Of the eighteen participants, twelve were women and six were men; ages ranged from 60 to 81 years. The 12 personas that were created captured some rural and urban, male and female, and immigrant perspectives.
Two major themes were developed from the analysis of persona scenario data regarding KT considerations: connecting to information via other people and personal venues (where examples of people include healthcare professionals, librarians, and personal networks; and examples of personal venues include clinics, libraries, pharmacies, and community gatherings); and health information delivery formats (e.g., printed and multimedia formats for web-based resources). For each theme, and any identified subthemes, a corresponding set of suggested KT strategies that could include some or all of the following: a) educational outreach/materials, b) information technology decision support, c) interactive small group sessions, d) media campaign/social media, e) champions/opinion leaders, and f) conferences.
Theme 1: Connecting to information via other people and personal venues
Subtheme: Trust in health information from healthcare providers
The scenarios indicated that older adults rely on their healthcare providers (e.g., family physicians, pharmacists) for information about their health and healthcare. For example, Mabel regularly relies on her physician for information: “Once a week Mabel still visits the doctor to rely on his information. The doctor discusses the information and then asks his nurse to provide a handout.” These healthcare providers are trusted sources of information, as illustrated by Frank:
You can trust something if it’s available in a doctor’s office, but if you get it elsewhere you can be a bit skeptical, especially if it’s online… knowing who the source of the information is and does the information seem reasonable…that it should be aligned with a health care professional.
Given the important roles that healthcare providers play as trusted sources of information, tailored KT strategies to increase awareness of the Portal and similar ICTs among providers are recommended (Table 1). The goals should be to increase knowledge and use of the ICTs by practitioners to support educating their patients.
Table 1
KT strategies involving healthcare providers
Theme: Connecting to information via people and venues
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Subtheme
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Suggested KT strategies
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Trust in health information from healthcare providers
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Educational outreach and materials
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• Create a publicity campaign targeting primary care physicians and pharmacists to inform them of the utility of the Portal or similar ICTs as a source of trustworthy information for older adult patients
• Provide printable handouts, posters, pamphlets with instructions to access the ICT or other form of specific health information
• Distribute printed outreach materials to physician offices and pharmacies; encourage placement and availability to patients or to facilitate conversations
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Information technology decision support
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• Encourage clinicians to push health promotion and health information to patients through targeted emails or using ICT functionality within their health record
• Enable push notifications or messages that contain a website link to access information on applicable health conditions (e.g., facts of the week), and notifications for their care plans (e.g., appointment times)
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Champions/opinion leaders
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• Develop relationships and connections with various health professionals to promote awareness of ICTs, including primary health care practitioners, regional health organizations, home health care and telehealth nurses, optometrists, and pharmacists, traditional healers
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Subtheme: Librarians and libraries as knowledge hubs
Libraries were described as social and knowledge hubs for the personas, “[Alice] often peruses the collection of pamphlets for health-related topics…if, in fact, the library doesn’t have that sort of information that would be one channel to get the information out.” Several scenarios described roles for librarians as knowledge brokers, including: “she heads to the library and she asks the librarian for help for information” (Edna) and “the usual way she has of getting trusted health information is she goes to a library to access internet, and to read books, access magazines, get help from the librarian…” (Sally). Evaluation metrics to determine the value of the approaches could capture interactions focused on health information seeking between older adult patrons and library staff, usage of the ICTs such as the Portal at libraries, training modules for library staff on how to use and connect older adults to ICT resources, and changes in health-related information provision skills among library staff (Table 2).
Table 2
KT strategies for librarians and libraries.
Theme: Connecting to information via people and venues
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Subtheme
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Suggested KT strategies
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Librarians and libraries as knowledge hubs
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Educational outreach and materials
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• Create and disseminate training modules (or other educational outreach) to familiarize public librarians with ICTs like the Portal, and how to guide and support target users to find and, if necessary, print desired health information
• Distribute accessible information pamphlets on various health topics at libraries
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Interactive small group sessions
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• Use libraries as a venue for information sessions for patients
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Champions/opinion leaders
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• Develop relationships with Librarian Associations (e.g., Canadian Library Association)
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Conferences
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• Attend library association meetings or conferences
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Subtheme: Family and informal caregivers
Family members were common sources of health information and support among the personas: “He tried to use a computer but without much success, so he relies on his daughter for any advice and questions he has about medicine.” (Jack). Getting trusted and reliable information to these knowledge users is important. Personas relied on offspring, spouses, and other relatives, as well as friends and caregivers in their communities. Recommended KT strategies include small group sessions facilitated by peers, creating resources for family and other informal caregivers and making them available in primary care offices, and developing public campaigns to increase awareness of these evidence-based sources of information (Table 3).
Table 3
KT strategies for family and informal caregivers
Theme: Connecting to information via people and venues
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Subtheme
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Suggested KT strategies
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Family and informal caregivers are common sources of health information
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Educational outreach and materials
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• Develop and distribute KT resources to be provided by primary care (before the patient or family leave the office) to address informational needs especially during wait times or between appointments
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Interactive small group sessions
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• Develop training program(s) for patients and their informal caregivers (family members, friends and neighbours of patients) on how to access and use health information on ICT like the Portal
• Support a seminar series or other speaking opportunities for users (older persons, caregivers) to share their experiences with others
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Media campaign
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• Purchase ads on websites and social media platforms that patients and their caregivers are likely to visit
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Champions/opinion leaders
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• Engage patients and ICT users (older persons, caregivers) in sharing knowledge about the ICT with their peers
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Subtheme: Community organizations as a source for health information
Personas went to a range of community organizations and locations for information. For example, church was an important community for Mabel: “…[She] also go[es] to the church and ask[s] fellow parishioners.” and Alice was “actively engaged in her church and thinks that the local health department could be more involved in sharing health information with the congregation.”
Community centres were identified as another common venue for acquiring information. For example, Sally “…goes to her community recreation centre for booklets and about programs and finds out information … from her friends.” Similarly, Sandra “…belong[s] to the [local seniors’ centre] …She’s contacted the…[seniors centre] to get more speakers to talk about many of these medical information [sic]…about learning about medical issues through medical information technology and what resources are available for seniors”.
Other venues that were mentioned included coffee shops, malls, organizations like the Heart and Stoke Foundation of Canada, and local hospital waiting rooms. KT strategies in the community could target community centres as avenues for passive dissemination of brochures or small group education sessions for community service providers and patrons of the centres (Table 4).
Table 4
KT strategies for general public and community organizations as the knowledge users
Theme: Connecting to information via people and venues
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Subtheme
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Suggested KT strategies
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Community organizations are a source for health information
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Educational outreach and materials
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• Provide or sponsor information pamphlets or sessions for targeted promotion of ICT during senior-related activities
• Distribute ICT promotional materials and pamphlets to community recreation centres
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Media campaign
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• Broaden dissemination to seniors’ centres, community organizations, other community services
• Request to host links to the ICTs on websites of applicable organizations
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Champions/opinion leaders
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• Engage with trusted professional and community health information providers (e.g., family health clinics, recreation centres, community health centres, patient health associations) to share consistent information about the ICT within these venues
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Subtheme: Multiple avenues and formats to seek health information
Persona scenarios illustrated that people use multiple avenues (people, venues, and formats) to seek health information; the process is dynamic and multifaceted. For example, Joe uses multiple information seeking approaches:
Joe usually uses several ways of getting trusted information: from his family physician…the public library – the librarian helps him access information from the computer…He generally relies on his son, Mark, who is computer literate. Also, he goes to [the] mall to speak with his good friends from [his previous industrial workplace].
Similarly, another scenario identified multifaceted information seeking approaches which also highlighted the need for consistency in information provided across sources:
Alice talked about getting information at her doctor’s office or at the library and sometimes from her daughter and sometimes on a website, and the need for that to be similar or else that could be confusing. Or her pharmacist as well… her GP is sort of the next person.
These illustrate that there are multiple opportunities to support their knowledge seeking needs.
Theme 2: Health information delivery formats
Users of digital sources want recognizable, trusted sources and preferred resources created in multiple formats. Participants described various print formats in which older adults preferred to access health information, which included magazines, pamphlets, and books:
June does not look at electronics, but she will look at ads and flyers and pamphlets. So, for example, if Shoppers Drug Mart has a flyer that says this is good for something, she will often think that that is true and purchase that product. (Pete’s wife and caregiver, June).
Another scenario emphasized the value of health information available in printed formats that are “just one page, maybe double-sided, and it has a very concise, summarized information and all that she needs on that one page.” (Sally).
Older adults or the people they trusted also consulted online resources: “One of her friends told her about the McMaster Portal to check that out. She also had… another friend [who] told her about the Mayo Clinic website.” (Sandra), though they identified concerns about trustworthiness. For example, in the case of Pete’s wife and caregiver June:
…her sister might be able to access electronic information through websites on Google… to be a completely trustable website it should have some kind of government or organization endorsing it…It would also be trustable if it’s the physician or pharmacist who gave June’s sister or June that information or website.
The various information seeking behaviours and different needs raised by participants suggest that multi-modal KT tools and formats are needed (Table 5). From the scenarios, we see that older adults use the internet to find health information, are interested in recognizing trusted sources, and prefer resources in multiple formats.
Table 5
Suggested formats for KT strategies to meet the needs of older adults seeking health information
Theme: Health information delivery formats
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Educational outreach and materials
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• Have handouts, poster boards, service demonstrations and sign-ups, or presentations on various relevant health topics at social gathering places such as Bingo halls, churches, community recreation centres, malls, crosswalks, coffee shops
• Engage trusted sources (primary care office, Ministry of Health) to provide push notifications to patients regarding healthy aging, common health conditions, the Portal as an example of a trusted source and how to recognize one
• Create a shortlist of consumer publications (e.g., magazines, newspapers, community papers, health columns) where adapted versions of Portal-style evidence syntheses could be presented
• Send query letters to publishers to explore possibility of publishing Portal-style evidence syntheses as consumer health content
• Convert evidence summaries to different formats such as booklets, fact sheets, flyers, newspaper
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Media campaign
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• Targeted ads and information for older adults (geographically or through their affiliation with health condition-based groups on social media platforms)
• Increased social media-based awareness and outreach
• Navigation to the Portal or other ICT Facebook page should be found in several ways (and should not require searching by the full website name on Facebook or though Google)
• Advertisements on billboards or city bus screens
• Links to other trusted information sources on the ICT
• Work with hosts of other reputable health websites visited or consulted by target users (e.g., Health Canada, Heart and Stroke Foundation, Mayo Clinic) to post cross-endorsements of each other's content
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Champions/opinion leaders
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• Engage community and health organizations in increasing knowledge or awareness among the public (e.g., at a religious centre, senior centre, community centre, or via a community organization such as the Canadian Association for Retired Persons)
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