Evaluation of the Choosing Wisely Australia® 5 Questions resource and a shared decision-making preparation video: Protocol for an online experiment

INTERVENTION: This study seeks to compare the relative effectiveness of multiple shared decision making interventions (a preparation video alone vs. enablement intervention alone vs. preparation video and enablement intervention) on consumer outcomes (2 primary and 6 secondary). It will also assess whether the level of health literacy will impact the two primary outcomes: the intention and the self‐efficacy of participants to use shared decision making.  Participants will be randomised into one of three intervention groups using randomisation embedded in Qualtrics, stratified by level of health literacy.  Each participant will then be randomly assigned to one of the three interventions and asked to complete an online questionnaire based around a hypothetical healthcare scenario to measure primary and secondary outcomes in regard to use of shared decision making. Mixed qualitative and quantitative methods will be used.  Following this, the links to both interventions will be shared with the participant for one month and the frequency visited used as the basis for measuring a behavioral effect in the 1‐month follow up survey. Link usage will be monitored online via Qualtrics.  Pre‐intervention, post‐intervention and 1 month follow‐up surveys will be used to measure change in primary outcomes. Secondary outcomes will be measured at post‐intervention and 1 month follow‐up surveys.  PREVENTION INTERVENTION The preparation intervention is a short 3 minute video given to survey participants via a link. Participants will have access to the video once within the post‐intervention survey and only permitted to progress with the intervention once 3 minutes have elapsed to ensure adherence. The preparation video script was developed via an iterative process drawing upon existing shared decision making literature to inform, encourage and clarify the rights of participants to engage in this process.  ENABLEMENT INTERVENTION The enablement CONDITION: Health Literacy ;Shared Decision Making ; ; Health Literacy ; Shared Decision Making Public Health ‐ Health promotion/education SECONDARY OUTCOME: Attitudes towards shared decision making ; ; Attitudes towards SDM are measured with a validated scale developed by Dormandy et al. 2006) and adapted for use in this context. ; ; Dormandy E, Michie S, Hooper R, Marteau TM. Informed choice in antenatal Down syndrome screening: A cluster‐randomised trial of combined versus separate visit testing. Patient Education and Counseling. 2006;61(1):56‐64.[At time of post‐intervention questionnaire completion ] Behaviour ; ; Patients will be sent an email with a link to the intervention they've been randomised to. The number of times each link has been clicked after one month will be monitored and recorded as a measure of behavioural effect. [At time of 1 month follow‐up questionnaire ] Healthcare questions ; ; Post intervention, participants will be asked to write down 5 questions they would ask the doctor given the hypothetical healthcare scenario. The content of individual responses will be anaysed via content analysis using inductive and deductive approaches. [At time of post‐intervention questionnaire completion ] Knowledge of patient's rights in regards to shared decision making ; ; ; ; ; Adapted from Shepherd et al. (2016) participants in each intervention group will be asked to rate if they would recommend the material/s to others. ; ; ; Adapted from Graham and O’Connor (2005), participants will be asked to complete the Preparation for Decision Making Scale. ; ; Graham ID, O’Connor AM. Preparation for Decision Making Scale. University of Ottowa; 1995 [Updated 2005].[At time of post‐intervention questionnaire completion ] PRIMARY OUTCOME: Intention to engage in shared decision making ; ; Self‐reported measure of intention to engage in SDM will be measured using a scale developed by Couet et al. (2015).; ; Couët N, Labrecque M, Robitaille H, Turcotte S, Légaré F. The impact of DECISION+2 on patient intention to engage in shared decision making: secondary analysis of a multicentre clustered randomized trial. Health Expectations. 2015;18(6):2629‐37. [Upon completion of: ; ‐ Pre‐intervention questionnaire; ‐ Post‐intervention questionnaire; ‐ 1 month follow‐up questionnaire ] Self‐efficacy to ask questions and be involved in healthcare decision‐making; ; Measures of self‐efficacy developed from Bandura's (2006) self efficacy theory. ; ; Bandura A. Chapter 14: GUIDE FOR CONSTRUCTING SELF‐EFFICACY SCALES. In: Pajares F, Urdan TC, editors. Self‐efficacy beliefs of adolescents. Greenwich, Conn: IAP ‐ Information Age Pub., Inc; 2006. [Upon completion of: ; ‐ Pre‐intervention questionnaire; ‐ Post‐intervention questionnaire; ‐ 1 month follow‐up questionnaire ] ; Knowledge of patient rights in regards to asking questions and sharing in health decisions are measured via questions adapted from Halawany et al. (2016) to include items from the Australian Charter of Healthcare Rights. ; Halawany HS, AlTowiher OS, AlManea JT, Abraham NB, Jacob V, AlMaflehi N. Awareness, availability and perception of implementation of patients’ rights in Riyadh, Saudi Arabia. The Saudi Journal for Dental Research. 2016;7(2):132‐7. ; Australian Commission on Safety and Quality in Healthcare. Australian Charter of Healthcare Rights 2008 [Available from: https://www.safetyandquality.gov.au/national‐priorities/charter‐of‐healthcare‐rights/.[At time of post‐intervention questionnaire completion ] Likelihood of recommending the material/s to others ; Shepherd HL, Barratt A, Jones A, Bateson D, Carey K, Trevena LJ, et al. Can consumers learn to ask three questions to improve shared decision making? A feasibility study of the ASK (AskShareKnow) Patient–Clinician Communication Model® intervention in a primary health‐care setting. Health Expectations. 2016;19(5):1160‐8.[At time of post‐intervention questionnaire completion ] Preparedness for shared decision making INCLUSION CRITERIA: Above 18 years Sufficient English language skills to complete the questionnaires in English