Discussion: healthcare management annotated ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: healthcare management annotated Im studying for my Management class and dont understand how to answer this. Can you help me study? Discussion: healthcare management annotatedDiscussion: healthcare management annotated HI, I UPLOADED MY INSTRUCTION FILE AND MY 8 SOURCES. YOU WILL NEED 12 SOURCES FOR THIS ASSIGNMENT. I ALREADY RESEARCH 8 SOURCES FOR YOU. YOU WILL NEED TO RESEARCH 4 SOURCES BY YOURSELF AND Sources can include books, article, monographs, websites and other documents. All sources should be substantial in length and content. All articles should come from appropriate professional journals. PLEASE LOOK AT ALL FILES WHICH I UPLOADED. I dont know how many pages will have for this assignment. I think It will have more than 4 pages. PLEASE LET ME KNOW IF YOU HAVE ANY QUESTION. annotated_bibliography.docx sources.docx SOURCE #1 How patients use of social media impacts their interactions with healthcare professionals Author links open overlay panel A.Benetoli ab T.F.Chen a P.Aslani a Show more https://doi.org/10.1016/j.pec.2017.08.015 Get rights and content Highlights Patients were empowered by using social media for health-related purposes. Patients could participate more actively in the treatment decision-making processes. The use of social media by patients improved their relationship with their healthcare professionals. However overt or tacit opposition from healthcare professionals was reported. Abstract Introduction Patients are increasingly accessing online health information and have become more participatory in their engagement with the advent of social media (SM). This study explored how patients use of SM impacted their interactions with healthcare professionals (HCPs). Methods Focus groups (n = 5) were conducted with 36 patients with chronic conditions and on medication who used SM for health-related purposes. The discussions lasted 6090 min, were audio-recorded, transcribed verbatim, and thematically analysed. Results Participants did not interact with HCPs on SM and were not expecting to do so as they used SM exclusively for peer interactions. Most reported improvement in the patient-HCP relationship due to increased knowledge, better communication, and empowerment . Participants supplemented HCP-provided information with peer interactions on SM, and prepared themselves for consultations. They shared online health information with HCPs, during consultations, to validate it and to actively participate in the decision-making. Although some participants reported HCP support for their online activities, most perceived overt or tacit opposition. Conclusion Participants perceived that their SM use positively impacted relationships with HCPs. They felt empowered and were more assertive in participating in decision-making. Practice implications HCPs should be aware of patients activities and expectations, and support them in their online activities. Previous article in issue Next article in issue Keywords Social media Patients Chronic conditions Decision-making Empowerment Healthcare professionals Introduction The Internet has increased access to a range of health-related information, and its evolution to Web 2.0 has provided a more participatory environment where users develop and disseminate online content. Web 2.0 has provided the technological foundation for the appearance of social media platforms [1] . Web 2.0 has allowed the development of easy-to-use and interactive platforms where individuals and communities share, co-create, discuss, and modify user-generated content (e.g. texts, images, audios, videos, games) employing mobile and web-based technologies [2] . Social media (SM), dubbed the participative Internet [3] , has therefore been enabled through the evolution of Web 2.0. Putting it simply, SM consists of a wide range of websites and applications whose content is created by Internet users [1] . It has provided a new venue for public communication, including health communication [4] . As a result, SM has turned out to be not only an emerging trend for patients seeking health information [5] , but also a venue for them to interact with one another. Online communities of patients with a shared health problem have become common [6] . Popular topics discussed include disease symptoms, prognosis, examinations and procedures, and treatments [7] . Besides getting additional useful information directly from peers [8] , online patients have also obtained social support for self-management of their chronic conditions [9] . It has been argued that patients access to online health information can impact their relationship with healthcare professionals (HCPs) [10] . As Web 2.0 and SM are dynamic communication technologies with increasing penetration in peoples daily lives, it is vital to keep abreast of changes in its use by patients. Additionally, it is important to fully comprehend how patients are accessing health services and interacting with their HCPs after engaging with peers on social media. Findings from the literature have revealed that patient participation in health-related discussions on SM and other online forums could have an impact on the patient-HCP relationship. Patients have felt empowered and confident with the knowledge and support obtained online [11] , [12] and consequently have asked more relevant questions and communicated better with HCPs [11] , [13] , [14] , [15] , [16] . However, on the flip side, it has been claimed that patients active participation in online health activities with peers could threaten HCP expertise in some cases [17] leading them to negatively react to patients online autonomous health activities. This in turn could have a disempowering effect on patients [18] . Patients have ended up looking for other health providers in response to a physicians negative attitude or due to the recommendation of good doctors from peers [15] . Chiu and Hsieh [13] investigated how cancer patients wrote (and read) blogs about their condition and the impact of such activity on their illness experience. Cancer patients reconstructed their life story in the blog, articulated their expected end of life and how they wished to be remembered after death [13] . Using in-person and virtual focus groups, Rupert et al. [18] found that patients used online health communities or support groups to obtain information not provided by HCPs and discussed information obtained online with their clinicians, positively impacting the patient-HCP relationship [11] , [18] . An Australian study [17] employing interviews explored the use of online support groups by men with prostate cancer . It showed that the online environment allowed patients to share private information without the constraints imposed by face-to-face social interactions . However, medical specialists perceived this behaviour as a threat to their expert status and control over decision-making processes [17] . A recent review by Smailhodzic et al. [19] about the use of SM in healthcare incorporated studies dealing with patients use of SM and its influence on their relationship with HCPs. While recognizing the limited number of studies on this topic, the authors proposed that SM use by patients increased their empowerment leading to a more equalized power balance between patients and HCPs. Considering the relative novelty and relevance of the topic, further research is deemed necessary. A comprehensive understanding of patients use, perceptions, and opinions about the use of SM for health-related purposes is important in order to design services that meet their needs and expectations. Moreover, further research is necessary in order to better understand SMs potential for supporting patient-HCP relationships [20] . Therefore, the aim of this research was to explore patients experiences, opinions and perceptions about their use of SM for health-related purposes. Specifically, the study objectives, reported here, were to determine the impact of these online activities on patients in-person healthcare services use and health decision-making behaviour; and its effect on patient-HCP relationships. Methods 2.1. Focus groups A qualitative approach was used to allow participants to articulate their experiences, and help elicit in-depth information from them [21] . Focus groups were chosen because they are an efficient way of gathering the views of several individuals simultaneously [22] , uncovering important constructs that may not be tapped through individual interviews [23] . A focus group guide (Appendix 1 in Supplementary materials) was developed to address the broad research aims. Findings pertaining to the questions on impact of SM on healthcare services use and healthcare professional interactions have been reported here. 2.2. Participants and recruitment 2.2.1. Inclusion criteria Participant inclusion criteria were: 1) adults with a chronic disease, 2) taking a medication for that disease, 3) had used SM for health-related purposes in the last 12 months, and 4) able to participate in the study without the assistance of a translator. 2.2.2. Recruitment All participants were recruited from the Sydney metropolitan area by a market research company. They received detailed verbal and written information about the study. Forty participants were recruited and thirty-six participated in the discussions. Each participant was reimbursed AUD$80 for their time and travel expenses. Discussion: healthcare management annotated 2.3. Data collection Five focus groups were conducted in three separate dedicated venues in Sydney, Australia. All participants provided written consent and completed a demographics questionnaire. Discussions lasted 6090 min and were facilitated by PA, a female pharmacist and academic experienced in conducting focus groups. The discussions were guided by the focus group questions (Appendix 1 in Supplementary materials) and audio-recorded. Focus groups were conducted until data saturation [24] , which was at the conclusion of the fourth focus group. One additional focus group was conducted for validation purposes. 2.4. Data analysis Note taking during discussions and debriefing immediately after ensured that important information was not ignored and constituted a preliminary analysis [23] . Therefore the data analysis started during and in parallel with data collection [25] . All audio-recordings were transcribed verbatim and thematically analysed [26] . Thematic analysis was chosen as it is not aligned with a particular epistemological, philosophical, or theoretical approach and is a flexible tool to generate themes in qualitative research [26] . Repeated reading of notes and transcriptions afforded familiarity with the data. Transcriptions were then coded line-by-line, by AB, with the assistance of NVivo 11 ® (QSR International), and discussed with PA. Coding was open, not restricted by theoretical assumptions and was dynamic and iteratively developed throughout the analysis. An inductive approach [27] assured a data-driven analysis. Codes with a repeated pattern across the data were collated together and grouped into sub-themes and later assembled into overarching themes. Results A total of 36 participants ( Table 1 ) took part in the focus groups (n = 5). A wide range of chronic disease states (e.g. hypertension, depression, anxiety, cancer, arthritis , Crohns disease) was represented among the participants. Table 1. Participants demogra phics. Discussion: healthcare management annotated Characteristic Participants (n = 36) Sex Female 17 (47%) Male 19 (53%) Age Range 2771 Mean ± SD 47.3 ± 10.2 Country of birth Australia 26 (72%) England 2 (5.5%) New Zealand 2 (5.5%) Other 6 (17%) Education Less than High School 3 (8%) High School 11 (30%) College or Technical Education (TAFE) a 6 (17%) Undergraduate 12 (33%) Postgraduate 2 (6%) Data missing 2 (6%) Employment status Full-time 18 (50%) Part-time 9 (25%) Home duties 3 (8%) Retired 2 (6%) Unemployed 4 (11%) Self-reported health status Excellent/very good 14 (39%) Fair 17 (47%) Poor/very poor 5 (14%) Three overarching themes related to the impact of SM in patients interactions with HCPs and health care services emerged from the analysis. Table 2 provides a sample of quotations illustrating such themes. Table 2. Overarching themes and respective quotation sample. Themes Illustrative quotations SM use and its impact on interactions with HCPs I think, if you know the language and youre familiar with concepts and closer to a level that a doctor understands or operates in, its a little bit easier, the interaction [Focus group (FG)2, female participant (f)10] I think if you prepare yourself for a session with the doctor, you know what exactly you want to ask; they can answer [FG5, f31] Discussion: healthcare management annotated I think they [HCPs] probably take you a bit more Discussion: healthcare management annotated seriously when you know your stuff, because they cant fool you around, because they know that you have the answers [FG2, f12] I have questions mentally prepared, questions which I think are going to be pragmatic for me and kind of get the information directly from a professional [FG5, m35] Decision-making process Ive gone to my doctor with the information. So, I dont just take it literally until I get further into it and then Ill decide or speak to the doctor about it [FG4, f27] I was like pretty helpless other times just gets really confusing if I tell them my stuff and then they tell me other stuff [FG3, m19] I was on a discussion group on polycystic ovaries. And there was this talk about metformin. Well, thats for diabetes. Wheres the connection? But some doctors had discovered that metformin worked really well for polycystic ovaries because are insulin resistant. So I went to my doctor with that and he gave me puzzled look. He said give me a week and Ill read up. And within that week I went back and he immediately put me on it [FG1, f8] I was having a problem with a high blood pressure tablet. I was getting dizzy, sick. And I said to the doctor theres something wrong with me. He said just give it some time. So I went on to the forum and people had the same problem. They said tell your doctor hes wrong and get off that, and tell him you want to try Drug XX or something else then I went back to the doctor and I told him and he changed the medication. Perfect. But if I stayed with the doctors advice and never checked it myself, Id feel sick all the time [FG2, m13] SM use and its impact on healthcare services usage I go to my doctor once a fortnight. I skipped the last two meetings. I was getting more online than I was in the office [FG3, m20] I have one [GP], but then I would do research and come to idea that I have some problem I would ask and insist on certain tests and then if she refused I found few other doctors that are completely okay with that [FG3, f16] Maybe it saves you the trip to the doctor because youre informed and can go to the pharmacist [FG5, m35] I used SM to figure out who are the good doctors and who are the bad doctors [FG5, m35] 3.1. SM use and its impact on interactions with HCPs No participant reported interacting with HCPs via SM. Only digital communication technology predating SM (e.g. chatroom) was used for communicating with HCPs. For example, non-government organisations like BeyondBlue (beyondblue.org.au) and Black Dog Institute (blackdoginstitute.org.au) were cited as useful online resources where psychologists and psychiatrists could be accessed for live chats. Participants received private counseling and referral to other services if needed. A private service named Ask the Doctor (askthedoctor.com), where patients could ask health-related questions, was also mentioned. No other online interactions with HCPs were reported. Most participants did not expect to interact with HCPs on any SM platforms they were using. In fact, they thought it would be strange if a HCP participated in online communities: I probably would be quite dubious if somebody sort of popped up and messaged saying hi, Im a professor or Im a brain surgeon I would be wary [FG1, f3]. However, some did expect that undercover HCP researchers could be among virtual community users. Interestingly, it was mentioned that not only HCPs credentials, but also the advice provided in these circumstances would be questionable since this service would be dissociated from a HCPs regular workload and employment. Even though not interacting with HCPs on SM, participants reported that being active online improved their face-to-face relationship with HCPs. This effect was perceived to be due to their empowerment , manifested as improved health literacy and better communication. Participants stated that interactions with online peers helped them to better prepare and to articulate questions during consultations: I think it helps also to ask your doctor the right questions because you understand your conditions better [FG2, f12]. Some participants even hypothesised that HCPs would have a higher regard for well-informed patients; consequently providing better services for them. This improved interaction was perceived to facilitate participants to obtain more useful information from their doctors: to make use of your time with your specialist, to ask the right questions youre going in armed with information so you can engage and get as much information [FG2, f10]. They believed that improved communication and being better prepared for consultations meant more efficient consultations, especially as they are often short. Moreover, participants believed that HCPs, particularly specialists, did not have to spend time explaining basic information about the disease, prognosis, and treatment options because they were better informed. 3.1.1. Sharing information obtained online with HCPs Most participants tended to discuss the information obtained online with their HCPs, especially with their doctors. It was pointed out that verifying the validity of the information found online was an important activity performed by HCPs: I read, take note, compare then when I go see the doctor, I ask to get more clarity [FG1, m1]. Similarly, pharmacists were mentioned as HCPs who could be accessed for double-checking online health information: I tend to ask the professionals I was with the pharmacist at the hospital, and I asked him about something. I talk to my chemist too [FG1, f5]. However talking to pharmacists was problematic due to lack of privacy in the community pharmacy setting: I tend to prefer my doctor because my pharmacist has a thousand people around with no privacy [FG1, f3]. 3.1.2. Participants experiences and perceptions of HCPs reactions to their use of SM Some participants reported on their HCPs reactions when they visited them with health-related information found online or discussed in SM groups. The majority felt that HCPs did not appreciate that their patients were accessing online health information. In fact, some participants reported that some HCPs overtly expressed opposition: I went to a sports injury physio, and when she talked about something she knows I want to check online, watch YouTube, then she tells me dont go to websites dont trust websites [FG3, f17]. They believed that this opposition may be because HCPs were concerned about patients being more inquisitive: maybe they feel that because we know what theyre going to talk about, we may ask more questions. I find doctor doesnt really like you to ask questions [FG3, f17]. In some cases, participants experienced hostility : he rolls his eyes and goes another ones been to the Internet again [FG2, m9]. Indifferent reactions were also reported. In general, several participants had the impression that HCPs do not support patients autonomous search for health information and participation in online forums and SM: doctors dont even like SM. I know one that hates it [FG5, m36], I think the [healthcare] professional people are very against it [SM] [FG3, f17]. On the other hand, there were some participants who reported that HCPs were receptive to their online health-related activities. Patients increased knowledge about their condition and treatment options not only led them to be more assertive when interacting with HCPs but also sometimes changed the way HCPs approached them, i.e. HCPs were more interested in their comments and opinions. A few participants reported strong support from physicians for their online activities: my doctor tells me to get whatever information I can and if Im not sure about it, just give him a call [FG3, m21]. With a few even reporting that doctors would recommend patients to go online to find ways of helping themselves, particularly when no actual treatment or procedure was indicated. This helped to establish a respectful and collaborative patient-HCP relationship. 3.2. Decision-making process SM had a significant role in fostering decision-making: listen to another peoples thoughts if theyve had the same experience help me to make a decision [FG3, f17]. Online engagement increased participants willingness to be actively engaged in therapeutic decision-making: if youve got knowledge, then you can negotiate, suggest, and talk about it more successfully rather than just being told this is what youre going to take [FG1, f5]. Several participants highlighted that decision-making was an agreement between the HCP and themselves and for most, discussing the information obtained online with HCPs before acting on it was the rule. However, a few expressed a firm resolve to follow what they themselves believed was right, regardless of HCPs opinions. Participants bringing and discussing online treatment information during consultations, influenced medication selection and initiation. A few participants reported that their doctors could be persuaded to change their treatment even though acknowledgment of the patients contribu tion was not always explicit: they might change it [treatment] but they wont tell you theyre changing it for that reason [information brought by patient] [FG4, m23]. Discussion: healthcare management annotated Suggestions to discontinue or change medications due to side-effects were also common after participants had discussed these matters with online peers. Participants felt they could better discuss treatment options with their doctors and treatments could be modified as they would suggest new treatments according to what they had learnt on SM. Being knowledgeable about health, however, did not change participants reliance on HCPs. Most articulated that HCPs were the most trusted and well-trained people: I want to be able to read and look, research, have all this knowledge. But you still got to go take it to people who do all that training [FG1, f8]. Despite most participants acknowledging that their online activities empowered them for the decision making process, some participants felt frustrated in the decision-making process when doctors did not acknowledge their contribution by disregarding the information they were presenting. Moreover, the negative impact on patients ability to participate in the decision-making process was strongly felt when HCPs expressed hostility towards their online activities: disempowers you pretty quickly [FG1, m9]. 3.3. SM use and its impact on healthcare services usage The use of SM for health-related purposes seemed to influence the frequency with which healthcare services were accessed by the participants, though a clear trend was not established in this study. On the one hand, a few participants accessed fewer healthcare services since some of their health needs were met by the virtual peer interactions and the information obtained. But on the other hand, there were participants who increased their healthcare services use due to improved health knowledge . One participant even identified HCPs inclined to accept suggestions obtained from online sources. Accessing other health services was also mentioned. For example, a few participants reported that with the information obtained on SM they could get their health needs addressed by their community pharmacist rather than their doctor. It is important to note that the selection of health services, in particular HCPs, was influenced by online peer interactions as patients were seeking recommendations. While some participants preferred to obtain a HCP recommendation from strangers within large online forums or SM groups, others believed that recommendations from close friends on social networking sites were more appropriate and trustworthy: sometimes I put out a message on my page saying, Im looking for a practitioner, has anyone got some good referrals? [FG2, m11]. SM was used as a platform to post complaints about health services and the health system: I use it for venting quite a lot about frustrations to do with access to services, stigma when it comes to using those services [FG3, m21]. Discussion and conclusions This study has demonstrated an overall positive impact on the patient-HCP relationship due to patients use of SM as clearly articulated by the participants, and has provided new insights into the specific aspects of patient-HCP relationship. This study also corroborated previous research indicating that patients use of SM for health-related purposes positively influenced their relationship with HCPs [11] , [14] , [18] , [28] . Whilst previous research found that patients did not disclose their Internet activity during clinical visits [29] , this current study demonstrated that they did. Participants stated being open about their online sources when interacting with HCPs. Therefore it can be hypothesised that SM use by patients can increase their openness about online activity compared to other types of Internet sources. Furthermore, it is also possible that the increased use of the Internet for information, in general, and for health, specifically, has shifted the societal norm to patients being more likely to report seeking and finding health-related information on-line (Internet and SM). The findings presented here are in line with previous research that has shown that patients access to online health information tended to diminish the paternalistic approach to care experienced since patients were more prepared and able to participate and take more responsibility for their health outcomes [10] . The interactive environment provided by SM can help not only to consolidate knowledge that could have been acquired from traditional sources and websites, but also provides a more informal and user-friendly mechanism for information transmission, expanding the chances of obtaining further knowledge. Such improvements in patients knowledge and empowerment are therefore reflected in a new patient-HCP relationship. Therefore, it is possible that SM is providing more opportunities for patients to learn, especially to gain first-hand experiences and opinions from peers, which can also support better engagement with HCPs. Additionally, the study has shown that patients were not only resorting to online peer interactions to supplement information from HCPs as shown in the literature [18] , but also they were preparing themselves prior to clinical consultations. For this reason, the findings substantiate a prediction made in 2003 that one of the key features of the future patient would be to bring a list of questions to consultations [30] . Irrespective of how and when patients were seeking health-related information on SM platforms, the availability of SM and their online activities have transformed their health-related behaviour as demonstrated in this study. Online peer interactions increase patients health-related knowledge [15] because patients share both relevant health information and their own experiential stories [31] . Such increased knowledge has been conducive to patient empowerment [11] , [12] , [32] , which is then reflected in patients ability to better articulate doubts and concerns [33] and to actively participate in the decision-making process, particularly treatment choices. The findings corroborate previous studies that have reported improved patient-HCP communication when patients actively participate in online discussions [11] , [32] , [33] . This study also revealed that patients believed the improvements in patient-HCP relationship were due to patient empowerment and the higher regard from HCPs towards informed patients. This study, however, did not investigate if patients with a relatively good relationship with their HCPs would be the ones to perceive the most improvement. Therefore future studies should address this point. This study highlighted that despite the health information accessed online and the increasing online discussions among patients about health-related matters, HCPs remained a trusted source to validate information. This is in line with studies reporting that most patients or carers relay the information found online with their doctors [34] . Such approach seems to be an important component of the improved communication previously discussed and a vital element for patients participation in decision-making. It has been found that peer-to-peer online discussions provide patients with useful quality information [35] and by discussing this information with their clinicians patients were asserting themselves during consultations and influencing treatment decisions. Although this active role in imparting their own information can be interpreted as a sign of patients concern that HCPs may not be aware of the latest treatment breakthroughs [33] , it is most probable that patients are increasingly taking responsibility for their own health. Interestingly, participants perceptions of improved relationships with HCPs contrasted with most of them reporting overt or tacit HCP opposition to their online health-related activities. HCPs negatively reacting to patients presenting online information during consultations have been reported previously [29] . There may be several reasons explaining this behaviour. For example, it is known that HCPs struggle between paternalism and patient autonomy as they see their expertise and judgment undermined by online informed patients [36] . HCPs who may feel threatened in their expertise may react negatively during consultations with patients who bring online content [17] , [18] . Other reasons that may lead HCPs to express opposition include concern about misleading health information, improper use of health services (e.g. delayed visits), incorrect disease self-management [37] , and limited time [38] . Regardless of the underlying reasons, HCPs resistance to patients use of SM for health-related purposes was found to disempower patients, as also reported by other researchers [18] . Additionally, HCPs should be mindful that their opposition can lead to patients not only getting a second opinion, but even to change their healthcare provider [15] , [18] . As SM use might represent an important element in the evolving nature of the patient-HCP relationship [39] , it is thus suggested that HCPs should move to information exchange (dialogue) rather than transfer [40] , favouring a patient-centred interaction involving collaboration in obtaining and analysing the information [41] . As a result, patients contribution would be acknowledged strengthening their relationship with their HCP. Lastly, patients use of SM may impact healthcare services usage. This finding contrasts with a previous research reporting that Internet use by patients had no impact on healthcare services usage [42] . One explanation for this difference could be due to the interactive nature of SM having a more pronounced effect on patients than the use of regular websites and emails. Nevertheless, it is important to emphasize that the findings presented here prevent the establishment of a trend as it pointed to both directions: increased and decreased use of healthcare services. While some participants reported decreasing use of health services, others reported that peer interaction and more knowledge led th

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