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Patients' perspectives on self-testing of oral anticoagulation therapy: content analysis of patients' internet blogs.

Shah SG, Robinson I - BMC Health Serv Res (2011)

Bottom Line: The key themes in relation to self-testing of OAT identified were as follows: Patient benefits reported were time saved, personal control, choice, travel reduction, cheaper testing, and peace of mind.Social issues included the pain and stress of taking and testing for OAT.Patients' blogs on PT/INR testing provide insightful information that can help in understanding the nature of the experiences and perspectives of patients on self-testing of OAT.

View Article: PubMed Central - HTML - PubMed

Affiliation: Multidisciplinary Assessment of Technology Centre for Healthcare, Department of Information Systems and Computing, Brunel University, Uxbridge, Middlesex UB8 3PH, UK. Sarwar.Shah@brunel.ac.uk

ABSTRACT

Background: Patients on oral anticoagulant therapy (OAT) require regular testing of the prothrombin time (PT) and the international normalised ratio (INR) to monitor their blood coagulation level to avoid complications of either over or under coagulation. PT/INR can be tested by a healthcare professional or by the patient. The latter mode of the testing is known as patient self-testing or home testing. The objective of this study was to elicit patients' perspectives and experiences regarding PT/INR self-testing using portable coagulometer devices.

Methods: Internet blog text mining was used to collect 246 blog postings by 108 patients, mainly from the USA and the UK. The content of these qualitative data were analysed using XSight and NVivo software packages.

Results: The key themes in relation to self-testing of OAT identified were as follows: Patient benefits reported were time saved, personal control, choice, travel reduction, cheaper testing, and peace of mind. Equipment issues included high costs, reliability, quality, and learning how to use the device. PT/INR issues focused on the frequency of testing, INR fluctuations and individual target (therapeutic) INR level. Other themes noted were INR testing at laboratories, the interactions with healthcare professionals in managing and testing OAT and insurance companies' involvement in acquiring the self-testing equipment. Social issues included the pain and stress of taking and testing for OAT.

Conclusions: Patients' blogs on PT/INR testing provide insightful information that can help in understanding the nature of the experiences and perspectives of patients on self-testing of OAT. The themes identified in this paper highlight the substantial complexities involved in self-testing programmes in the healthcare system. Thus, the issues elicited in this study are very valuable for all stakeholders involved in developing effective self-testing strategies in healthcare that are gaining considerable current momentum particularly for patients with chronic illness.

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Map of patients' perspectives on self-testing of oral anticoagulation therapy reported in patients' Internet blogs.
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Figure 2: Map of patients' perspectives on self-testing of oral anticoagulation therapy reported in patients' Internet blogs.

Mentions: Qualitative research methods are required in situations that require in depth investigation and an understanding of process to determine the exact nature of the issue being investigated, especially when the data are available in non-numeric form e.g. through text or through visual means [38]. We undertook qualitative content analysis of the data, which we collected in text form from blog postings. Validation of qualitative content analysis can be achieved through using software packages [39]; in this case we used two software packages i.e. XSight version 2 ( trial version) and NVivo version 8 (http://www.qsrinternational.com) to analyse the data because qualitative data analysis cannot easily be undertaken using single piece of software [38]. Another advantage of computer assisted content analysis of textual data is the coding reliability that helps in generating comparable results [40]. The data analysis was undertaken in a number of stages. As a first step, all data from selected blogs were saved as html files along with the details (e.g. nicknames) of bloggers. In the second step, data from the html files were saved as a single file in Microsoft word. In the third step, all data were imported into NVivo software and the frequency of most commonly used words was ascertained after removing the details of bloggers, dates, numbers and the most commonly used English words. Thereafter, a word cloud of the most commonly used words in the blogs' text was created as shown in Figure 1 (This was created in the Wordle - a Java applet, which is available at http://www.wordle.net/). This process helped us in identifying some key terms and themes relevant to blood coagulation testing as well as ensuring the suitability and relevance of the text of the blogs for the study objectives. In the fourth step, the text of all blog postings was read and issues such as the benefits, limitations, safety, training, cost, purchasing, maintenance and communications with healthcare providers were noted and a map of these issues (Figure 2) was created in XSight software, which helped in categorising the findings of this study.


Patients' perspectives on self-testing of oral anticoagulation therapy: content analysis of patients' internet blogs.

Shah SG, Robinson I - BMC Health Serv Res (2011)

Map of patients' perspectives on self-testing of oral anticoagulation therapy reported in patients' Internet blogs.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3045880&req=5

Figure 2: Map of patients' perspectives on self-testing of oral anticoagulation therapy reported in patients' Internet blogs.
Mentions: Qualitative research methods are required in situations that require in depth investigation and an understanding of process to determine the exact nature of the issue being investigated, especially when the data are available in non-numeric form e.g. through text or through visual means [38]. We undertook qualitative content analysis of the data, which we collected in text form from blog postings. Validation of qualitative content analysis can be achieved through using software packages [39]; in this case we used two software packages i.e. XSight version 2 ( trial version) and NVivo version 8 (http://www.qsrinternational.com) to analyse the data because qualitative data analysis cannot easily be undertaken using single piece of software [38]. Another advantage of computer assisted content analysis of textual data is the coding reliability that helps in generating comparable results [40]. The data analysis was undertaken in a number of stages. As a first step, all data from selected blogs were saved as html files along with the details (e.g. nicknames) of bloggers. In the second step, data from the html files were saved as a single file in Microsoft word. In the third step, all data were imported into NVivo software and the frequency of most commonly used words was ascertained after removing the details of bloggers, dates, numbers and the most commonly used English words. Thereafter, a word cloud of the most commonly used words in the blogs' text was created as shown in Figure 1 (This was created in the Wordle - a Java applet, which is available at http://www.wordle.net/). This process helped us in identifying some key terms and themes relevant to blood coagulation testing as well as ensuring the suitability and relevance of the text of the blogs for the study objectives. In the fourth step, the text of all blog postings was read and issues such as the benefits, limitations, safety, training, cost, purchasing, maintenance and communications with healthcare providers were noted and a map of these issues (Figure 2) was created in XSight software, which helped in categorising the findings of this study.

Bottom Line: The key themes in relation to self-testing of OAT identified were as follows: Patient benefits reported were time saved, personal control, choice, travel reduction, cheaper testing, and peace of mind.Social issues included the pain and stress of taking and testing for OAT.Patients' blogs on PT/INR testing provide insightful information that can help in understanding the nature of the experiences and perspectives of patients on self-testing of OAT.

View Article: PubMed Central - HTML - PubMed

Affiliation: Multidisciplinary Assessment of Technology Centre for Healthcare, Department of Information Systems and Computing, Brunel University, Uxbridge, Middlesex UB8 3PH, UK. Sarwar.Shah@brunel.ac.uk

ABSTRACT

Background: Patients on oral anticoagulant therapy (OAT) require regular testing of the prothrombin time (PT) and the international normalised ratio (INR) to monitor their blood coagulation level to avoid complications of either over or under coagulation. PT/INR can be tested by a healthcare professional or by the patient. The latter mode of the testing is known as patient self-testing or home testing. The objective of this study was to elicit patients' perspectives and experiences regarding PT/INR self-testing using portable coagulometer devices.

Methods: Internet blog text mining was used to collect 246 blog postings by 108 patients, mainly from the USA and the UK. The content of these qualitative data were analysed using XSight and NVivo software packages.

Results: The key themes in relation to self-testing of OAT identified were as follows: Patient benefits reported were time saved, personal control, choice, travel reduction, cheaper testing, and peace of mind. Equipment issues included high costs, reliability, quality, and learning how to use the device. PT/INR issues focused on the frequency of testing, INR fluctuations and individual target (therapeutic) INR level. Other themes noted were INR testing at laboratories, the interactions with healthcare professionals in managing and testing OAT and insurance companies' involvement in acquiring the self-testing equipment. Social issues included the pain and stress of taking and testing for OAT.

Conclusions: Patients' blogs on PT/INR testing provide insightful information that can help in understanding the nature of the experiences and perspectives of patients on self-testing of OAT. The themes identified in this paper highlight the substantial complexities involved in self-testing programmes in the healthcare system. Thus, the issues elicited in this study are very valuable for all stakeholders involved in developing effective self-testing strategies in healthcare that are gaining considerable current momentum particularly for patients with chronic illness.

Show MeSH
Related in: MedlinePlus