention to increase the use of a wiki-based reminder by EPs and AHPs. Using this theory facilitated our comparison with similar studies and contributed to our elaboration of a theoretical basis for understanding the decision making leading to this behavior. It will also allow researchers to carry out a systematic review in this area. Furthermore, the steps taken to analyze the content of beliefs are rarely described in detail. Our detailed and rigorous description of the content analysis makes it possible for other researchers to reproduce this approach to exploring health care professionals’ salient beliefs about the use of other social media in health care.
This theory-based study has systematically identified the beliefs underlying EPs’ and AHPs’ intention to use information from a wiki when caring for patients with a traumatic brain injury. It is the first step in our attempt to understand EPs’ and AHPs’ intentions to use such a reminder, and will help us construct a validated questionnaire that will survey a broader population of EPs and AHPs about their intention to use wiki-based reminders promoting evidence-based traumatic brain injury care. By identifying the most important determinants of EPs’ and AHPs’ intention to use a wiki-based reminder, we will better understand how wikis could act as knowledge translation interventions to increase evidence-based practices in this area.
Description of services offered at each level of trauma center.
Video for emergency physicians.
Video for nursing personnel.
Video for respiratory therapists.
Video for pharmacists.
Clinical vignette and semistructured questionnaire.
Table 4. Emergency physicians’ nonsalient beliefs about using a wiki-based reminder.
Table 5. Allied health professionals’ nonsalient beliefs about using a wiki-based reminder.
Allied health care professional
Emergency physician
information and communication technology
Funding for this project was provided by a CADRE program (reference number: PDA 1850) (supported by a partnership between the Canadian Health Services Research Foundation and the Canadian Institutes of Health Research). KT Canada, the Département de médecine familiale et médecine d’urgence at Université Laval and CSSS Alphonse-Desjardins (CHAU de Lévis) also contributed funding. The funding agencies and organizations did not influence the content of the manuscript. France Légaré holds the Canada Research Chair in Implementation of Shared Decision Making in Primary Care and is a member of KT Canada. Marie-Pierre Gagnon holds the Tier 2 Canada Research Chair in Technologies and Practices in Health and is a KT Canada member. We thank Jennifer Petrela for editing the manuscript, Yves Lessard for drawing the cartoons for the video, Alain Audet for filming the video, and Amélie Bourassa for sharing parts of a video she produced. We also thank Lee LeFever and Common Craft for permitting us to adapt the original
PA, AB, MPG, KA, AL, JL, JP, MPD, and FL declare that they have no competing interests. Sylvain Croteau is president of Solution Doc 2.0 Inc., a company that is developing a commercial clinical decision support system containing a wiki-based decision support tool.
The principal investigator (PA) wrote a first draft of the manuscript. FL, MPG, AB, AL, JL, JP, KA, SC, and MPD reviewed and modified different versions of this manuscript and approved its final version. AB performed all the interviews. AB and KA performed the content analysis. PA, AB, KA, FL, and MPG reviewed the results. SC, MPD, and PA conceived the idea of the wiki. PA, SC, and MPD developed the script for the video. PA produced the video.