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Abstract
The paper reports on the design and development of QUESt, a platform that is aimed at enabling lay users to deploy web-based multi-page dynamic questionnaires. The platform requires little effort and no programming skills, as it uses a simple configuration file that can be expressed in an almost unstructured and text-based manner. We have validated the approach and platform in the healthcare domain, where the questionnaires were intended to solicit and collect both structured and unstructured feedback from large communities of practitioners in response to the sharing and dissemination of relevant case studies; more specifically in this paper we use a qualitative research approach, encompassing evaluation questionnaires and a particular kind of focus group, and the incremental prototype-based development that led to the current release of QUESt. The paper also reports on the experimentation of the platform in a real context, involving almost 100 orthopaedics, including the post-use evaluation of the participants. In light of this evaluation, we discuss the specific requirements of openness and flexibility that end-users ask for in order to be autonomous in developing their own tools for knowledge-sharing; in particular, we discuss the role of lightweight tools, like QUESt to support the dissemination and discussion of clinical case reports.
Acknowledgements
I acknowledge that the anonymous reviewers all had a strong influence on the final version of this manuscript, and some of them participated in its improvement with great attention and competence. I am also grateful to Andrea Casella MD, Alberto Aliprandi, MD and Prof. Paolo Cabitza, my father and a physician, for their warm and friendly involvement in the research, and for the progressive refinement of the QUESt platform. I would also like to thank all the focus group participants for their valuable contributions and their faith that we will give them something useful for their profession (that helps). Simone Mazzotta (MSc) also contributed in the development of the first QUESt prototype during his Master thesis project and made things work fairly well. In any case, most of the good things in the general architecture of the system are due to the good intuitions of Alessandro Bahgat Shehata (MSc).
Notes
1. This is the acronym of ‘Questionnaires for the User-driven Externalisation of Stories’.
2. Acronym of ‘YAML Ain't Markup Language’.
3. According to the US Preventive Services Task Force, randomised, controlled trials are associated with evidence of level I, while ‘Opinions of respected authorities, based on clinical experience; descriptive studies and case reports; or reports of expert committees’ are associated with evidence of level III, on a scale of five rankings (e.g. I, II-1, II-2, II-3 and IIII)
4. For example, the Journal of Medical Case Reports (unofficial impact factor: 0.35): http://www.jmedicalcasereports.com/
5. This is not to say that ICT designers should side with an approach to medical work and decision-making or with the other (e.g. evidence-based vs. consensus-based vs. case-based and the like). They would probably not have the necessary competence to take a firm stand on this point, for which heated debates still occur in the medical community. Moreover, probably no approach may be considered good ‘per se’ and for this reason better than the others.
9. Even recently the International Committee of Medical Journal Editors felt the need to issue a recommendation stating that ‘biomedical journals should provide the readership with a mechanism for submitting comments, questions, or criticisms about published articles’. In the last decades the most important English-language medical journals (e.g. JAMA, BMJ, The New England Journal of Medicine, The Lancet) have allotted about 6–8% of their page space (with an increasing trend) to letters to the editor concerning their original articles and reviews (Baethge and Seger Citation2009).
10. Interested readers can get access to the full-fledged questionnaire at this URL: http://qmed.heroku.com/?token=wuiuvtn9dawkjng. The questionnaire is in Italian.
11. All statistical tests were done at a significance level of.05 and P-values estimates were calculated at a confidence level of.95.
12. Null hypothesis expressed on the equality of distributions, significance level of.05 at a confidence level of.95.