We analyzed the contributions of 146 professionals out of 185 recruited. e-mpodera vCoP participants’ characteristics are described in Table 2.
For 65 weeks, a total of 3571 contributions were done in the 63 forum threads of the vCoP, of which 3379 belonged to 146 participants. Two contents included surveys with 69 and 99 responses each and four collaborative documents. Quantitative results relevant to each value creation cycle are presented in Table 3. Cycles of value creation are described through indicators that progressively decrease in presence and intensity while the platform evolves over time and in stages.
Cycle 1. Immediate value. Activities and interactions
During the initial three months of the vCoP’s launch, the onboarding process promoted a strong and immediate value creation structure. The exchange of comments allowed members to introduce themselves, discover common interests, and engage in reflections related to empowerment as the central topic.
– I am xxx… Physician from xxx. I believe that empowering patients is fundamental and facilitates the results in the long run, improving the health of the patients, which is definitively what is pursued. (Ps_429)
Bringing experiences and problems of daily practice into the learning space was the main activity that enriched this level. The discussion revolved around significant issues such as challenges and barriers to empowerment, possible causes, and their impact on professionals and/or patients.
– Due to the lack of time and the care burden, we ended up giving them some guidelines that we have decided to be like this, guidelines suitable for the process, but perhaps not all suitable for the person. (Ns_349)
Several characteristics of the activity itself may account for the high rate of returning to the vCoP (85.4%), such as having fun or meeting other professionals facing similar issues.
– What a good time I had with the video! I still have a smile on my face;) (Ns_348).
– Hello @xxx, I laughed reading your comment because everything you say has happened to me with hair and signs! (Ps_306)
The goal-based pathway proved to be highly engaging, with 76.1% of comments concentrated in 33.3% of the goals activities. Particularly, those with entertaining actions such as sharing images of (de)empowerment and characterizing patients received a higher number of comments. Additionally, 79.5% of participants reach at least one challenge and gamification elements (points, badges, and leaderboard) likely contributed to goal orientation. Furthermore, the feedback reported showed participants’ interest and perceived usefulness of the vCoP as main values related to their participation.
– The score motivates me. (Ns_142)
– Thank you very much for the contributions! Very interesting… (Ns_331).
– A month has passed since my post, and I can keep on saying that patients have become more involved and that I find this method useful. (Ns_198)
Although nested chats accounted for 23.8% of the comments, the community heavily relied on answering questions as a main action, since most activities were based on a question, and many members opted to respond directly to the main post instead of using the “replay” button.
In addition to discussing practice-related problems, some questions sought assistance or opinions: open-ended queries seeking specific advice; reflective or rhetorical questions, and inquiries related to the platform itself. A total of 106 different questions were posted by members.
– What experiences or knowledge do you have that group education is more effective in many cases to empower patients? (Ns_331)
– Do all patients want that empowerment? It implies a shared responsibility. Are all patients willing to assume their share of responsibility? (Ps_267)
– Can someone tell me where the “Training Pills” are?” (Ns_278)
Collaboration efforts were limited to a few initiatives with stated intentions, however notable progress was achieved when the moderator proposed specific activities (Challenges 16a, 16b, 16c and 16d).
– I have chosen this group because we are currently carrying out an edition in our city of the Expert Caregiver Program of Catalonia, where I participate as an observer together with @I…. who is also doing this course within this same group. (Ns_139)
Engaging in content queries, and expressing personal opinions allowed flow and nurtured a respectful environment and a feeling of community.
– And here I do not agree with other colleagues… (Ps_141).
– I would also raise the case in the same way… (Ps_174).
– I hope to enjoy this experience and that we all learn a lot from each other. (Ns_243)
Cycle 2. Potential value: knowledge capital
This level includes connections, new concepts learned, skills and tools potentially useful for the future. Getting to know each other, relationships deepen, fostering a heightened level of trust within the community, which encouraged members to openly share not only “good practices”, but also their mistakes, challenges, professional failures, ad problem-solving skills. This reflects the personal and human value of participation and the sense of companionship of social learning (social and human capital).
– These days I have learned something. As a result of several claims that I have received from treatment. (Ns_247)
Deeper reflections about their own practices and expectations were done. The relationship between patients and physician, professionals’ role, and potential for bringing about change started to be discussed (reputational capital).
– After reading the article I have learned that the problems regarding understanding and communication of information are not based on people’s minds, but in the way in which the problem to be solved is represented. (Ps_215)
Users initiated some debates by asking for tools and calling for action.
– What experience or knowledge do you have about group education being more effective to empower patients, in many cases? (Ns_331)
– Do you think it’s good to share resources? (Ps_210)
Furthermore, solutions to concrete problems were offered, such as initiatives to share directories of resources, relevant documents, and links (interviews, surveys, infographics, etc.). A total of 48 responses aimed at addressing members’ queries were provided, primarily involving ideas and some resources, which were well appreciated by users, who expressed their interest and chances to use them. Enthusiasm for in learning activities was also expressed at this level. Other responses were solved by the moderator.
– I think it is very applicable into day-to-day practice and I will do so. (Ps_215)
– The format (of the e-mpodera vCoP) is interesting, it gives rise to several options to exchange with other members of e-mpodera and learn at the same time (Ns_254)
Certain challenges proposed a patient’s case to problem-solve (Challenge 10 and 13), resulting in 130 solutions. The iterative nature of discussions facilitated accumulative knowledge, as solutions were refined and improved throughout the thread and feedback was provided on each solution.
– I liked this approach! However, we must inform the patient that we can initiate a therapeutic strategy, either hygienic-dietary or pharmacological measures and that we are able to substitute, replace or do both at the same time, they are not exclusive, far from it. (Ps_145)
The content types that received the highest number of solutions were mainly problem-solving cases (Challenge 10 with 74 and 13, with 56), and those opened by users (likely due to the specific nature of queries), followed by the collaborative challenges (16a, 16b, 16c, and 16d).
A total of 1366 resources were exchanged by users, including self-created materials, research papers and files from the Internet. Products shared addressed topics of interest and provided answers to specific questions. For instance, information to share with patients, images from congresses, etc. (tangible capital). Due to platform limitations, it was not possible to track the number of downloads for each resource, unless explicitly mentioned in comments, as new information received.
– I think the survey was excellent. I didn’t know it. I will certainly try to apply it in my work. (Ns_309)
Confidence within the group also boosted sharing images of their work environments, ongoing projects and real situations.
The solutions to questions and specific challenges hold the potential of application in different practice context. The method and format of the activity offered could also serve as inspiration for members (learning capital).
– The format is interesting, it gives rise to several options to exchange with other members of e-mpodera and learn at the same time (Ns_254)
Cycle 3. applied value: change in practice
Time played a crucial role in transforming potential capital into applied value, alongside motivation to share outcomes within the vCoP. The e-mpodera guided learning skills development model along with the moderator’s facilitation, enabled members to engage in action-oriented activities and analyze the results. Challenges 9, 10, 13, 14, and 15 exemplify this type of activity. For instance, Challenge 9 involved implementing practice improvements, assessing results after pilot testing, and expanding the scope of implementation (to be explained in Challenge 14).
– I have piloted the experience with 2 patients, LMG (patient name) a 28-year-old woman and DAG (patient name), a 26-year-old man, both with debut asthma (Ps_215).
Certain practices implemented didn’t rely on previously shared information within the community, but the implementation itself fostered the opportunity to test and share as a common value. Members shared positive and negative results, enabling exploration to improve the practice they wanted to change. Sometimes, these ideas entailed novel approaches, fresh perspectives on concepts and alternative language usage, which could inspire further ideas.
– In my view, there are “empowerable” patients and others are not. (Ps_165)
– As I write this, I have realized that by disempowering the patient, he relieves himself of responsibility. (Ps_157)
Reporting results of applied resources and tools, holds a key importance within professional learning environments. As members receive this information, they gain insights that get inspired to replicate the experience, innovate, and strive for new and improved results.
– The experience has been very interesting and the practical effects in improving medication intake in the elderly were practically immediate. (Ps_292)
– This experience was very negative in our pilot, but it helped us to improve in the following exercise prescription activities. Most of the patients abandoned the activity in the first sessions. (Ps_141)
Some of the results were obtained in complex projects, where the opportunity appeared and the innovation could potentially be applied to newly implemented systems (expert-patient projects, e-consultation, etc.).
– Patients have enthusiastically received the launch of the e-consultation for doubts and questions, and during this time I have answered 12 questions (basically related to treatment, side effects…) (Ps_215).
Moreover, transferring what is happening in the vCoP to other spaces entails the creation of something valuable, allowing other contexts or individuals to benefit from that learning.
– I have been able to carry out the exercise with a co-worker, although she does not participate in e-mpodera. (Ps_182)
– I’m sorry, I have shared it on Facebook for my acquaintances and friends. It seems very real and very cruel! (Ps_141)
The use of social connections made them gang together for collaboration in a task, also promoted by the e-mpodera guided learning skills development model. As a result, a series of challenges (16 A, 16B, 16C2, 16D) were proposed to prepare several workshops for patients regarding various conditions, such as obesity, dementia, ischemic heart disease and chronic obstructive pulmonary disease. These activities prompted participants to reflect on the practical use of their social learning.
– I’m not in this group but I do congratulate you! I loved it. Very well structured. I would love to be able to do it in my health center one day!!!! (Ns_126)
Cycle 4. realized value: performance improvement
At this level, evidence available from the vCoP was limited since organizational aspects were not included into the intervention design. Even though, organizational performance is identified.
– With these training sessions we have reduced the cost of glycaemic test strips, patients have improved self-control and we have introduced a behavior change in the control of DM. (Ns_113)
Considering professionals’ performance indicators available in the vCoP, 38.77% of participants obtained a training certification (available for members with 1000 points and 20 challenges completed), while a total of 55.78% achieved 10 or more goals, which represents half of the e-mpodera activities proposed. Overall, most of the results of the experiences shared after implementing new practices can be seen as professional achievements, particularly when positive results are observed.
Professionals reported delivering knowledge products to clients, including tools and resources.
– In total, I was able to extend the activity to 40 families, I quantified that more than 80% had consulted the Internet for information from the prenatal to preschool period. I realized that most of them did not feel safe and were even embarrassed to admit that they had consulted web pages to find out about the care of their children. This is how the directory of web pages “Together from the beginning 2.0” arises, where parents and other caregivers can find out about care during pregnancy, childbirth, the puerperium, breastfeeding, first care of the newborn, complementary feeding, etc. (Ns_348.)
However, not all applied knowledge resulted in performance improvements that align with stakeholders’ priorities. To gather comprehensive indicators at this level, additional data from patients (feedback and satisfaction) is needed for supplementation.
Cycle 5. reframing value: redefinition of success
This redefinition of success can occur at individual, collective, and organizational levels. Few findings of this cycle were identified, mainly referring to new assessment methods and metrics to redefine success. One example included the time distribution for actions in consultations, addressed through a survey activity.
– Many of the patients who started exercising with us have changed their habits and continue to exercise in a group. And not just them but myself too. Before, I only took a few minutes to talk about exercise and now it is a priority part of the daily consultation. (Ps_211)
New frameworks emerge for certain participants, regarding patient expert programs, that were fully implemented in some facilities, while in others were discovered as an effective approach for empowerment within this vCoP.
– In our practice, groups with “the expert patient” have been incorporated. A highly recommended and effective experience. (Ps_250)
– The only thing that is not implanted in the day to day, is something punctual. (Ns_247)
– The organizational improvement level wasn’t considered in the design of the vCoP, nor in the trial. However, few specifics comments referred to organizational change implemented.
– A simple circuit for receiving CS procedures is provided for local clinics that, due to their size, do not have administrative professionals for customer service. (Ps_157)
At individual level, a new framework regarding empowerment and its impact was achieved.
– This course has made me really get down to work and I believe in it in every-day practice; empowering improves the doctor-patient relationship, the self-management of the disease and the quality of life of patients. (Ns_247)
