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Harnessing resources from the Internet to maximise outcomes from GP consultations (HaRI): a qualitative study
Principle Investigator: Professor Fiona Stevenson
Start date: September 2017
Finish date: completed
Main aim or mission of the project:
To establish how material from the internet is managed by GPs and patients in consultations.
Background:
Given the unrelenting pressure on primary care, patients are increasingly expected to manage their health outside of medical consultations. According to the latest figures from the Office for National Statistics (2019) 93% of UK households have internet access and 63% of adults reporting looking for health related information, up from 53% in 2017, making the Internet an important potential source of health-care information and advice. However, existing research findings based on interview or questionnaire studies report that both patients and doctors may find raising use of the internet in consultations problematic. Harnessing resources from the Internet to maximise outcomes from GP consultations (HaRI) study combines survey data, with data from video-recorded consultation and interviews with patients and GPs to understand what happens in consultations and identify strategies that will lead to smoother interactions in relation to the invocation of the internet in primary care consultations.
Study Methods:
Three data collection methods were employed: a pre-consultation patient survey, video-recorded consultations between GPs and patients, and semi-structured interviews with GPs and patients. We sought to recruit up to 10 GPs practicing in Southeast England, and up to 300 patients (approximately 30 per GP) to complete questionnaires and have their consultation video-recorded. We aimed to conduct semi-structured interviews with up to 30 patients (approximately 3 per GP) and all participating GPs in the weeks following the video-recorded consultation. Patient interviewees were selected in accordance with a wide range of socio-demographic characteristics, and a variety of ways the use of, or information from, the internet was present or absent during their consultation. The interview topic guides were designed to elicit GP and patient views of online health information. Descriptive statistics were used to analyse the surveys, conversation analysis was used to analyse the consultations data, and thematic analyse was employed to analyse interview data (Seguin et al 2018).
Study results:
The HaRI data set consists of 281 video recorded primary care consultations, all with an associated pre-consultation questionnaire. This is complemented with data from interviews with all 10 participating doctors (equally split in terms of gender) and 28 of the patients. The consultations were collected from eight GP practices which varied size, measures of deprivation and geographical setting (rural, suburban and urban) across London and the southeast of England. One practice was in a deprived neighbourhood, three practices were in the middle of the social deprivation index range, and two practices in area of low deprivation. Practices range in size from just under 4,000 to just under 17,500 registered patients. 231 (82%) of participants consented to reuse of data for the purposes of research, subject to ethical approval, 239 (85%) gave permission for reuse for the purposes of education. More details can be ound at (Seguin et al 2018).
Anecdotal evidence suggests that ‘Dr Google’ appears in 80% of consultations. However just over a quarter (79 respondents, 28%) of the 281 respondents in the HaRI study reported ‘going online’ prior to their consultation to seek information about the health issue about which they were consulting. Analysis of the consultations found only 26 patient mentions of the internet in 18 consultations (6%) with mentions by GPs in 15 consultations (5%) and use by the GP in 23 consultations (8%). By matching invocations in interviews and consultation data it was possible to see how what people said about using the internet translated into invocation of the internet in the consultation. Patients invoke the internet in interviews in relation to identity work and presentation of self as a responsible actor who is informed and only seeks medical care when absolutely necessary. Yet detailed analysis of consultations in which the internet was invoked by patients demonstrates the interactional delicacy with which invoking the internet was approached and that this only occurs, when necessary, in the service of advocating for a particular action or agenda. For instance, patients may invoke the internet to leverage knowledge to advocate for a particular treatment or to press for clarification. Patients design their talk in relation to the internet and are careful to ensure their talk is fitted to the actions of the consultation at that time. We can see similar attention to the interactional delicacy of raising the internet when we examine GPs introduction, and use, of information from the internet. We characterised this by developing and extending Nettleton’s (2004) idea of ‘e-scaped medicine’ to argue that Internet resources may be ‘recaptured’ by GPs, with information transformed and translated into a medical offering so as to maintain the asymmetry between patients and practitioners necessary for the successful functioning of medical practice (Stevenson et al 2019).
Project co-applicants
Professor Sue Ziebland (University of Oxford)
Professor Elizabeth Murray (UCL)
Professor Trisha Greenhalgh (University of Oxford)
Professor Geraldine Leydon (University of Southampton)
Dr Rebecca Barnes (University of Bristol)
Mr Charles Prince (PPI)
Mr Jonathan Benford (PPI)
Project collaborators:
Professor Catherine Pope (University of Southampton)
Dr Helen Atherton (University of Warwick)
Funded by:
National Institute for Health Research (NIHR) School for Primary Care Research
Contact details:
Fiona Stevenson (f.stevenson@ucl.ac.uk)
Ethics approval:
Ethical approval was granted by the London – Camden & Kings Cross Research Ethics Committee.