Development of the dyspepsia educational tool was funded by a grant received from The Netherlands Organization for Health Research and Development (ZonMw), in the context of the &#39;to do or not to do&#39; program by the Netherlands Federation of University Medical Centers (NFU). We also would like to thank all the staff from Medify bv. for support, equipment, and expertise. In addition we would like to thank all our participants.

All procedures described in this protocol were approved by the Radboud university medical center Institutional Review Board (file no. 2016-3074).
1. Preliminary research
<ol>
	<li>Focus groups to assess unmet needs in dyspepsia management
	<ol>
		<li>Create a structure for a focus group with dyspeptic patients and with general practitioners.</li>
		<li>Conduct a focus group. Keep conducting additional focus groups until saturation of information is reached. 
		NOTE: For this study two f...

<ol>
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C., Marwaha, A., Lim, A., Moayyedi, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=What+is+the+prevalence+of+clinically+significant+endoscopic+findings+in+subjects+with+dyspepsia?+Systematic+review+and+meta-analysis.">What is the prevalence of clinically significant endoscopic findings in subjects with dyspepsia? Systematic review and meta-analysis.</a> Clinical Gastroenterology and Hepatology. 8 (10), 830-837 (2010).</li><li>Matsuzaki, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Burden+of+impaired+sleep+quality+on+work+productivity+in+functional+dyspepsia.">Burden of impaired sleep quality on work productivity in functional dyspepsia.</a> United European Gastroenterology Journal. 6 (3), 398-406 (2018).</li><li>Keefer, L., Palsson, O. S., Pandolfino, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Best+Practice+Update:+Incorporating+Psychogastroenterology+Into+Management+of+Digestive+Disorders.">Best Practice Update: Incorporating Psychogastroenterology Into Management of Digestive Disorders.</a> Gastroenterology. 154 (5), 1249-1257 (2018).</li><li>Feinle-Bisset, C., Azpiroz, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Dietary+and+lifestyle+factors+in+functional+dyspepsia.">Dietary and lifestyle factors in functional dyspepsia.</a> Nature Reviews Gastroenterology &amp; Hepatology. 10 (3), 150-157 (2013).</li><li>Manes, G., Balzano, A., Marone, P., Lioniello, M., Mosca, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Appropriateness+and+diagnostic+yield+of+upper+gastrointestinal+endoscopy+in+an+open-access+endoscopy+system:+a+prospective+observational+study+based+on+the+Maastricht+guidelines.">Appropriateness and diagnostic yield of upper gastrointestinal endoscopy in an open-access endoscopy system: a prospective observational study based on the Maastricht guidelines.</a> Alimentary Pharmacology &amp; Therapeutics. 16 (1), 105-110 (2002).</li><li>de Jong, J. 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D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Patient+portals+and+health+apps:+Pitfalls,+promises,+and+what+one+might+learn+from+the+other.">Patient portals and health apps: Pitfalls, promises, and what one might learn from the other.</a> Healthcare (Amsterdam). 5 (3), 81-85 (2017).</li><li>Sleurs, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mobile+health+tools+for+the+management+of+chronic+respiratory+diseases.">Mobile health tools for the management of chronic respiratory diseases.</a> Allergy. , (2019).</li><li>Yuan, S. L. K., Marques, A. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+ProFibro+-+a+mobile+application+to+promote+self-care+in+patients+with+fibromyalgia.">Development of ProFibro - a mobile application to promote self-care in patients with fibromyalgia.</a> Physiotherapy. 104 (3), 311-317 (2018).</li><li>Huckvale, K., Morrison, C., Ouyang, J., Ghaghda, A., Car, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+evolution+of+mobile+apps+for+asthma:+an+updated+systematic+assessment+of+content+and+tools.">The evolution of mobile apps for asthma: an updated systematic assessment of content and tools.</a> BMC Medicine. 13, 58 (2015).</li><li>Mayer, R. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Applying+the+science+of+learning:+evidence-based+principles+for+the+design+of+multimedia+instruction.">Applying the science of learning: evidence-based principles for the design of multimedia instruction.</a> American Psychologist. 63 (8), 760-769 (2008).</li><li>Zhang, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interactive+Multimedia-Based+E-Learning:+A+Study+of+Effectiveness.">Interactive Multimedia-Based E-Learning: A Study of Effectiveness.</a> American Journal of Distance Education. 19 (3), 149-162 (2005).</li><li>Northrup, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+framework+for+designing+interactivity+intoWeb-based+instruction.">A framework for designing interactivity intoWeb-based instruction.</a> Educational Technology. 41 (2), 31-39 (2001).</li><li>Stalmeijer, R. 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The authors have nothing to disclose.

The digital dyspepsia educational tool, developed using the abovementioned protocol, is a novel multimedia educational tool to assist patients and physicians in management of dyspepsia. This tool may be deployed to stimulate patient engagement, and improve health outcomes while curtailing inappropriate use of medical resources.
A similar procedure has been described for development of a fibromyalgia app15. As with dyspepsia, management of fibromyalgia focuses initially ...

Patient education is an important component of healthcare, enabling active engagement of patients in responsible management of their health1. To improve efficacy and appropriate use of healthcare resources, contemporary and disease-specific measures are needed to facilitate patient engagement. 
Nowadays, digital tools increasingly replace paper versions of patient education, benefiting from their sustainability, effective distribution, and potential to visualize information. For chronic illnesses that lack curative treatment and biological substrate, education is essential for motivation of patients to engage in self-management2,3. Dyspepsia is a condition that often causes long-term complaints. Exact origin of symptoms remains unclear, although evidence indicates three main pathophysiological mechanisms, including 1) hypersensitivity to gastric distension, 2) impaired gastric accommodation, causing inadequate distension in reaction to a meal, and 3) delayed gastric emptying4. Additionally, duodenal perturbations, brain-gut disturbances, and dietary factors have been suggested to play a role5. Main symptoms comprise post-prandial fullness, epigastric pain, early satiety, and epigastric burning. Upper gastrointestinal (GI) endoscopy in dyspeptic patients reveals no cause of symptoms in over 70%; these cases are referred to as functional dyspepsia. Pharmacological treatment options for dyspepsia are limited, often inciting patients to resolve to complementary and alternative therapies6,7. Quality of life in dyspepsia patients is often reduced as dyspepsia is associated with concomitant issues, such as impaired sleep quality and loss of work productivity8. Dyspepsia management benefits from active patient engagement, as behavioral interventions are a main component of dyspepsia treatment9,10. These interventions require a significant effort from patients, which may be facilitated by personalized and interactive support. 
Correct management of dyspepsia is essential to improve healthcare outcomes and prevent overuse of medical resources. Upper gastrointestinal (GI) endoscopy for dyspepsia is a well-known form of overuse as its diagnostic yield is limited11. Several methods have been proposed to reduce the number of upper GI endoscopies, mostly focused on physician education or drug-based symptom reduction12. Uncertainty about the cause of dyspepsia is often unsatisfactory for patients, and diagnostic tests may be performed in excess as a consequence. Consequently, education of patients about pathogenesis, treatment options, and conservative management would be an effective strategy to reduce the number of upper GI endoscopies. 
While digital tools potentially provide an excellent platform for patient education, several functionalities of a digital tool are required, in order to maximize patient adoption and subsequent patient engagement in disease management13. The expected success of digital education mainly depends on its development process and measures taken to optimize information transfer. However, development processes of digital educational tools are infrequently published, impairing reproduction, progression, and evaluation of the validity and safety1,14.
There is need for a detailed description and evaluation of development of a patient-centered digital educational tool. We describe the development of our dyspepsia educational tool, to serve as a template for future educational tool development.

<table border="0" cellpadding="0" cellspacing="0" style="width:591px;" width="589">
	<tbody>
		<tr height="62">
			<td height="62" style="height:63px;width:223px;">Dyspepsia e-learning</td>
			<td style="width:73px;">Dyspepsia e-learning</td>
			<td style="width:123px;"></td>
			<td style="width:172px;">Digital educational tool for dyspepsia management</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:223px;">Paper Food Diary</td>
			<td style="width:73px;">Any</td>
			<td style="width:123px;"></td>
			<td>Schedule to record food consumption and symptoms</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:223px;">Computer</td>
			<td style="width:73px;">Any</td>
			<td style="width:123px;"></td>
			<td>A computer or tablet should be used to complete the e-learning</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:223px;">Medify Content Management System</td>
			<td style="width:73px;">Medify BV</td>
			<td style="width:123px;"></td>
			<td>A content management system to process the e-learning content</td>
		</tr>
	</tbody>
</table>

the dyspepsia educational tool as a novel aid in dyspepsia management

Digital educational tools have a well-established role in current healthcare. In particular, disorders that are managed non-pharmacologically benefit from this development, as it enables patient engagement in self-management. Dyspepsia is a condition thought to arise from gastric and duodenal perturbations, brain-gut axis disturbances, and dietary factors. Behavioral interventions are a major part of dyspepsia treatment, hence patient engagement and motivation through education is essential. Protocols that describe the development process of such educational tools are scarce. We provide a methodology describing development of a dyspepsia educational tool. Assessment of users' needs is the first step, followed by a literature search. The content is developed based on the main themes and entered into a content management system, to build the program. Final adjustments are made after a pilot test of the tool. The presented protocol can be used as a guide for development of a digital dyspepsia educational tool or as a tool for similar situations.

Results of focus groups
Five patients, recruited through patient networks (n = 2) or at the outpatient clinic (n = 3), were invited to join a focus group. All focus group patients were diagnosed with dyspepsia based on the opinion of a gastroenterologist. Characteristics of included patients are presented in Table 1.
Most participants ...

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The Dyspepsia Educational Tool As a Novel Aid in Dyspepsia Management

This protocol describes the development process of a digital dyspepsia educational tool. Assessment of unmet needs and literature, content development, and building of the tool are presented. The methodology can be used as a guide for future development of digital educational tools.

Digital educational tools have a well-established role in current healthcare. In particular, disorders that are managed non-pharmacologically benefit from ...

Development of an e-learning for patient education comprises several steps. Here we provide the step by step protocol for development of a dyspepsia e-learning. Incorporating steps to ensure future adoption of the tool by patients is essential early in the process.It is important to assess the views of patients and healthcare providers on current dyspepsia management, and particularly, which elements are missing. Conduct focus groups until saturation of information is reached. Recruit participants from patient organization platforms under the Gastroenterology Outpatient Clinic and general practitioners, through local, general practitioner networks.Provide all participants with a patient information form, but do not present the questions of the focus group in the information form. Obtain written, informed consent from all participants. During the focus group, ask open questions to initiate discussion.All participants should be encouraged to voice their own opinion. Record the session and transcribe it afterwards. Extract the main themes from the focus group.Based on the main outlines that resulted from assessment of needs, make an overview of the topics that should be supported by literature. Use the online databases to search for recent literature. Select the most relevant articles to use as scientific background in the tool.Find local and national guidelines related to dyspepsia management. Make a selection of recommendations most relevant to the target audience. Summarize existing national patient information on dyspepsia.Use approved primary and secondary care information, as well as, government supported web-based information. Combine all collected data in one file and merge related topics. Create a clear overview of all items that should be addressed in the tool, and organize the items into a logical flow that will be maintained in the e-learning.Organize a process session with all stakeholders. Discuss all items in the overview and identify elements that can be visualized through real life videos or animation, or should appear as text. Start every chapter with an overview of the chapter.Introduce important items and terms. At the end of every chapter, give a chapter summary. Refrain from giving redundant information that may distract attention.Highlight essential information using bullet points and/or bold text. Use plain language writing when writing texts. When writing a text that will appear in the tool, clearly consider the target audience and write from that perspective.Maintain a seventh to eighth grade reading level and limit paragraphs to a maximum of ten sentences. For the videos, write detailed scripts and log files for all videos. Carefully select an appropriate location for shooting of the videos.Some elements may be visualized in 3D to improve comprehension of the content. Use visual references for each step of the desired 3D animation. Split animations into clips of eight to 12 seconds.Before and after a clip, provide text blocks with information about the clip. As soon as all the content is created, the content should be incorporated into e-learning. Add all the content to a content management system to adjust the order and appearance.This comprises several steps. The first step is to add all the text and the videos to panels. The second step is to choose a background image or 3D visualization that is available.The third step is to add the customized questionaires. And the fourth and last step is to check if everything is correctly incorporated into the e-learning. Administer the pilot educational tool to two patients and two general practitioners and ask for feedback on layout, content and user friendliness.Adjust the tool based on the test comments. Validate the efficacy and usability of the educational tool in a randomized controlled trial. The dyspepsia e-learning features several chapters, consisting of, 3D animations, text blocks and videos.The first chapter addresses prevalence of dyspepsia, and the value and capabilities of upper gastrointestinal endoscopy. In the second chapter, normal gastric function and disturbances of gastric function are explained, and the third chapter lists a number of causes of gastric inflammation. Lifestyle advice is given in the fourth chapter, and the fifth chapter describes the pharmacological mechanisms of several gastro-protective drugs.Assess the user experience with the dyspepsia e-learning. Focus on usability, completeness of information, follow the instructions and advice and suggestions for improvements. Once the e-learning is finalized it should be implemented in a randomized clinical trial to assess its usability and efficacy.From development of the dyspepsia e-learning we learn the importance of involving patients into the development process. While one focus group gives important information, it is best to do several focus groups until information saturation is reached. Also, we learn that it's important to include an interactive element into the e-learning to improve user experience.

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6.5K Views.  Radboud University Medical Center. Lo sviluppo di un e-learning per l'educazione dei pazienti comprende diverse fasi. Qui forniamo il protocollo passo dopo passo per lo sviluppo di un e-learning dispepsia. Incorporare misure per garantire la futura adozione dello strumento da parte dei pazienti è essenziale all'inizio del processo.È importante valutare le opinioni dei pazienti e degli operatori sanitari sull'attuale gestione della dispepsia e, in particolare, quali elementi mancano. Condurre focus group fino a raggiun...