We included studies of risk and DA interventions. Although this category of studies was the largest, only a few of the key concepts were included and interventions usually focused on one of the key concepts, concept 5. We included 97 such studies. EBM and CA interventions typically included concepts related to judging whether a comparison of treatments is a fair comparison concepts 2. These interventions targeted mainly three concepts associated with specific areas of consent information, including concepts 2. Five studies were categorised as science education studies and were conducted in school settings.
All of them included patients or consumers students , and four were targeted at younger students grade 7 and above. The purpose of these interventions was to facilitate critical thinking and science literacy. This may be why this category included most key concepts related to recognizing the need for fair comparisons, including concepts concept 1. Factors associated with the interventions and intervention effects were measured on a range of covariates and outcomes. The most common outcomes measured were knowledge and skills studies and attitudes and beliefs studies , followed by behavioural outcomes studies , health related outcomes including mental health and quality of life 80 studies , and costs, use of services and other resources 21 studies see Fig.
Overall, the number of key concepts included in assessment tools ranged from 0 to 15 concepts. Although some studies included key concepts in their interventions, these were not always included in any of the assessment tools used in the same study. Only four assessment tools included 10 or more key concepts [ 38 , 39 , 44 , 45 ]. Two were used for assessing EBM and CA skills and two for assessing understanding of the results and the certainty of the evidence from systematic reviews. None of the assessment tools that included 10 or more concepts targeted patients or consumers.
The Body: The Key Concepts (The Key Concepts) Lisa Blackman: Berg Publishers
Assessment tools used in studies targeting patients or consumers included only seven or fewer key concepts. The large majority of these were risk and DA studies, and generally only touching upon one concept 5. The most frequently used assessment tools, were the Fresno tool, which measures competency in EBM used in nine studies , and the Decisional Conflict Scale, which measures the amount of uncertainty a person has regarding a course of action and the factors contributing to the uncertainty used in 71 studies [ 46 ].
A limitation of mapping reviews is that they tend to be time constrained [ 29 ]. Furthermore, mapping reviews do not usually include any quality assessment of the included studies [ 29 ]. On the other hand, mapping reviews serves as an excellent starting point for initiating new research and reviews.
The major contribution of this review is that it provides an overview of the body of research addressing the key concepts, across different fields of research. We have used pragmatic, but explicit criteria guided by a list of the key concepts we believe is important for people to be able to understand and assess treatment claims.
Fashion Studies: Key Concepts
Our overview provides information about which key concepts have been targets of interventions, how understanding and skills have been evaluated, and which concepts have received little attention in research. The findings of this review provide a starting point for decisions about which concepts to address when developing new interventions, and which additional assessment tools should be considered.
This review did not attempt to compare the effects of such interventions, this should be done by using other review methods.
Applying the key concept list to the identified research literature, we sorted the interventions into four categories: risk and DA, EBM, and CA, understanding of controlled trials, and science education. Overall, interventions focused on a small number of key concepts, and typically targeted the same concepts within each research area.
The most common key concepts in interventions were concepts 5. A variety of assessment tools were identified, with approximately discreet tools and procedures. Four assessment tools included 10 or more key concepts, but none of these instruments targeted patients or consumers. The most frequently used assessment tools were the Fresno tool and the Decisional Conflict Scale [ 44 , 46 ].
A challenge we had conducting this review was that the descriptions and reporting of interventions and assessment tools were often limited.
In cases in which key concepts were not explicitly stated as part of the intervention or assessment tools, we did not attempt to make any assumptions about whether concepts could have been included. A typical example would be decision aids, for which key concepts such as risk are usually presented as part of the decision aid and concept 5. In such cases, we did not assume that this concept was considered unless educating people about this concept was an explicitly reported component of the intervention.
Another example is studies evaluating the effects of interventions teaching people EBM and CA skills. It was often unclear and rarely reported which concepts were included in these interventions and assessment tools. As a result, we may have missed relevant interventions or assessment tools that addressed some of the key concepts, or the number of concepts included may be underreported. Furthermore, the understanding of certain key concepts has changed over the years, for example, the reporting of p values and confidence intervals concepts 3.
In cases where the interpretation of these concepts was not explicit, we did not include them.
Another limitation of our review is that our search for studies was deliberately focused, and may not have identified all studies or assessment tools targeting one or more of our key concepts. However, we are quite certain, based on the large number of studies we included, that we have probably identified the most relevant interventions and assessment tools targeting the key concepts in our list.
The list of key concepts is an evolving document, which will undergo yearly revisions where new key concepts may be added or existing concepts may be revised. While conducting this review, one concept was added and one concept was divided into two concepts. This did not have any implication for the review methods or results, other than that we did not map or identify instruments that addressed this newly added concept. We included interventions and assessment tools used for both patients and health professionals.
Patient education in critical thinking is fairly new, and we believe that when developing such interventions researchers and others may learn from what has been done in interventions developed for health professionals.
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Evidence also suggests that patients and health professionals have many of the same needs when it comes to training in the key concepts. For example, in studies evaluating specific concepts such as risk, no differences were found between patients and health professionals in understanding of different statistical formats of risk [ 27 ].
Furthermore, evidence-based practice and the need for fair tests of treatments has yet to be universally acknowledged [ 48 , 49 ]. Thus, many professionals may not have had training in these concepts as part of their professional training. Therefore, interventions and assessment tools relevant for professionals may also be relevant to patients and vice versa, although terminology and examples used in such training may differ [ 50 ].
Rothwell Victoria Junior School
This was because the main purpose of this review was to identify an assessment tool we could use to evaluate interventions targeted at the concepts in the list. If we had identified such instruments, the next step in this process would have been to ascertain the quality of these. However, none of the studies we found included more than half of the key concepts. Some instruments also include critical appraisal skills; however, none of the health literacy instruments we found addressed the key concepts directly.
Instead, they measured more general understanding of health information and medical terminology [ 54 — 56 ]. We identified several such assessment tools; however, none of these met our inclusion criteria. This may be because many of these instruments are not publicly available and are apparently subject to change on a regular basis. Furthermore, such instruments generally focus on measuring understanding of basic science and mathematics.
Although we found that many instruments included content relevant to our concepts, such as the importance of supporting claims by research evidence, preparing a protocol, conducting laboratory experiments and calculating probabilities, they did not address our key concepts directly.
The findings of this review indicate that the key concepts people need to understand to assess claims about treatment effects are of interdisciplinary research interest. This suggests that many of the key concepts have not been focus of research, and that there is great need to explore how understanding about these key concepts can be improved and how such understanding can be evaluated. The findings of this review consequently should inform future research priorities, such as the choice of key concepts to include in interventions and for considering appropriate outcomes and assessment tools.
Med Decis Mak. How do consumers search for and appraise information on medicines on the internet? A qualitative study using focus groups. J Med Internet Res. How do patients evaluate and make use of online health information? Soc Sci Med. Lloyd A. Qual Health Care.