An internet based approach to improve general practitioners' knowledge and practices: The development and pilot testing of the "ABC's of vitamin D" program

BACKGROUND Online continuing medical education (CME) offers a number of advantages for physicians including flexibility with regards to location and timing of use. In order to effect physician practices and improve patient outcomes, it is important that the development of online CME is theory and evidence-based. OBJECTIVES This paper aims to describe the development of an online CME program for practising general practitioners (GPs) on vitamin D and sun health called "The ABC's of Vitamin D for GPs" using elements of design principles for physician-education web sites as a framework. The paper will also report the program's usability and acceptability pilot test results. METHODS The ABC's of Vitamin D program was developed following nine principles: needs assessment; evidence-based content development; multimodal program and modularisation; clinical cases; tailoring and interactivity; audit and feedback; credibility of the web site host; patient education materials; ease of use and navigation. Among the 20 GPs invited, acceptability and useability was tested with 12 GPs (60%) who agreed to participate and were interviewed following use of the program. The study was conducted between 2011 and 2013. RESULTS An online CME program consisting of eight modules was constructed. Of the 12 participating GPs, most (n=11) reported that the program was clear and easy to understand, logical, easy to navigate, and took a reasonable amount of time (estimated between 1 and 3h) to complete. Eleven of 12 participants said they would use the program as an accredited CME activity and all participants indicated that the program was 'very or somewhat' likely to lead to changes in the advice patients are given. CONCLUSION This study found that a theory and evidence based approach for the development of an online CME program for GPs was acceptable to users. Further research is needed to examine whether the online CME program is effective at changing GP practices and improving patient outcomes.

[1]  Kent L. Norman,et al.  Levels of automation and user participation in usability testing , 2006, Interact. Comput..

[2]  B. Diffey.  Do we need a revised public health policy on sun exposure? , 2006, The British journal of dermatology.

[3]  M. Ray,et al.  Designing Tailored Web-Based Instruction to Improve Practicing Physicians' Preventive Practices , 2003, Journal of medical Internet research.

[4]  B. Schneirdeman,et al.  Designing the User Interface: Strategies for Effective Human-Computer Interaction , 1998 .

[5]  M. Holick.  Vitamin D deficiency. , 2007, The New England journal of medicine.

[6]  C. Wagner,et al.  Normal serum vitamin D levels. , 2005, The New England journal of medicine.

[7]  Jocelyn Lockyer,et al.  A meta‐analysis of continuing medical education effectiveness , 2007, The Journal of continuing education in the health professions.

[8]  Jane M. Young,et al.  Audit and feedback: effects on professional practice and healthcare outcomes. , 2012, The Cochrane database of systematic reviews.

[9]  J. Eisman,et al.  Vitamin D and adult bone health in Australia and New Zealand: a position statement , 2005 .

[10]  B. Astor,et al.  25-Hydroxyvitamin D Levels and the Risk of Mortality in the General Population , 2008 .

[11]  B. Bonevski,et al.  Prescribing sunshine: A cross‐sectional survey of 500 Australian general practitioners' practices and attitudes about vitamin D , 2012, International journal of cancer.

[12]  Duane D. Miller,et al.  The role of vitamin D in cancer prevention. , 2015, Chinese journal of natural medicines.

[13]  Sara Gandini,et al.  Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. , 2007, Archives of internal medicine.

[14]  O. Gillie.  A new government policy is needed for sunlight and vitamin D , 2006, The British journal of dermatology.

[15]  K. Try,et al.  The vitamin D status of man at 70° north , 1980 .

[16]  A. D. Alwadie,et al.  Online Continuing Medical Education in Saudi Arabia , 2013 .

[17]  E. Rogers,et al.  Diffusion of innovations , 1964, Encyclopedia of Sport Management.

[18]  J. Moan,et al.  Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure , 2008, Proceedings of the National Academy of Sciences.

[19]  S. Vanlint.  Vitamin D and adult bone health in Australia and New Zealand: a position statement , 2005, The Medical journal of Australia.

[20]  Christine L. Taylor,et al.  Committee to Review Dietary Reference Intakes for Vitamin D and Calcium , 2011 .

[21]  L. Faulkner.  Beyond the five-user assumption: Benefits of increased sample sizes in usability testing , 2003, Behavior research methods, instruments, & computers : a journal of the Psychonomic Society, Inc.

[22]  Gavin Giovannoni,et al.  A ChIP-seq defined genome-wide map of vitamin D receptor binding: associations with disease and evolution. , 2010, Genome research.

[23]  K. Try,et al.  The vitamin D status of man at 70 degrees north. , 1980, Scandinavian journal of clinical and laboratory investigation.

[24]  M. Holick,et al.  Sunlight regulates the cutaneous production of vitamin D3 by causing its photodegradation. , 1989, The Journal of clinical endocrinology and metabolism.

[25]  P. Lips,et al.  Estimates of optimal vitamin D status , 2005, Osteoporosis International.

[26]  L. Sher,et al.  The Internet, suicide, and human mental functions. , 2000, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[27]  J. Pasco,et al.  Vitamin D status of women in the Geelong Osteoporosis Study: association with diet and casual exposure to sunlight , 2001, The Medical journal of Australia.

[28]  A D Oxman,et al.  Changing physician performance. A systematic review of the effect of continuing medical education strategies. , 1995, JAMA.

[29]  A. Parisi,et al.  Vitamin D insufficiency in south‐east Queensland , 2001, The Medical journal of Australia.

[30]  M. Holick.  Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. , 2004, The American journal of clinical nutrition.

[31]  N. Freemantle,et al.  Continuing education meetings and workshops: effects on professional practice and health care outcomes , 2001 .

[33]  Laura R. Olevitch,et al.  Tailoring Health Messages: Customizing Communication With Computer Technology , 1999 .

[34]  Martin Lipkin,et al.  The role of vitamin D in cancer prevention. , 2006, American journal of public health.

[35]  P ? ? ? ? ? ? ? % ? ? ? ? , 1991 .

[36]  J. Bell,et al.  Online CME: an effective alternative to face-to-face delivery , 2007, Medical teacher.