51
|
Dahne J, Collado A, Lejuez CW, Risco CM, Diaz VA, Coles L, Kustanowitz J, Zvolensky MJ, Carpenter MJ. Pilot randomized controlled trial of a Spanish-language Behavioral Activation mobile app (¡Aptívate!) for the treatment of depressive symptoms among united states Latinx adults with limited English proficiency. J Affect Disord 2019; 250:210-217. [PMID: 30870770 PMCID: PMC6461510 DOI: 10.1016/j.jad.2019.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 03/03/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND To address the need for disseminable, evidence-based depression treatment options for Latinx adults with limited English proficiency (LEP), our team developed ¡Aptívate!, a Spanish-language Behavioral Activation self-help mobile application. Primary aims of this study were to: 1) examine feasibility and uptake of ¡Aptívate! among depressed Latinx adults with LEP and 2) preliminarily examine ¡Aptívate! efficacy for depression treatment. METHODS Participants (N = 42) with elevated depressive symptoms were randomized 2:1:1 to: 1) ¡Aptívate! (n = 22), 2) an active control Spanish-language app ("iCouch CBT"; n = 9), or 3) Treatment As Usual (i.e., no app; n = 11). Feasibility was assessed via self-reported app utilization and app analytics data. Depressive symptoms were assessed weekly for eight weeks via self report. RESULTS All ¡Aptívate! participants used the app at least once, 81.8% of participants used the app ≥8 times, and 36.4% of participants used the app ≥56 times. Weekly retention was strong: 72.7% and 50% of participants continued to use the app at one- and two-months post-enrollment, respectively. Generalized Estimating Equation models indicated a significant interaction between time and treatment, such that ¡Aptívate! participants reported significantly lower depressive symptoms over time than TAU. Depressive symptoms did not differ on average across time between the iCouch and TAU conditions, nor between iCouch and ¡Aptívate!. LIMITATIONS Limitations include small sample size, limited follow-up, and lack of analytics data for the active control condition. CONCLUSIONS With further research, ¡Aptívate! may offer a feasible, efficacious approach to extend the reach of evidence-based depression treatment for Latinx adults with LEP.
Collapse
Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, United States; Hollings Cancer Center, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, United States.
| | - Anahi Collado
- Alvord, Baker, and Associates, LLC, 3200 Tower Oaks Blvd, Suite 200, Rockville, MD 20852, United States; Department of Psychology and Cofrin Logan Center for Addiction Research and Treatment, The University of Kansas, 1000 Sunnyside Ave, Lawrence, KS 66045, United States
| | - C W Lejuez
- Department of Psychology and Cofrin Logan Center for Addiction Research and Treatment, The University of Kansas, 1000 Sunnyside Ave, Lawrence, KS 66045, United States
| | - Cristina M Risco
- Department of Psychology and Office of the Senior Vice President and Provost, University of Maryland, College Park, 2131 Biology-Psychology Building, College Park, MD 20742, United States
| | - Vanessa A Diaz
- Department of Family Medicine, Medical University of South Carolina, 5 Charleston Center, Suite 263, Charleston SC 29425, United States
| | - Lisa Coles
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, United States
| | - Jacob Kustanowitz
- MountainPass Technology, 2 Wisconsin Circle, Suite 700, Chevy Chase, MD 20815, United States
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Fred J. Heyne Building, Suite 104, Houston, Texas 77204, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Houston, Texas 77030, United States
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, United States; Hollings Cancer Center, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, United States
| |
Collapse
|
52
|
Schallhorn SC, Hannan SJ, Teenan D, Pelouskova M, Schallhorn JM. Informed consent in refractive surgery: in-person vs telemedicine approach. Clin Ophthalmol 2018; 12:2459-2470. [PMID: 30568424 PMCID: PMC6278698 DOI: 10.2147/opth.s183249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to compare the quality of consent process in refractive surgery between patients who had a preoperative consent discussion with the surgeon using a telemedicine approach and those who had a face-to-face discussion. Methods Patients treated between January and December 2017 (8,184 laser vision correction [LVC] and 3,754 refractive lens exchange [RLE] patients) that attended day 1 and 1-month postoperative visit were retrospectively reviewed. Preoperative consent preparation included a consultation with an optometrist, observation of an educational video, and written information. Patients then selected either a face-to-face appointment with their surgeon (in-clinic group) or a telemedicine appointment (remote group) for their consent discussion, according to their preference. Patient experience questionnaire and clinical data were included in a multivariate model to explore factors associated with consent quality. Results Prior to surgery, 80.1% of LVC and 47.9% of RLE patients selected remote consent. Of all LVC patients, 97.5% of in-clinic and 98.3% of remote patients responded that they were adequately consented for surgery (P=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (P=0.47). In a multivariate model, the major predictor of patient's satisfaction with the consent process was postoperative satisfaction with visual acuity, responsible for 80.4% of variance explained by the model. Other significant contributors were postoperative visual phenomena and dry eyes, difficulty with night driving, close-up and distance vision, postoperative uncorrected distance visual acuity, change in corrected distance visual acuity, and satisfaction with the surgeon's approach. The type of consent (remote or in-clinic) had no impact on patient's perception of consent quality in the regression model. Conclusion The majority of patients opted for telemedicine-assisted consent. Those who chose it were equally satisfied as those who had a face-to-face meeting with their surgeon. Dissatisfaction with surgical outcome was the major factor affecting patient's perception of consent quality, regardless of the method of their consent.
Collapse
Affiliation(s)
- Steven C Schallhorn
- Department of Ophthalmology, University of California, San Francisco, CA, USA, .,Optical Express, Glasgow, UK,.,Carl Zeiss Meditec, Dublin, CA, USA,
| | | | | | | | - Julie M Schallhorn
- Department of Ophthalmology, University of California, San Francisco, CA, USA, .,F.I. Proctor Foundation, University of California, San Francisco, CA, USA
| |
Collapse
|
53
|
Khairat S, Ottmar P, Sleath B, Welch B, Qanungo S, Nichols M, Obeid JS. Facilitating the Informed Consent Process Using Teleconsent: Protocol for a Feasibility and Efficacy Study. JMIR Res Protoc 2018; 7:e11239. [PMID: 30333095 PMCID: PMC6234333 DOI: 10.2196/11239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background Informed consent is among the biggest challenges in recruiting participants for clinical research studies. Researchers face many challenges in conducting clinical trials, some of which include budgetary restrictions, lack of trained personnel, and difficulty recruiting study participants—particularly minorities and participants from rural communities. Objective The objective of this study is to utilize telemedicine to improve the informed consent process for clinical trials and studies. We aim to assess the feasibility and efficacy of the teleconsent intervention among residents in urban and rural settings. Methods This study will be conducted separately yet concurrently at two institutions, the Medical University of South Carolina and the University of North Carolina at Chapel Hill, to compare results within and across institutions. Results Enrollment for Phase 1 began in March of 2018 and concluded in May 2018. Data transcription and analysis will be conducted through June and September of 2018. Conclusions In this paper, we present a novel approach for conducting informed consent using a new telemedicine modality, namely, teleconsent. Teleconsent presents the ability to conduct a live interaction among clinical research coordinators and potential participants while synchronously presenting the consent form on the screen and obtaining participant’s signature through doxy.me, the teleconsent system. Teleconsent provides potential to improve obtaining informed consent from potential clinical trial participants. Registered Report Identifier RR1-10.2196/11239
Collapse
Affiliation(s)
- Saif Khairat
- University of North Carolina- Chapel Hill, Chapel Hill, NC, United States
| | - Paige Ottmar
- University of North Carolina- Chapel Hill, Chapel Hill, NC, United States
| | - Betsy Sleath
- University of North Carolina- Chapel Hill, Chapel Hill, NC, United States
| | - Brandon Welch
- Medical University of South Carolina, Charleston, SC, United States
| | - Suparna Qanungo
- Medical University of South Carolina, Charleston, SC, United States
| | - Michelle Nichols
- Medical University of South Carolina, Charleston, SC, United States
| | - Jihad S Obeid
- Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
54
|
Dahne J, Wahlquist AE, Boatright AS, Garrett-Mayer E, Fleming DO, Davis R, Egan B, Carpenter MJ. Nicotine replacement therapy sampling via primary care: Methods from a pragmatic cluster randomized clinical trial. Contemp Clin Trials 2018; 72:1-7. [PMID: 30010086 PMCID: PMC6133738 DOI: 10.1016/j.cct.2018.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Primary care is the most important point of healthcare contact for smokers. Brief physician advice to quit, based on the 5As/AAR model, offers some efficacy but is inconsistently administered and has limited population impact. Nicotine replacement therapy (NRT) sampling, defined as provision of a brief NRT starter kit, when added to the 5As/AAR, is well-suited to primary care because it is simple, brief, and can be provided to all smokers. This article describes the design and methods of an ongoing comparative effectiveness trial testing standard care vs. standard care + NRT sampling within primary care. METHODS Smokers were recruited directly from primary care practices between July 2014 and December 2017 within an established network of South Carolina clinics. Interventions were delivered randomly by clinic personnel, and phone-based follow-ups were centrally coordinated by research staff to track outcomes through six months post-intervention. Primary study aims are to examine the impact of NRT sampling on smoking, inclusive of cessation, quit attempts, and uptake of evidence-based treatment. RESULTS Twenty-two clinics were recruited. Across clinics, patient census ranged from 985 to 10,957 and number of providers ranged from 1 to 63. Average patient age across clinics was 52.9 years and smoking prevalence across ranged from 10.6% to 28.5%. CONCLUSION Improving the effectiveness and reach of brief interventions within primary care could have a considerable impact on population quit rates. We consider the advantages and disadvantages of key methodological decisions relevant to the design of future primary care-based cessation trials.
Collapse
Affiliation(s)
- Jennifer Dahne
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA.
| | - Amy E Wahlquist
- Department of Public Health Sciences, MUSC, Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Amy S Boatright
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Elizabeth Garrett-Mayer
- Department of Public Health Sciences, MUSC, Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA
| | - Douglas O Fleming
- Care Coordination Institute, Greenville, SC, USA; Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Robert Davis
- Care Coordination Institute, Greenville, SC, USA; School of Medicine, University of South Carolina Greenville, Greenville, SC, USA
| | - Brent Egan
- Care Coordination Institute, Greenville, SC, USA; School of Medicine, University of South Carolina Greenville, Greenville, SC, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC, USA; Department of Public Health Sciences, MUSC, Charleston, SC, USA; Hollings Cancer Center, MUSC, Charleston, SC, USA.
| |
Collapse
|
55
|
López CM, Qanungo S, Jenkins C, Acierno R. Technology as a Means to Address Disparities in Mental Health Research: A Guide to "Tele-Tailoring" your Research Methods. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2018; 49:57-64. [PMID: 30034085 PMCID: PMC6052868 DOI: 10.1037/pro0000176] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We must include rural participants in health-related research if we are to address health-related disparities and inequity, particularly in mental health. However, the first step of the research process, in person, witnessed, signed informed consent is often a limiting factor and insurmountable barrier to precisely the type of research (e.g., telehealth) designed to overcome barriers of geographic distance and travel time. Telehealth, or the provision of medical care or services to patients by means of audio/video and procedure-specific technology, addresses some barriers to health created by rurality by making health care professionals more accessible to patients. A logical complement to telehealth is "teleconsent." Teleconsent can be defined as using remote, facial integrated identity verification to allow (a) remote guidance of participants through consent documents, and (b) digital signing by all parties, obviating the need for in person signed consent. The ability to review and sign consent documents via telehealth with synchronous viewing is a novel, innovative means by which to overcome the initial significant barrier to recruitment of rural participants into healthcare research. By leveraging the growing capabilities of telehealth, teletailoring studies can improve the efficiency of research recruitment and facilitate the consent process for under-represented populations in research. Strategies for implementation are clearly relevant to increasing the success of clinical trial recruitment.
Collapse
Affiliation(s)
| | - Suparna Qanungo
- College of Nursing, Medical University of South Carolina, SC
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, SC
| | - Ron Acierno
- College of Nursing, Medical University of South Carolina, SC
| |
Collapse
|
56
|
McGowan CR, Houlihan CF, Kingori P, Glynn JR. The Acceptability of Online Consent in a Self-Test Serosurvey of Responders to the 2014-2016 West African Ebola Outbreak. Public Health Ethics 2017; 11:201-212. [PMID: 30135701 PMCID: PMC6093377 DOI: 10.1093/phe/phx027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Online participation in research is used increasingly to recruit geographically dispersed populations. Obtaining online consent is convenient, yet we know little about the acceptability of this practice. We carried out a serostudy among personnel returning to the UK/Ireland following deployment to West Africa during the 2014–2016 Ebola epidemic. We used an online procedure for consenting returnees and designed a small descriptive study to understand: how much of the consent material they read, how informed they felt and if they preferred online to traditional face-to-face consent. Of 261 returnees, 111 (43 per cent) completed the consent survey. Participants indicated a high level of engagement with the consent materials, with 67 per cent reporting having read all and 20 per cent having read ‘most’ of the materials. All participants indicated feeling completely (78 per cent) or mostly (22 per cent) informed about the purpose, methods and intended uses of the research, as well as what participation was required and what risks were involved. Only three participants indicated a preference for face-to-face consent. Free-text comments suggested that online consent may be an acceptable modality for uncomplicated and low-risk studies. The study sample was largely composed of health professionals, suggesting acceptability of online consent within this population.
Collapse
Affiliation(s)
- Catherine R McGowan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine and Humanitarian Public Health Technical Unit, Save the Children
| | - Catherine F Houlihan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine and Faculty of Medical Sciences, University College London
| | - Patricia Kingori
- Ethox Centre, Nuffield Department of Population Health, University of Oxford
| | - Judith R Glynn
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine
| |
Collapse
|
57
|
Langarizadeh M, Moghbeli F, Aliabadi A. Application of Ethics for Providing Telemedicine Services and Information Technology. Med Arch 2017; 71:351-355. [PMID: 29284905 PMCID: PMC5723167 DOI: 10.5455/medarh.2017.71.351-355] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/26/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Advanced technology has increased the use of telemedicine and Information Technology (IT) in treating or rehabilitating diseases. An increased use of technology increases the importance of the ethical issues involved. The need for keeping patients' information confidential and secure, controlling a number of therapists' inefficiency as well as raising the quality of healthcare services necessitates adequate heed to ethical issues in telemedicine provision. AIM The goal of this review is gathering all articles that are published through 5 years until now (2012-2017) for detecting ethical issues for providing telemedicine services and Information technology. The reason of this time is improvement of telemedicine and technology through these years. This article is important for clinical practice and also to world, because of knowing ethical issues in telemedicine and technology are always important factors for physician and health providers. MATERIAL AND METHODS the required data in this research were derived from published electronic sources and credible academic articles published in such databases as PubMed, Scopus and Science Direct. The following key words were searched for in separation and combination: tele-health, telemedicine, ethical issues in telemedicine. A total of 503 articles were found. After excluding the duplicates (n= 93), the titles and abstracts of 410 articles were skimmed according to the inclusion criteria. Finally, 64 articles remained. They were reviewed in full text and 36 articles were excluded. At the end, 28 articles were chosen which met our eligibility criteria and were included in this study. RESULTS Ethics has been of a great significance in IT and telemedicine especially the Internet since there are more chances provided for accessing information. It is, however, accompanied by a threat to patients' personal information. Therefore, suggestions are made to investigate ethics in technology, to offer standards and guidelines to therapists. Due to the advancement in technology, access to information has become simpler than the past. This has prompted hackers to seize the opportunity. DISCUSSION This research shows that the ethical issues in telemedicine can be investigated from several aspects like technology, doctor-patient relationship, data confidentiality and security, informed consent, patient's and family's satisfaction with telemedicine services. Following ethical issues in telemedicine is a primary aspect of high quality services. In other words, if therapists abide by ethical rules, they can provide better services for patients. Attention to ethical issues in telemedicine guarantees a safer use of the services.
Collapse
Affiliation(s)
- Mostafa Langarizadeh
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moghbeli
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Aliabadi
- Department of Health Information Technology Paramedics School, Zahedan University of Medical Sciences, Zahedan, Iran
| |
Collapse
|
58
|
Ploug T, Holm S. Eliciting meta consent for future secondary research use of health data using a smartphone application - a proof of concept study in the Danish population. BMC Med Ethics 2017; 18:51. [PMID: 28810914 PMCID: PMC5558710 DOI: 10.1186/s12910-017-0209-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 08/01/2017] [Indexed: 11/18/2022] Open
Abstract
Background The increased use of information technology in every day health care creates vast amounts of stored health data that can be used for research. The secondary research use of routinely collected data raises questions about appropriate consent mechanisms for such use. One option is meta consent where individuals state their own consent preferences in relation to future use of their data, e.g. whether they want the data to be accessible to researchers under conditions of specific consent, broad consent, blanket consent or not at all. This study investigates whether meta consent preferences can be successfully elicited by a smartphone application in the adult Danish population. Methods A smartphone app was developed for the elicitation of meta consent preferences. An invitation to use the app was distributed to a stratified, representative sample of the Danish adult population. The meta consent choices, the use of the app, user experience data, and demographic data were logged and analysed statistically using IBM SPSS version 20. Results Of 1000 potential respondents 221 used the app. One hundred eighty-eight of the respondents were female and 103 male. The age range was 19 to 79 years with an average of 51 years (SD 16). Most users indicate 1) that they find the choices they are asked to make easy to understand (>75% find it ‘Easy’ or ‘Very easy’), 2) that the application is easy to use (>75% find it ‘Easy’ or ‘Very easy’), and 3) that this kind of choice should be offered to people (89% find it ‘Absolutely’ or ‘Somewhat’ important). Conclusions It is possible to collect meta consent preferences in the general, adult population using a smartphone app. Electronic supplementary material The online version of this article (doi:10.1186/s12910-017-0209-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Thomas Ploug
- Centre for Applied Ethics and Philosophy of Science, Department of Communication, Aalborg University Copenhagen, A C Meyers Vænge, 2450 Kbh. SV, Aalborg, Denmark.
| | - Søren Holm
- Centre for Social Ethicse and Policy, School of Law, University of Manchester, M13 9PL, Manchester, UK.,Center for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway.,Centre for Applied Ethics, Aalborg University, Aalborg, Denmark
| |
Collapse
|