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Collaborative writing applications (eg, wikis and Google Documents) hold the potential to improve the use of evidence in both public health and health care. The rapid rise in their use has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use.
Through the Levac six-stage methodology, a scoping review was undertaken to explore the depth and breadth of evidence about the effective, safe, and ethical use of wikis and collaborative writing applications (CWAs) in health care.
Multiple strategies were used to locate studies. Seven scientific databases and 6 grey literature sources were queried for articles on wikis and CWAs published between 2001 and September 16, 2011. In total, 4436 citations and 1921 grey literature items were screened. Two reviewers independently reviewed citations, selected eligible studies, and extracted data using a standardized form. We included any paper presenting qualitative or quantitative empirical evidence concerning health care and CWAs. We defined a CWA as any technology that enables the joint and simultaneous editing of a webpage or an online document by many end users. We performed qualitative content analysis to identify the factors that affect the use of CWAs using the Gagnon framework and their effects on health care using the Donabedian framework.
Of the 111 studies included, 4 were experimental, 5 quasi-experimental, 5 observational, 52 case studies, 23 surveys about wiki use, and 22 descriptive studies about the quality of information in wikis. We classified them by theme: patterns of use of CWAs (n=26), quality of information in existing CWAs (n=25), and CWAs as KT tools (n=73). A high prevalence of CWA use (ie, more than 50%) is reported in 58% (7/12) of surveys conducted with health care professionals and students. However, we found only one longitudinal study showing that CWA use is increasing in health care. Moreover, contribution rates remain low and the quality of information contained in different CWAs needs improvement. We identified 48 barriers and 91 facilitators in 4 major themes (factors related to the CWA, users’ knowledge and attitude towards CWAs, human environment, and organizational environment). We also found 57 positive and 23 negative effects that we classified into processes and outcomes.
Although we found some experimental and quasi-experimental studies of the effectiveness and safety of CWAs as educational and KT interventions, the vast majority of included studies were observational case studies about CWAs being used by health professionals and patients. More primary research is needed to find ways to address the different barriers to their use and to make these applications more useful for different stakeholders.
Health care decision makers—providers, patients, managers, and policy makers—are failing to use research evidence to inform their decisions [
Collaborative writing applications (CWAs) [
Among the types of CWAs, wikis and its most famous representative—Wikipedia—are perhaps the most popular. Wikipedia is an online encyclopedia whose medical articles are viewed about 150 million times per month and exist in 271 languages [
However, questions remain about the safety [
A detailed description of our peer-reviewed research protocol and conceptual framework can be found elsewhere [
Our research question was developed by consulting a group of knowledge users to determine their needs and questions about using collaborative writing applications for knowledge translation. We defined “collaborative writing applications” as a category of social media that enables the joint and simultaneous editing of a webpage or an online document by many end users (eg, wikis, Wikipedia, Google Knol, Google Docs, Google Sites) [
Seven scientific databases (Cochrane Library, PubMed, EMBASE, CINAHL, PsycINFO, ERIC, ProQuest Dissertations and Theses) were searched systematically for the period covering January 1, 2001 (Wikipedia’s inaugural year), to September 16, 2011. Our search strategy was peer-reviewed using the PRESS criteria [
We did not exclude any citations based on language. In addition, study reference lists; the 2010 and 2011 editions of the Medicine 2.0, WikiSym, and American Medical Informatics Association conference proceedings; clinicaltrials.gov and Open Medicine’s websites; expert consultation (eg, the authors of WikiProject Medicine [
Full search strategy for each database.
Pubmed |
Wiki*[All Fields] OR “Web 2.0”[TIAB] OR “Web2.0”[TIAB] OR (google* AND knol) OR (google* AND docs) OR “Social media” [TIAB] OR (Collaborative [tiab] AND writing [tiab]) OR (collaborative technolog*) OR (collaborative software*) |
Embase |
wiki* OR “collaborative technology” OR “collaborative technologies” OR “collaborative writing” OR “collaborative writings” OR “collaborative software” OR “collaborative softwares” OR “google docs” OR “google knol” OR “ehealth 2.0” OR “health 2.0” OR “e+health 2.0” OR “Web 2.0” |
CINAHL |
TI (wiki* or “google docs” or “google knol” or “medecine 2.0.” or “Web 2.0” or “collaborative technolog*” or “collaborative writing” or “ehealth” or “e-health” or emedicine or “e-medicine”) OR AB (wiki* or “google docs” or “google knol” or “medecine 2.0.” or “Web 2.0” or “collaborative technolog*” or “collaborative writing” or “ehealth” or “e-health” or emedicine or “e-medicine”) |
PsychINFO |
(wiki* or “google docs” or “google knol” or “collaborative software” or “collaborative writing” or “collaborative technologies” or “collaborative technology” ):Any Field OR ( “medicine 2.0” or “emedicine” or e-medicine or “health 2.0” or “ehealth” or e-health or “Web 2.0” ):Title OR ( “medicine 2.0” or “emedicine” or e-medicine or “health 2.0” or “ehealth” or e-health or “Web 2.0” ):Abstract |
ERIC |
((Keywords:wiki* or Keywords: “Web 2.0” or Keywords: “google docs” or Keywords: “google knol” or Keywords: “collaborative technologies” or Keywords: “collaborative technology” or Keywords: “collaborative software” or Keywords: “collaborative writing” or Keywords: “e-health” or Keywords: ehealth) or (Title: wiki* or Title: “Web 2.0” or Title: “google docs” or Title: “google knol” or Title: “collaborative technologies” or Title: “collaborative technology” or Title: “collaborative software” or Title: “collaborative writing” or Title: “e-health” or Title: ehealth) and (Thesaurus Descriptors: “Health services”)) |
Dissertation abstract & Thesis |
Citation & Abstract (wiki* or “health 2.0” or “Web 2.0” or “e-medicine” or emedicine or “google docs” or “google knol” or “collaborative technologies” or “collaborative technology” or “collaborative writing” or “collaborative software”) |
Cochrane Library (n=56) | (wiki* or “Web 2.0” or ehealth or “e-health” or “google docs” or “google knol” or “collaborative writing”) in Title, Abstract or Keywords in All Cochrane Library |
Google, Bing, and Yahoo (n=1200 in total) | “wiki in health care”; “Google Knol in health care”; “Google Docs in health care”; “collaborative writing applications in health care” |
Three teams of 2 reviewers (SR/MF, TB/AB, PA/CK) independently screened titles, abstracts, and grey literature and retained articles that presented empirical data about any CWA applied to the field of health care. In case of disagreements, a third reviewer was consulted (PA, TB, or SR). To reach a high level of agreement, we conducted 4 series of assignments (400 abstracts in total) whereby the screening of a number of studies was followed by a teleconference to reach agreement about which studies to include and to discuss uncertainties. Once consensus was reached for all cases, the remaining studies were coded by the same 3 pairs of screeners (SR/MF, TB/AB, PA/CK). Subsequently, 2 reviewers (TB and PA) conducted another round of screening based on full text studies. As a result, a narrowed definition of health care was applied in order to focus the analysis. Hence, studies that concerned the care of patients were included, and those from the fields of basic medical sciences, the conduct of clinical trials, biomedical library science and medical informatics were excluded.
A data-charting form was developed and built into EPPI-Reviewer for the extraction of quantitative and qualitative variables and to facilitate data coding. It was tested and refined by 4 reviewers (PA, CN, ME, CF) using the first 50 studies. Three pairs of 2 reviewers (CN/CF, CN/ME, ME/CF) then independently extracted data from the remaining studies. Disagreements were resolved through discussion with a third reviewer (PA or TB). Using EPPI-Reviewer’s inductive coding function, we extracted all the pre-planned variables described in our published protocol [
We summarized the included studies in a table comparing each of the study’s characteristics. Attempting to present an organized description of the current literature on the use of CWAs in health care, we grouped studies based on purpose. Three emergent themes were the use patterns of CWAs (Theme 1), quality of information found in different CWAs (Theme 2), and CWAs used as knowledge translation interventions (Theme 3). We also added a description of each of the applications’ features (the type of CWA and software used) to examine CWA use among studies (Objective 2).
To compare the different CWA applications identified, a Venn diagram was constructed to situate each application in relation to the others depending on two features: their collaborative writing features and their conversational features. To create the most reliable representation of how different CWAs could be represented in relation to each other, each CWA was assessed by 2 reviewers using a scoring system we created based on a classification proposed by Kaplan et al [
Studies whose purpose was to describe the users and the frequency of CWA use were grouped together. We compared each study in a table presenting the population surveyed, the response rate of the population surveyed, the reported results, the prevalence of use, the contribution rate, the time of assessment, and the purpose of CWA use. We also used Eysenbach’s Medicine 2.0 map [
We synthesized papers that evaluated the quality of information in CWAs by constructing a table presenting a summary of each evaluation. Three reviewers (PA, TB, SG) assigned a score on a three-point scale based on the original authors’ own recommendations about future use of information contained in the different CWAs. When authors concluded that the information contained within the collaborative writing project was of high quality and that it could be used in medical decision making, we gave the paper a score of 1. When the authors concluded that the information reported was not reliable and should never be used in decision making, a score of 3 was attributed. When authors were uncertain and/or suggested that more research was needed, a score of 2 was given. This score was attributed after discussion between the three reviewers until consensus was achieved.
Three reviewers (PA, TB, SG) performed a mixed inductive and deductive thematic analysis of the content coded in Stage 4 to classify and interpret the perceived positive and negative effects related to the use of a CWA. They began by developing a coding scheme using qualitative content analysis, a method whereby reviewers interpreted the data subjectively by classifying and coding data and identifying patterns [
The Donabedian framework [
A second thematic content analysis was performed on the data regarding barriers and facilitators to the use of CWAs in health care with the initial coding scheme reflecting an existing framework concerning the determinants of ICT adoption [
As specified in our published protocol [
After removing duplicates (n=1372), we screened the title and abstract of 4436 citations as well as the studies/abstracts from the grey literature, conference proceedings, expert consultation, and reviewing of reference lists (
Crowdsourcing identified two studies through Google Docs that were excluded. After review, we included 111 citations. Among these 111 citations, there were 28 abstracts without published full text but with sufficient results to be included. Twenty-six studies were grouped into Theme 1 (use patterns of CWAs), 25 into Theme 2 (quality of information in different CWAs), and 73 into Theme 3 (use of CWAs as a knowledge translation intervention).
Flowchart of our mapping process and study selection.
Histogram of the number of publications related to our search strategy per year.
We found 4 experimental studies, 5 quasi-experimental, 5 observational analytic, 52 case studies, 22 describing the quality of wikis, and 23 surveys on wiki use (
Two of the six studies pertaining to Google Docs were experimental [
Collaborative writing applications Venn diagram.
We found a total of 26 studies that presented different patterns of CWA use in health care: who uses the different CWAs, how much, and for what reasons (
In general, CWA use varied depending on the training level (eg, 70% or 132/188 first-year medical students using Wikipedia vs 37% or 86/234 third-year medical students [
Medicine 2.0 map of the different collaborative writing applications (CWAs) and their users described in the included studies.
We found 25 papers reporting on the quality of information in CWAs (
As an educational tool, Wikipedia was reported to be comprehensive, of high quality, current, and appropriate for learning in gastroenterology and pathology [
We identified four experimental studies in support of CWA use as educational and knowledge translation interventions (
We classified the perceived positive and negative effects associated with CWAs into a taxonomy, covering eight categories (
In total, 57 positive effects and 23 negative effects were identified. Among the categories of positive effects that we found, the most frequently reported were that CWAs improve collaboration (n=41), positively impact learning (n=30), influence psychological domains (n=28), facilitate knowledge management and accessibility to information (n=30), improve efficiency of health care (n=19), improve quality of health care (n=6), and prevent disease (n=3). Among these effects, the Theoretical Domains Framework [
We found 2 studies referring to theoretical frameworks to describe their effects. Among the frameworks, the concept of communities of practice [
The most frequently cited negative effects were that CWAs could have unfavorable impacts on knowledge management (n=14) such as information overload (n=4) and fast dissemination of poorly validated information (n=4), as well as on certain psychological domains (n=6) such as added stress (n=1) and negative emotions (n=5). Some authors stated that CWAs could impede certain aspects of collaborative work (n=4) such as enhancing the perception of unequal work distribution (n=2) and encouraging conversation more than collaborative writing (n=1). Potentially serious negative effects of deletion of important medication information on Wikipedia by pharmaceutical companies (n=1) [
A total of 48 barriers and 91 facilitators to the use of CWAs in health care were identified, of which 20 barriers and 69 facilitators were new determinants (
Among the latter, some were specific to social media (eg, social aspects of ICT, presence of a moderator, presence of a community of practice) and others were not (eg, information overload, mobile access, lack of proficiency in English). Although we found only 5 studies [
The five barriers most frequently mentioned, in order of frequency, were unfamiliarity with ICTs (n=8), time constraints and workload (n=6), lack of self-efficacy (belief in one’s competence to use ICT) (n=6), material resources—access to ICT (n=5), worries about the scientific quality of the information (n=5), and the presence of a closed wiki protected by a password (n=5). The five most recurrent facilitators were having had training (n=12), scientific quality of the information (n=10), ease of use (n=8), triability (n=7), presence of a community of practice or a community of learners (n=7), and presence of a moderator (n=7).
Positive and negative impacts of collaborative writing applications.
Impacts | Number of papers in which the impacts perceived as positive | Number of papers in which the impacts perceived as negative | |||
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28 | 6 | ||
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1.1.1 Self-Efficacy/empowerment: Not further specified | 10 [ |
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1.1.2 Empowering environment | 2 [ |
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1.1.3 Empowerment of families/relatives | 1 [ |
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1.1.4 Patient participation | 3 [ |
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1.2.1 Engagement | 7 [ |
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1.3.1 Satisfaction | 5 [ |
1 [ |
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1.3.2 Loss of autonomy/feeling of being monitored | 1 [ |
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1.3.3 Feeling of working in isolation | 1 [ |
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1.3.4 Feeling of guilt about not participating | 1 [ |
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1.3.5 Frustration due to technical issues | 1 [ |
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1.3.6 Added stress |
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1 [ |
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30 | 1 | ||
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2.1 Subjective learning improvements: Not further specified | 9 [ |
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2.2.1 Communication skills eg, feedback | 2 [ |
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2.2.2 Handle fears and feelings | 1 [ |
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2.2.3 Adapt to different learning styles | 4 [ |
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2.2.4 Information and communication technology skills | 1 [ |
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2.2.5 Transfer of knowledge into practice | 1 [ |
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2.2.6 More efficient critiquing and evaluating the medical literature | 1 [ |
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2.2.7 Development of professionalism on students | 1 [ |
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2.2.8 Enhanced understanding of concepts | 1 [ |
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2.2.9 Decreased learning of diagnostic skills |
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1 [ |
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2.3.1 Knowledge (not further specified) | 4 [ |
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2.3.2 Awareness of guidelines | 1 [ |
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2.4 Better supervision by teachers | 2 [ |
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2.5 Better exam preparation | 2 [ |
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24 | 2 | ||
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3.1 Communication: Not further specified (impedes/improves) | 9 [ |
2 [ |
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3.2 Feedback | 2 [ |
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3.3 Collegiality | 1 [ |
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3.4 Patient/health professionals communication | 2 [ |
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3.5 Communication of tacit knowledgeb | 3 [ |
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3.6 Creates a network for families | 1 [ |
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3.7 Apomediation (communication process whereby individuals “stand by” to guide consumers to high quality information without being a prerequisite to obtain that information in the first place)b | 1 [ |
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3.8.1 Mutuality (the recognition of organization–public relationships)b | 1 [ |
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3.8.2 Propinquity (the temporality and spontaneity of interactions with publics)b | 1 [ |
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3.8.3 Empathy (the supportiveness and confirmation of public goals and interests)b | 1 [ |
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3.8.4 Risk (the willingness to interact with individuals and publics on their own terms)b | 1 [ |
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3.8.5 Commitment (the extent to which an organization gives itself over to dialogue, interpretation, and understanding in its interactions with publics)b | 1 [ |
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41 | 4 | ||
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4.1 Collaboration: Not further specified (impedes/improves) | 23 [ |
1 [ |
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4.2 Reduces geographical barriers | 11 [ |
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4.3 Perceived unequal/equal separation of work | 3 [ |
2 [ |
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4.4 Asynchronous communication | 1 [ |
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4.5 Wiki used as a conversational manner without contributing to the same text | 1 [ |
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4.6 Define team responsibilities | 1 [ |
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4.7 Interprofessional collaboration | 1 [ |
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4.8 Creation of online presence | 1 [ |
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30 | 14 | ||
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5.1 Dissemination of information | 8 [ |
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5.2 Fast dissemination of poorly validated information | 4 [ |
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5.3 Better access to information | 8 [ |
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5.4 Better exposure to world | 1 [ |
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5.5 Better knowledge translation across organizations | 2 [ |
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5.6 Centralized knowledge management | 5 [ |
1 [ |
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5.7 Constantly updated information | 1 [ |
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5.8 Facilitates management of various content | 1 [ |
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5.9 Privacy issues health related data |
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1 [ |
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5.10 Spam/vandalism |
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2 [ |
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5.11 Updating of knowledge synthesis |
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1 [ |
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5.12 Saves paper | 1 [ |
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5.13 Information overload | 4 [ |
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5.14 Wiki allows daily surveillance (looking for spurious edits) | 1 [ |
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5.15 Compiling anonymous data | 1 [ |
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5.16 Creativity/new ideas | 1 [ |
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5.17 Editing wars | 1 [ |
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19 | 4 | ||
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6.1 Efficiency: Not further specified | 5 [ |
2 [ |
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6.2 Saves money | 1 [ |
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6.3 Saves time/loses time | 11 [ |
1 [ |
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6.4 Decreases/increases duplicate work | 1 [ |
1 [ |
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6.5 Reduces workload | 1 [ |
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6 | 2 | ||
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7.1 Quality improvements: Not further specified | 5 [ |
1 [ |
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7.2 Wiki content didn’t meet users’ needs | 1 [ |
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7.3 Reduces errors | 1 [ |
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3 [ |
aThe Donabedian framework [
bThese items are processes that were taken from other psychological and organizational frameworks for change and used to describe and classify the effects of CWAs found in this review [
Barriers and facilitators related to the use of collaborative writing applications.
Factors (Gagnon et al 2012 taxonomy) | Number of papers in which the factor was mentioned as a facilitator | Number of papers in which the factor was mentioned as a barrier | |||||
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13 | 8 | ||||
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1.1.1 Readability of the informationa |
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1 [ |
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1.1.2 Appearance of wiki (font, etc.)b | 1 [ |
1 [ |
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1.1.3 Organization of informationb | 5 [ |
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1.1.4 Immediately available technical informationa | 1 [ |
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1.1.5 Having a sense of continuity and stabilityb[ |
1 [ |
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1.1.6 References not intrusive in lay language textsa | 1 [ |
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1.1.7 Information overloada |
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2 [ |
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1.1.8 Mobile accessb | 1 [ |
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1.1.9 Spam filtera | 1 [ |
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1.1.10 System can improvea | 1 [ |
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1.1.11 Rapid information changesb | 1 [ |
1 [ |
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1.1.12 Design and technical concern – other |
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3 [ |
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33 | 5 | ||||
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1.2.1.1 Ease of content editinga | 6 [ |
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1.2.1.2.1 Consistency (principle of minimum amazement)b[ |
1 [ |
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1.2.1.2.2 Prevent error messagesb[ |
1 [ |
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1.2.1.2.3 Temporal contiguity (easy mental associations are made between verbal and visual)b | 1 [ |
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1.2.1.3 Reduce short-term memory loadb[ |
1 [ |
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1.2.1.4 Ease of use/complexity – other | 8 [ |
4 [ |
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1.2.2.1 Permit Easy Reversal of Actionsb[ |
3 [ |
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1.2.2.2 Triability – other | 7 [ |
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1.2.3 Relative advantage (usefulness) or lack of |
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1 [ |
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1.3 System reliability | 2 [ |
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1.4 Interoperability (including Web browser interoperability) | 3 [ |
2 [ |
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2 | 6 | ||||
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1.5.1 Confidentiality - privacy concerns | 2 [ |
3 [ |
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1.5.2 Liabilitya |
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1 [ |
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1.5.3 Copyright concernsa |
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2 [ |
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16 | 9 | ||||
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1.6.1 Scientific quality of the information resources | 10 [ |
5 [ |
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1.6.2 Content available (completeness) | 2 [ |
2 [ |
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1.6.3 Appropriate for the users (relevance) | 2 [ |
1 [ |
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1.6.4 Content updated frequentlya |
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1 [ |
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1.6.5 Highly prevalent diseasea | 1 [ |
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1.6.6 Rapidly growing body of researcha | 1 [ |
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1.7 Cost issues: low human and hardware costs | 3 [ |
2 [ |
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28 | 7 | ||||
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1.8.1 Integrated support tools within wiki (toolbox, FAQ, forum, policies)b | 6 [ |
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1.8.2 Open access wikib | 1 [ |
5 [ |
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1.8.3 Good balance between restricted areas within wiki (private info) vs open areas (info for all)a | 2 [ |
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1.8.4 Interface linking content to conversationsb | 2 [ |
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1.8.5 Use of template and seed with core set of pagesa | 4 [ |
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1.8.6 Webmetric tool integrated with ICT to measure use (eg, Google Analytics) and contributions/authorship (eg, Wikigenes)a | 1 [ |
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1.8.7 Simultaneous real-time collaborative editinga | 1 [ |
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1.8.8 Gives informative feedbackb[ |
1 [ |
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1.8.9 Authorship transparent to increase reliabilitya | 3 [ |
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1.8.10 Socialization tactics (eg, welcome message)a | 1 [ |
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1.8.11 Controversial contenta | 1 [ |
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1.8.12 Important impact on a large number of health professionalsa | 1 [ |
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1.8.13 Lack of interest in topica |
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1 [ |
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1.8.14 Wiki enabled with an RSS feed or email notifications (reminders)b | 4 [ |
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1.8.15 Inappropriate automatic computer editinga |
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1 [ |
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1 | 12 | ||||
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2.1.1 Awareness of the existence and/or objectives of the ICT |
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2 [ |
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2.1.2.1 Skillsb[ |
1 [ |
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2.1.2.2 Familiarity with ICT – other |
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8 [ |
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2.1.3 Lack of proficiency in English (the language of the Web)a |
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1 [ |
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2.1.4 Lack of knowledge about systematic review methodsa |
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1 [ |
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17 | 18 | ||||
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2.2.1.1 Challenge to autonomy |
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1 [ |
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2.2.1.2 Outcome expectancy (use of the ICT leads to desired outcome) | 1 [ |
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2.2.1.3 Motivation to use the ICT (readiness)/resistance to use the ICT |
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4 [ |
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3 [ |
1 [ |
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2.2.1.4.1 Motivation to contribute needs to be consistent with the person’s goals, plans, values, beliefs and interestsb[ |
2 [ |
1 [ |
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2.2.1.5 Self-efficacy (believes in one’s competence to use the ICT) | 6 [ |
6 [ |
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2.2.1.6 Preference for private learning environment compared to open environmenta | 2 [ |
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2.2.1.7 Impact on personal lifeb[ |
1 [ |
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2.2.1.8 Confidence in ICT developer |
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1 [ |
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2.2.1.9 Agreement with the particular ICT – other | 1 [ |
2 [ |
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2.2.2 Agreement with ICTs in general (welcoming/resistant) | 1 [ |
2 [ |
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3 | 0 | ||||
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3.1.1.1 Sharing of information between doctors and patientsa | 1 [ |
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3.1.1.2 Sharing of information between doctorsa | 1 [ |
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3.1.1.3 Sharing of information between patientsa | 1 [ |
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25 | 7 | ||||
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3.2.1.1 Support by nursesb | 1 [ |
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3.2.1.2 Support by physiciansb | 1 [ |
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3.2.1.3 Support by traineesb | 1 [ |
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3.2.1.4 Support and promotion by colleagues (not further specified) | 3 [ |
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3.2.2.1 Credential verificationa |
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1 [ |
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3.2.2.2 Frustration about having someone else edit personal contributionb |
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3 [ |
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3.2.2.3 Reluctance to team workb |
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3 [ |
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3.2.2.4 Using constructivist theoretical framework to setup a wiki is helpfulb[ |
3 [ |
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3.2.2.5.1 Critical mass of scholarsa | 1 [ |
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3.2.2.5.2 Presence of a small group of motivated editorsa | 1 [ |
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3.2.2.5.3 Presence of community of practice/community of learners (not further specified)b | 7 [ |
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3.2.2.6 Openness, trust and respectb | 4 [ |
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3.2.2.7 Need for reciprocity (questions answered)b | 2 [ |
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3.2.2.8 Create teams of two collaborators working on same wiki pagea | 1 [ |
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69 | 27 | ||||
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4.1.1.1.1 Ultra-rapid decision making environmentb |
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1 [ |
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4.1.1.1.2 Time constraints and workload – other | 1 [ |
6 [ |
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4.1.2.1 Resources available (additional) |
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1 [ |
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4.1.2.2.1 Lack of constant Internet connection/accessb |
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2 [ |
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4.1.2.2.1.2 Material resources (access to ICT) – other | 6 [ |
5 [ |
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4.1.2.3 Human resources (IT support) | 4 [ |
1 [ |
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4.1.2.4 Having a single platforma | 1 [ |
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4.1.3.1.1 Face-to-face trainingb | 6 [ |
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4.1.3.1.2 Use smaller groups (n=15-20) for one on one feedbackb | 1 [ |
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4.1.3.1.3 Educators must be aware of human-computer interactionsb | 1 [ |
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4.1.3.1.4 Training medical educators in using Web 2.0 ICTsa | 1 [ |
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4.1.3.1.5 Need for active learning/constructivist learningb |
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1 [ |
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4.1.3.1.6 Training –other | 12 [ |
1 [ |
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4.1.3.2.1 Start with pilot project (implementation strategy)a | 1 [ |
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4.1.3.2.2 Index with Google - use Google Adwords (implementation strategya) | 1 [ |
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4.1.3.2.3 Monitoring of use with Web metricsb | 3 [ |
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4.1.3.2.4 Management – other |
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2 [ |
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4.1.3.3 Presence and use of “champions” | 1 [ |
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4.1.3.4 Participation of end-users in the design | 1 [ |
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4.1.3.5.1 Work with computer science department to implement a plan to generate traffic to wikia | 1 [ |
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4.1.3.5.2 Getting new staff to participate for new looka | 1 [ |
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4.1.3.5.3 Encourage writers to contribute using their own stylea | 1 [ |
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4.1.3.5.4 Forcing students to edit wikia | 1 [ |
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4.1.5.5.5 Participating in a community of wiki editorsa | 1 [ |
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4.1.5.5.6 Communication – other | 3 [ |
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4.1.3.6.1 Interactive Web applications permitted and unblocked within the health care institutionb | 1 [ |
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4.1.3.6.2 Administrative/ organizational support – other | 3 [ |
1 [ |
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4.1.3.7.1 Giving continuing medical education (CME) credita | 1 [ |
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4.1.3.7.2 New set of scholarly impact metricsa | 1 [ |
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4.1.3.7.3 Major cultural barrier in academia against participating in social mediaa |
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1 [ |
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4.1.3.7.4 Incentive structures – other | 5 [ |
2 [ |
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4.1.3.8 Presence of a moderatorb | 7 [ |
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4.1.3.9 Presence of metacognitive participants and dialogical participantsb[ |
2 [ |
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4.1.3.10 Accept that not all will participate and that lurkers will always exists/frustration about the lurkers who don’t contributeb | 1 [ |
3 [ |
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1 | 1 | ||||
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4.2.1 Financing of ICT/financial support |
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1 [ |
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4.2.2 Coupling traditional publications with wiki contributionsa | 1 [ |
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aThese new determinants did not exist in the Gagnon et al framework
bThese new determinants were identified in papers using a theoretical framework.
We confirmed that CWAs are currently being used frequently in health care, by a variety of stakeholders including patients, professionals, and researchers, for a large diversity of purposes. Our complete portrait of the literature shows that wikis are by far the most commonly studied type of CWA and that most studies had observational designs. Each type of CWA has different collaborative writing and conversational features that must be considered by decision makers when making a choice about which CWA to use in different collaborative projects. Many positive effects are attributed to the use of CWA in health professions education and knowledge translation. Further systematic synthesis of experimental and quasi-experimental evidence is needed before any clear policy recommendations can be made about implementing these tools in current practice. Moreover, there is an array of potential negative effects and barriers that need to be addressed in future primary research projects.
Despite the controversy surrounding the use of information in Wikipedia in clinical decision making [
Based on the Medicine 2.0 map [
Researchers are starting to explore the use of CWAs, for example in updating a scoping review [
After comparing how each CWA was used in different collaborative writing projects, we found that wikis and certain hybrid custom-built wikis have collaborative writing features that are more prominent compared to their conversational features. These collaborative writing features produce artefacts of synthesized knowledge that lend themselves more readily to daily use than those produced from conversational knowledge. For example, using a wiki to store and update care protocols readily applicable to the care of emergency department patients would be more useful in daily practice than reading the discussion page found in support of the wiki page itself. Conversely, Google Docs, certain knowledge management applications (eg, Google Sites, Microsoft Sharepoint) and other social media platforms (eg, MijnZorgNet, Atlassian Confluence, MinJournal) integrate additional features that favor conversation and deliberation between users. These additional conversational features produce discussions between users about the knowledge being shared and add to users’ understanding about the content found on the collaborative writing pages of these applications.
Most evidence stemmed from case reports and observational studies demonstrating perceived positive effects of CWA use in health care on behavior change, education, communication, collaboration, knowledge management and access to knowledge, and better quality and efficiency of health care. These findings support claims that CWAs and wikis facilitate that online professional communities create, share, and synthesize knowledge; increase access to health information; and offer opportunity for public participation and citizenship [
The use of CWAs in health care faces barriers that limit their use that are similar to those experienced in other fields: unfamiliarity with ICT [
A recurrent finding about the information in Wikipedia was that it is in large part accurate, free, and easy to access. However, even though Wikipedia does not recommend including medication doses due to concerns about errors [
Maintaining high-quality information as well as high contribution levels is a heated debate with opposing views (ie, password-protected wiki vs open wiki) [
We believe that our findings are important for consumers, professionals, researchers, and health care organizations around the world that are already using CWAs and/or planning to use a CWA to improve health care. Although we have found some evidence from experimental studies to support the use of CWAs as a health profession’s educational intervention and a large body of observational evidence supporting the use of CWAs as a knowledge translation intervention, a formal systematic review should be conducted to further synthesize the evidence and conduct a formal risk of bias assessment before making practice recommendations. Furthermore, the implementation of CWAs is fraught with barriers and the potential for adverse effects, requiring primary research to assess their safety.
Unfortunately, the breadth and depth of the literature on the use of CWAs specific to public health is scarce. However, based on some ongoing and promising projects [
This is the first study that has conducted a scoping review to examine the depth and breadth of evidence about the use of CWAs in health care. We rigorously followed scoping review methodology and conducted a systematic and broad search of CWA use in multiple scientific databases and grey literature sources. A scoping review was the ideal methodology to employ for a number of reasons. First, it is an explorative method used when the relevant literature is considered to be broad and diverse [
Even though we did everything possible to minimize publication bias by systematically and extensively searching for any sources of the grey literature presenting negative results (eg, including a lay media newspaper article [
Second, our scoping review methodology [
Third, our scoping review was limited to reviewing CWAs using a definition that excluded related applications like blogs, microblogs, discussion forums, and patient communities (eg, PatientsLikeMe). Even though these social media applications are collaborative as well and share some common features with CWAs, we believe that it is important to study them separately to better understand each application’s impact and interaction with other social media.
Finally, our search strategy is limited to studies published between January 1, 2001, and September 16, 2011, while several more recent studies about CWAs have been published [
This scoping review has identified a number of research gaps. There is a need to conduct systematic reviews to further synthesize the results of experimental and quasi-experimental studies in the field of health professions education and to further synthesize evidence about implementation strategies addressing the different barriers identified. Given that the majority of the literature presently exists in the form of case reports with self-reported measurements, it is essential that further prospective trials with objective outcomes be conducted. Future trials should identify implementation processes that can be influenced by CWAs and how to measure them (possibly using Web metrics [
Before conducting such trials, researchers and decision makers must reflect on defining the purpose of using a CWA as a knowledge translation intervention. Researchers must also find ways to adapt CWAs to the particular needs of different stakeholder groups (consumers, professionals, and researchers). Important barriers such as the quality of information contained in different wikis must be better addressed. As previous authors have stated [
In addition to other technical considerations [
The prevalence of CWA use is high in various fields of health care, and they are used for a variety of purposes. They present many potential positive and negative effects as knowledge translation tools. Although we found some experimental and quasi-experimental evidence in favor of using CWAs as educational and knowledge translation interventions, the vast majority of included studies were observational case reports about CWAs being used by health professionals and patients. More research is needed to determine which stakeholders benefit the most from using CWAs, to address the barriers to their use, to find ways to ensure the quality of their content, to foster contributions, and to make these tools effective knowledge translation tools for different stakeholders. Answers to these questions are needed before clear policy recommendations can be made about the safe use of CWAs in health care.
Characteristics of included studies.
Patterns of use of collaborative writing applications.
Quality of information in collaborative writing projects.
Characteristics and results of experimental studies.
Association of Faculties of Medicine of Canada
collaborative writing application
information and communication technologies
International Medical Informatics Association
Federation of Patients and Consumer Organization in the Netherlands
Pan American Health Organization
Funding for this project was provided by a Canadian Institutes for Health Research Knowledge Synthesis Grant (FRN 116632); a Fonds de recherche du Québec—Santé career scientist award (24856); a Fonds de Recherche du Québec—Santé, Establishment of young researchers—Juniors 1 Grant (24856); and a research grant from the Centre de santé et services sociaux Alphonse-Desjardins (CHAU de Lévis). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.
We gratefully thank the following people for helping us with importing and reviewing the astonishing number of 7461 abstracts: Michèle Dugas, Cynthia Fournier, Mathieu Édmond, Azadeh Bojmehrani, Catherine Nadeau, and Hugo-Pierre Racine. We gratefully thank Elmie Peters and Monique Clar for their advice on search strategies in scientific databases. We thank Jennifer Petrela, Sandra Owens, and Laura Bégin for editing our manuscript. We also want to extend our gratitude to Bertalan Meskó, Dean Giustini, Lisa Kruesi, Lyndal Trevena, Michaël Laurent, Finn Årup Nielsen, Lynn McCleary, Jacob F. de Wolff, Holly Witteman, Robin Hervé, Linda Hawes Clever, and Tunde Varga-Atkins for providing links to articles, book chapters, and grey literature that were essential to the success of this initiative. We would also like to thank the board of directors of HLWIKI and Dean Giustini for allowing us to use their wiki to crowdsource references. We must also thank Peter Murray (IMIA) for giving us insight into what CWAs we should include in our scoping review. We are also very grateful for the help Ewa Dobrogowska offered in translating an article she wrote in Polish. Finally, we must thank our families for having supported us during the long hours conducting this review.
One of the authors (GE) is also editor of the Journal of Medical Internet Research (JMIR). Because of his involvement in the conduct of this research and writing of this paper, assessment and peer review have been carried out entirely by an associate editor (Potts), who was not made aware of the fact that GE was a coauthor. GE has not been involved in any editorial decisions related to this paper.