Consumer Co-Design of an Online Resource to Build Communication Skills of Health Consumers: Mixed Methods Study.

Background: Information provided by health professionals can be complex and is often not well understood by health care consumers, leading to adverse outcomes. Clinician-led communication approaches such as "teach-back" can improve consumer understanding, yet are infrequently used by clinicians. A possible solution is to build consumers' skills to proactively check their understanding rather than waiting for the clinician to do so; however, there are few educational resources to support consumers in building these skills. Objective: This study aimed to co-design a web-based learning resource for consumers to check they have understood information provided by a clinician (ie, to "check-back"). Methods: This mixed methods study used a co-design approach, consisting of 2 phases. The study was conducted during the COVID-19 pandemic, and all activities were conducted online, via email or telephone. Phase 1 (needs assessment) involved first establishing an Expert Panel of consumers, clinicians, and academic experts to guide all co-design steps of the study. Next, we sought to understand issues around health communication through focus groups and interviews with consumers and clinicians. Participants were recruited from outpatient settings and consumer representative programs within 3 health services in Victoria, Australia. Focus groups and interviews aimed to identify factors that might influence consumers' use of check-back. Deductive analysis based on the Capability, Opportunity, and Motivation-Behavior (COM-B) model was used to identify initial themes; these were discussed in depth with the Expert Panel and barriers within each theme identified. A rapid literature review was undertaken to identify strategies for web-based communication training for consumers. Phase 2 (creation of the online resource) involved an iterative process. In an online meeting, Expert Panel members brainstormed ideas for addressing barriers and prioritized these ideas for inclusion in the resource. Several drafts of the content were written before a draft online version was built. This draft was reviewed by the Expert Panel, who recommended extensive revisions. Following these revisions, we conducted an online survey and focus group with consumers and clinicians from Phase 1 to identify further improvements. Findings from this consultation were used to make final changes to the online resource. Results: The Expert Panel included 12 members. Phase 1 focus groups and interviews were held with 39 consumers and 16 clinicians. Five themes were identified: self-efficacy, pre-existing skills, clinician attitudes, information complexity, and internal barriers such as embarrassment. Phase 2 survey and focus group participants identified several issues with the second draft of the resource, focusing on functionality, accessibility, and layout. Usability and acceptability of the resource were rated highly by participants. Conclusions: Findings highlight the value of using co-design to develop a consumer-centered, web-based learning resource. Further evaluation is required to demonstrate its effectiveness at improving consumer understanding.