The Doctor Interactive Group Medical Appointment (DIGMA) is a group health intervention that combines the services of behavioral health and primary care. The DIGMA was first invented by Edward Noffsinger in 1996, in response to his own difficulties with the overtaxed primary care system at Kaiser Permanente in California (Noffsinger, 1999). Integrating healthcare services in this way has practical implications such as efficient use of resources, treating multiple complaints at once, and beginning to view the mind and body as one (Noffsinger, 1999; Engel, 1977). The DIGMA at the Austin Veterans Outpatient Clinic was designed to address the specific needs of veterans with hypertension. It consists of 4 sessions of 1.5 hours each and addresses such varied topics as exercise, stress-management, nutrition, and medication adherence. These topics are discussed in a group format with the tenets of group psychotherapy (Yalom & Leszcz, 2005) as a backdrop. An exploratory study was warranted to determine whether programs of this sort would be effective on a broad scale. A pretest/posttest design was utilized to determine if the DIGMA was effective at reducing symptoms of hypertension; improving health promoting behavior; increasing self-efficacy to manage hypertension; and increasing internal health locus of control while decreasing chance and powerful others health locus of control. Groups were conducted over a period of seven months with a total of 73 male veterans enrolled in the study. The final n was 58. Findings indicated that both systolic and diastolic blood pressure readings were reduced significantly from pretest to posttest. Health promoting behavior increased significantly; hypertension self efficacy increased significantly; and locus of control did not change significantly from pretest to posttest. The exploratory study concluded that the DIGMA may be efficacious for a variety of aspects of the management of hypertension. It is suggested that further research be conducted but that integrating services in this way can lead to improved patient outcomes and can also be cost-effective. / text

Context: Organizations generate a number of solutions or ideas for a problem, by then select and synthesize some of these ideas for further development. Idea synthesis as an important phase of innovation process causes a reduction of enormous ideas to be considered by an interested company. Accordingly, innovation process can benefit from integration of ideas with restricted perspectives. Idea synthesis is effective when the defined product is novel, has high impact, is of low cost, and has good support from stakeholders. Idea synthesis is facilitated by the used of variety of structures. Interactive groups which require physical meeting of the participants are a facilitated forum for idea synthesis, where organizations try to utilize the multiple perspectives of groups. An alternative to this approach is bilateral communication between potential innovators. Bilateral communication is used by innovators that network with each other to identify related ideas and technologies in the context of open innovation. Software not only enables interactive groups and bilateral communication but also amplifies the performance of these structures by replacing them with online workshops or social networking. While both these structures are performed and justified through the use of software, it is not clear which of these structures is more effective. Objectives: The aim behind conducting this research is to compare the effectiveness of interactive groups and bilateral communication for idea synthesis. Additionally, besides the factors that affect achieving an agreement among the group members in both structures, a consistent pattern of idea synthesizing can be identified through the observation of participants’ behaviors,. Methods: In this study two research methodologies were used; a controlled experiment and a multiple-case study. First, an experiment was conducted to compare the effectiveness of idea synthesis of interactive group and bilateral communication channel for software product innovation. A total of 78 software engineering students generated software based solutions for a problem individually and subsequently combined their ideas to improve their initial solutions, either through the interactive groups or bilateral communication. Second, a multiple-case study using the collected data from the participants’ chat and questionnaires was conducted to identify the consistent pattern of idea synthesizing and the factors that affect achieving an agreement among the group members in both structures. Results: Statistical analyses of experimental results show no difference between interactive group and bilateral communication channels significantly for idea synthesis. It was found that the groups in bilateral communication channels could not generate more effective ideas than interactive groups in terms of novelty, feasibility, impact value, and stakeholder support through the ideas synthesizing. The identified factors which influence agreement among the group members, both challenges and determinants, in interactive groups and bilateral communication channels are categorized separately. Barriers in achieving an agreement between participants are included in context of ideas and participants’ interests in bilateral communication, while the barriers in interactive groups are features of ideas and participants’ features. Moreover, an agreement between participants is yielded in context of ideas and participants’ features in bilateral communication, while the agreement in interactive groups is yielded in context of ideas and participants’ interests. Conclusions: We conclude that there is no difference between interactive groups and bilateral communication for idea synthesis. The solutions achieved through both structures are not significantly different in terms of novelty, feasibility, impact value and stakeholder support. Moreover, achievement of an agreement in both structures not only depends on the context and features of ideas but also features of participants. On the one hand, the presence of ideas with consistent context and features besides motivated participants, interested in performing the idea synthesizing, lead to achieving an agreement. On the other hand, ideas with inconsistent context and features, lack of participants’ interest in sharing and synthesizing idea, lack of communicating, and lack of time managing hinder achieving to an agreement. / Department of Informatics University of Zurich Binzmühlestrasse 14 CH-8050 Zürich