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Rawl SM, Perkins SM, Tong Y, Katz ML, Carter-Bawa L, Imperiale TF, Schwartz PH, Fatima H, Krier C, Tharp K, Shedd-Steele R, Magnarella M, Malloy C, Haunert L, Gebregziabher N, Paskett ED, Champion V. Patient Navigation Plus Tailored Digital Video Disc Increases Colorectal Cancer Screening Among Low-Income and Minority Patients Who Did Not Attend a Scheduled Screening Colonoscopy: A Randomized Trial. Ann Behav Med 2024; 58:314-327. [PMID: 38470961 PMCID: PMC11008590 DOI: 10.1093/abm/kaae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Up to 50% of people scheduled for screening colonoscopy do not complete this test and no studies have focused on minority and low-income populations. Interventions are needed to improve colorectal cancer (CRC) screening knowledge, reduce barriers, and provide alternative screening options. Patient navigation (PN) and tailored interventions increase CRC screening uptake, however there is limited information comparing their effectiveness or the effect of combining them. PURPOSE Compare the effectiveness of two interventions to increase CRC screening among minority and low-income individuals who did not attend their screening colonoscopy appointment-a mailed tailored digital video disc (DVD) alone versus the mailed DVD plus telephone-based PN compared to usual care. METHODS Patients (n = 371) aged 45-75 years at average risk for CRC who did not attend a screening colonoscopy appointment were enrolled and were randomized to: (i) a mailed tailored DVD; (ii) the mailed DVD plus phone-based PN; or (iii) usual care. CRC screening outcomes were from electronic medical records at 12 months. Multivariable logistic regression analyses were used to study intervention effects. RESULTS Participants randomized to tailored DVD plus PN were four times more likely to complete CRC screening compared to usual care and almost two and a half times more likely than those who were sent the DVD alone. CONCLUSIONS Combining telephone-based PN with a mailed, tailored DVD increased CRC screening among low-income and minority patients who did not attend their screening colonoscopy appointments and has potential for wide dissemination.
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Affiliation(s)
- Susan M Rawl
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Susan M Perkins
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yan Tong
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mira L Katz
- Department of Health Behavior and Health Promotion, College of Public Heath, The Ohio State University (OSU), Columbus, OH, USA
- Cancer Control Program, Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH, USA
| | - Lisa Carter-Bawa
- Community Outreach and Engagement, Center for Discovery & Innovation, Cancer Prevention Precision Control Institute, Hackensack Meridian Health, Nutley, NJ, USA
| | - Thomas F Imperiale
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Peter H Schwartz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hala Fatima
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Connie Krier
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Kevin Tharp
- Indiana University Center for Survey Research, Bloomington, IN, USA
| | - Rivienne Shedd-Steele
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | | | - Caeli Malloy
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Laura Haunert
- School of Health and Human Sciences, Physician Assistant Program, Indiana University at Indianapolis, Indianapolis, IN, USA
| | - Netsanet Gebregziabher
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Electra D Paskett
- Cancer Control Program, Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Victoria Champion
- Center for Research and Scholarship, School of Nursing, Indiana University at Indianapolis, Indianapolis, IN, USA
- Cancer Prevention and Control Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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Ethical and methodological challenges slowing progress in primary care-based suicide prevention: Illustrations from a randomized controlled trial and guidance for future research. J Psychiatr Res 2022; 154:242-251. [PMID: 35961180 PMCID: PMC10124132 DOI: 10.1016/j.jpsychires.2022.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Despite the pressing need for primary care-based suicide prevention initiatives and growing acknowledgement of recruitment difficulties and Institutional Review Board (IRB) challenges in suicide research, we are aware of no illustrative examples describing how IRB decisions in the design of a primary care trial can compound recruitment challenges. METHODS The CDC-funded trial (NCT02986113) of Men and Providers Preventing Suicide aimed to examine the effects of a tailored computer program encourage men with suicidal thoughts (n = 304, ages 35-64) to discuss suicide with a primary care clinician and accept treatment. Before a visit, participants viewed MAPS or a non-tailored control video. Post-visit, both arms were offered telephone collaborative care, as mandated by the institutional review board (IRB). We previously showed that exposure to MAPs led to improvements in communication about suicide in a primary care visit. In this paper, we report data on the study's primary outcome, suicide preparatory behaviors. RESULTS After screening nearly 4100 men, 48 enrolled. Recruitment challenges, which were exacerabted by an IRB mandate narrowing post-intervention patient management differences between trial arms, limited detection of the effects of MAPS on suicide preparatory behaviors. CONCLUSIONS While primary care settings are key sites for suicide prevention trials, issues such as recruitment difficulties and overly restrictive IRB requirements may limit their utility. Methodological innovation to improve recruitment and ethical guidance to inform IRB decision-making are needed.
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Preuhs K, van Keulen H, Andree R, Wins S, van Empelen P. A Tailored Web-Based Video Intervention (ParentCoach) to Support Parents With Children With Sleeping Problems: User-Centered Design Approach. JMIR Form Res 2022; 6:e33416. [PMID: 35438640 PMCID: PMC9066318 DOI: 10.2196/33416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many parents frequently struggle with undesirable or problematic behavior (ie, temper tantrums and whining) displayed by their child. To support parents in promoting positive parenting skills (ie, recognizing challenging situations and reacting appropriately), the interactive video e-learning tool ParentCoach was developed. The tool aims to teach parents generic behavioral responses by means of situational learning, tailoring, and problem solving. The first demonstration focused on sleeping problems. Objective The aim of this paper is to illustrate the user-centered development of ParentCoach. Methods We conducted usability, understandability, and acceptance tests among the target group (29 parents, 7 youth health care professionals, and 4 individuals with former lower health literacy) in different phases of the development process via focus groups, interviews, and surveys. This allowed for relevant insights on specifications and user requirements to guide the development and revision of the tool in each iteration. Results Iterative testing and development allowed for the final demonstration of ParentCoach to be experienced as a relevant and accessible parenting intervention that can be used as a stand-alone program or in combination with another program. Conclusions This paper elaborates on the iterative development process and its benefits for the final demonstration of ParentCoach.
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Affiliation(s)
- Katharina Preuhs
- Expertise Group Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Hilde van Keulen
- Expertise Group Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Rosa Andree
- Expertise Group Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Sophie Wins
- Expertise Group Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Pepijn van Empelen
- Expertise Group Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
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Fatima H, Wajid M, Krier C, Champion V, Carter-Harris L, Shedd-Steele R, Imperiale TF, Schwartz P, Strom S, Magnarella M, Rawl SM. Development of a Computer-Tailored Intervention/Decision Aid To Increase Colorectal Cancer Screening in Health Systems. Cureus 2022; 14:e23372. [PMID: 35475065 PMCID: PMC9020808 DOI: 10.7759/cureus.23372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/09/2022] Open
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Caballero J, Jacobs RJ, Ownby RL. Development of a computerized intervention to improve health literacy in older Hispanics with type 2 diabetes using a pharmacist supervised comprehensive medication management. PLoS One 2022; 17:e0263264. [PMID: 35139107 PMCID: PMC8827421 DOI: 10.1371/journal.pone.0263264] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 01/17/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
The primary objective was to develop a computerized culturally adapted health literacy intervention for older Hispanics with type 2 diabetes (T2D). Secondary objectives were to assess the usability and acceptability of the intervention by older Hispanics with T2D and clinical pharmacists providing comprehensive medication management (CMM).
Materials and methods
The study occurred in three phases. During phase I, an integration approach (i.e., quantitative assessments, qualitative interviews) was used to develop the intervention and ensure cultural suitability. In phase II, the intervention was translated to Spanish and modified based on data obtained in phase I. During phase III, the intervention was tested for usability/acceptability.
Results
Thirty participants (25 older Hispanics with T2D, 5 clinical pharmacists) were included in the study. Five major themes emerged from qualitative interviews and were included in the intervention: 1) financial considerations, 2) polypharmacy, 3) social/family support, 4) access to medication/information, and 5) loneliness/sadness. Participants felt the computerized intervention developed was easy to use, culturally appropriate, and relevant to their needs. Pharmacists agreed the computerized intervention streamlined patient counseling, offered a tailored approach when conducting CMM, and could save them time.
Conclusion
The ability to offer individualized patient counseling based on information gathered from the computerized intervention allows for precision counseling. Future studies are needed to determine the effectiveness of the developed computerized intervention on adherence and health outcomes.
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Affiliation(s)
- Joshua Caballero
- Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, Athens, Georgia, United States of America
- * E-mail:
| | - Robin J. Jacobs
- Departments of Health Informatics, Nutrition, Medical Education & Research, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
| | - Raymond L. Ownby
- Department of Psychiatry and Behavioral Medicine, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America
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Scheerens C, Gilissen J, Volow AM, Powell JL, Ferguson CM, Farrell D, Li B, Berry C, Sudore RL. Developing eHealth tools for diverse older adults: Lessons learned from the PREPARE for Your Care Program. J Am Geriatr Soc 2021; 69:2939-2949. [PMID: 34081773 PMCID: PMC8497394 DOI: 10.1111/jgs.17284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Electronic Health (eHealth) tools offer opportunities for people to access health information online; yet, most tools are not designed to meet the unique needs of diverse older adults, leading to health disparities. Our goal was to provide guidance for the development of eHealth tools for diverse older populations for use in geriatric care models. DESIGN Guidance for eHealth tools was compiled from user design resources and eHealth design literature. Pragmatic examples were provided from an evidenced-based eHealth tool called PREPAREforYourCare.org (PREPARE). We used quantitative feasibility data from PREPARE research studies and qualitative analysis of PREPARE focus groups, cognitive interviews, and feedback from randomized trials to further inform our recommendations. RESULTS Guidance and lessons learned include: (1) define clear objectives and a conceptual framework; (2) co-create with the target population; (3) optimize the design and layout for accessibility and ease of use, such as text at the 5th grade reading level, closed captioning, etc.; (4) use simple, standardized navigation design; (5) use actionable information to enhance behavior change, such as modeling of behaviors; (6) align accompanying written materials with the eHealth tool; and (7) create tracking mechanisms for ongoing user feedback. PREPARE is used as a case example to provide pragmatic illustrations for how the guidance may be operationalized. CONCLUSION eHealth tools can be tailored to the unique characteristics, preferences, and needs of diverse older populations. Following the "lessons learned" may help decrease health disparities among diverse older adults and ensure eHealth tools are readily accessible and culturally appropriate.
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Affiliation(s)
- Charlotte Scheerens
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- Department of Public Health and Primary Health Care, Ghent University, Ghent, Belgium
| | - Joni Gilissen
- Department of Public Health and Primary Health Care, Ghent University, Ghent, Belgium
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI), University of California, San Francisco, California, USA
| | - Aiesha M Volow
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Jana L Powell
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | - Clarissa M Ferguson
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | | | - Brookelle Li
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
| | | | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Innovation and Implementation Center on Aging and Palliative Care, Division of Geriatrics, University of California, San Francisco, California, USA
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Peipert JD, Lad T, Khosla PG, Garcia SF, Hahn EA. A Low Literacy, Multimedia Health Information Technology Intervention to Enhance Patient-Centered Cancer Care in Safety Net Settings Increased Cancer Knowledge in a Randomized Controlled Trial. Cancer Control 2021; 28:10732748211036783. [PMID: 34565193 PMCID: PMC8481731 DOI: 10.1177/10732748211036783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We tested whether a low-literacy-friendly, multimedia information and assessment system used in daily clinical practice enhanced patient-centered care and improved patient outcomes. This was a prospective, parallel-group, randomized controlled trial with 2 arms, CancerHelp-Talking Touchscreen (CancerHelp-TT) versus control, among adults with Stage I-III breast or colorectal cancer receiving chemotherapy and/or radiation therapy in safety net settings. Each patient was assessed for outcomes at 4 timepoints: after starting treatment (baseline), during treatment, immediately after treatment, and at follow-up assessment. The primary outcomes were health beliefs, cancer knowledge, self-efficacy, and satisfaction with communication about cancer and its treatments. Health-related quality of life (HRQOL) was a secondary outcome. A total of 129 patients participated in the study (65 intervention and 64 control), and approximately 50% of these completed the study. Patients randomized to receive the CancerHelp-TT program had a significantly larger increase in their cancer knowledge in comparison to those randomized to the control arm (effect size = .48, P = .05). While effect sizes for differences between randomized groups in self-efficacy, health beliefs, HRQOL, and satisfaction with communication were small (.10-.48), there was a consistent trend that participants in the intervention group showed larger increases over time in all outcomes compared to the control group. The CancerHelp-TT software was favorably rated by intervention participants. The CancerHelp-TT program showed promise to increase vulnerable cancer patients' cancer knowledge and adaptive health beliefs and attitudes. However, vulnerable patients may need additional interventional support in settings outside cancer clinics.
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Affiliation(s)
- John D. Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Thomas Lad
- John H. Stroger, Jr. Hospital, Chicago, IL, USA
| | | | - Sofia F. Garcia
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth A. Hahn
- Department of Medical Social Sciences and Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Thomas-Purcell K, Ibe TA, Purcell D, Quinn G, Ownby R. Exploring Spirituality and Technology Receptivity Among a Sample of Older Blacks to Inform a Tailored Chronic Disease Self-Management mHealth Intervention. PATIENT-RELATED OUTCOME MEASURES 2020; 11:195-207. [PMID: 33117016 PMCID: PMC7553651 DOI: 10.2147/prom.s260949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/21/2020] [Indexed: 11/23/2022]
Abstract
Introduction Having multiple chronic conditions (MCC) is the most common health condition in older US adults of which Blacks are disproportionally affected. The management of each condition presents many challenges. Blacks in the US frequently cite spirituality as facilitator to well-being. More information is needed to understand the many aspects of spirituality that older Black patients use to manage MCCs. Methods In the current study, focus groups were conducted with 30 black men and women with MCCs to examine how spirituality can be incorporated into a mobile health intervention designed to increase chronic disease self-management (CDSM) skills by improving health literacy. Groups discussed spiritual practices used to facilitate CDSM and their perceptions about mobile technology use. Results Inductive thematic analysis suggested that a chronic disease wellness plan that acknowledges the relationship between spirituality and health was preferred by most participants. Additionally, the desire for mobile health (mHealth) among this group points to an opportunity for intervention. Discussion Creating culturally appropriate educational messages about CDSM that incorporate spiritual practices may be a useful method for building sustainable CDSM skills. Next steps include the development of a mHealth intervention prototype based on the results and pre-testing it prior to deployment.
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Affiliation(s)
- Kamilah Thomas-Purcell
- Department of Health Science, Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Tochukwu Adaobi Ibe
- Mayo Clinic, College of Medicine and Science, Department of Internal Medicine, Jacksonville, FL, USA
| | - Donrie Purcell
- Department of Psychiatry, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
| | - Gwendolyn Quinn
- Department of OB-GYN, Department of Population Health, New York University, Langone Medical Center, New York, NY, USA
| | - Raymond Ownby
- Department of Psychiatry, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, USA
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Holt JM, Cusatis R, Winn A, Asan O, Spanbauer C, Williams JS, Flynn KE, Somai M, Laud P, Crotty BH. The Impact of Previsit Contextual Data Collection on Patient-Provider Communication and Patient Activation: Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e20309. [PMID: 32965223 PMCID: PMC7542405 DOI: 10.2196/20309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patient-centered care is respectful of and responsive to individual patient preferences, needs, and values. To provide patient-centered care, clinicians need to know and incorporate patients' context into their communication and care with patients. Patient contextual data (PCD) encompass social determinants of health and patients' needs, values, goals, and preferences relevant to their care. PCD can be challenging to collect as a routine component of the time-limited primary care visit. OBJECTIVE This study aims to determine if patient-provider communication and patient activation are different for patient users and patient nonusers of an electronic health record (EHR)-integrated PCD tool and assess if the impact of using PCD on patient-provider communication and patient activation differs for Black and White patients. METHODS We describe a randomized controlled trial of a prospective cohort of non-Hispanic White and Black patients who receive primary care services at a midwestern academic health care system in the United States. We will evaluate whether providing PCD through a consumer informatics tool enhances patient-provider communication, as measured by the Communication Assessment Tool, and we will evaluate patient activation, as measured by the Patient Activation Measure for PCD tool users and nonusers. Furthermore, owing to racial disparities in care and communication, we seek to determine if the adoption and use of the tool might narrow the differences between patient groups. RESULTS The trial was funded in November 2017 and received local ethics review approval in February 2019. The study began recruitment in April 2019 and enrollment concluded in October 2019 with 301 participants. The analysis was completed in May 2020, and trial results are expected to be published in winter 2020. CONCLUSIONS Recently, there has been increased attention to the role of health information technology tools to enable patients to collaborate with providers through the sharing of PCD. The adoption of such tools may overcome the barriers of current EHRs by directly engaging patients to submit their contextual data. Effectively, these tools would support the EHR in providing a more holistic understanding of the patient. Research further supports that individuals who have robust digital engagement using consumer informatics tools have higher participation in treatment follow-up and self-care across populations. Therefore, it is critical to investigate interventions that elicit and share patients' social risks and care preferences with the health care team as a mechanism to improve individualized care and reduce the gap in health outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03766841; https://clinicaltrials.gov/ct2/show/NCT03766841. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/20309.
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Affiliation(s)
- Jeana M Holt
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
- Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Rachel Cusatis
- Hematology and Oncology Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Aaron Winn
- School of Pharmacy, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Charles Spanbauer
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joni S Williams
- Department of Medicine, Medical College of Wisconsin, Center for Advancing Population Science, Milwaukee, WI, United States
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Melek Somai
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Purushottam Laud
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Bradley H Crotty
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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Jerant A, Duberstein P, Kravitz RL, Stone DM, Cipri C, Franks P. Tailored Activation of Middle-Aged Men to Promote Discussion of Recent Active Suicide Thoughts: a Randomized Controlled Trial. J Gen Intern Med 2020; 35:2050-2058. [PMID: 32185660 PMCID: PMC7351903 DOI: 10.1007/s11606-020-05769-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Middle-aged men are at high risk of suicide. While about half of those who kill themselves visit a primary care clinician (PCC) shortly before death, in current practice, few spontaneously disclose their thoughts of suicide during the visits, and PCCs seldom inquire about such thoughts. In a randomized controlled trial, we examined the effect of a tailored interactive computer program designed to encourage middle-aged men's discussion of suicide with PCCs. METHODS We recruited men 35-74 years old reporting recent (within 4 weeks) active suicide thoughts from the panels of 42 PCCs (the unit of randomization) in eight offices within a single California health system. In the office before a visit, men viewed the intervention corresponding to their PCC's random group assignment: Men and Providers Preventing Suicide (MAPS) (20 PCCs), providing tailored multimedia promoting discussion of suicide thoughts, or control (22 PCCs), composed of a sleep hygiene video plus brief non-tailored text encouraging discussion of suicide thoughts. Logistic regressions, adjusting for patient nesting within physicians, examined MAPS' effect on patient-reported suicide discussion in the subsequent office visit. RESULTS Sixteen of the randomized PCCs had no patients enroll in the trial. From the panels of the remaining 26 PCCs (12 MAPS, 14 control), 48 men (MAPS 21, control 27) were enrolled (a mean of 1.8 (range 1-5) per PCC), with a mean age of 55.9 years (SD 11.4). Suicide discussion was more likely among MAPS patients (15/21 [65%]) than controls (8/27 [35%]). Logistic regression showed men viewing MAPS were more likely than controls to discuss suicide with their PCC (OR 5.91, 95% CI 1.59-21.94; P = 0.008; nesting-adjusted predicted effect 71% vs. 30%). CONCLUSIONS In addressing barriers to discussing suicide, the tailored MAPS program activated middle-aged men with active suicide thoughts to engage with PCCs around this customarily taboo topic.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis (UCD) School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817 USA
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854 USA
| | - Richard L. Kravitz
- Division of General Medicine, Department of Internal Medicine, UCD School of Medicine, 4150 V Street, Suite 2400, PSSB, Sacramento, CA 95817 USA
| | - Deborah M. Stone
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341 USA
| | - Camille Cipri
- Center for Healthcare Policy and Research, UCD, 2103 Stockton Blvd, Sacramento, CA 95817 USA
| | - Peter Franks
- Department of Family and Community Medicine, University of California Davis (UCD) School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817 USA
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Nguyen MH, Smets EM, Bol N, Loos EF, van Laarhoven HW, Geijsen D, van Berge Henegouwen MI, Tytgat KM, van Weert JC. Tailored Web-Based Information for Younger and Older Patients with Cancer: Randomized Controlled Trial of a Preparatory Educational Intervention on Patient Outcomes. J Med Internet Res 2019; 21:e14407. [PMID: 31573911 PMCID: PMC6774239 DOI: 10.2196/14407] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 12/22/2022] Open
Abstract
Background Many patients with cancer, including older patients (aged ≥65 years), consult the Web to prepare for their doctor’s visit. In particular, older patients have varying needs regarding the mode in which information is presented (eg, via textual, visual, or audiovisual modes) owing to age-related sensory (eg, impaired vision and hearing) and cognitive decline (eg, reduced processing speed). Therefore, Web-based information targeted at older patient populations is likely to be used and processed more effectively, and evaluated more positively, when tailored to age-related capabilities and preferences. This, in turn, may benefit patient outcomes. Objective This randomized controlled trial tested the effects of a Web-based tailored educational intervention among newly diagnosed younger (<65 years) and older (≥65 years) patients with cancer. We compared the intervention group who viewed a mode-tailored website (ie, enabling patients to tailor information using textual, visual, and audiovisual modes) with 3 control groups view a nontailored website (ie, text only, text with images, and text with videos). We examined website experience outcomes (ie, website satisfaction, website involvement, knowledge, anxiety, and communication self-efficacy) and consultation experience outcomes (ie, question asking during consultation, anxiety, and information recall). Methods Patients from a multidisciplinary outpatient clinic (N=232) viewed a mode-tailored or nontailored website as preparation before their hospital consultations to discuss diagnosis and treatment. Data were collected before (T1), during (T2), and after (T3) visitation. Website experience outcomes were assessed with questionnaires (T1). Patients’ question asking was coded from videotaped consultations, and anxiety was assessed through a questionnaire (T2). Telephone interviews were conducted to assess knowledge acquired from the website before (T1) and after consultation (T3), and information recall from the consultation (T3). Results The preparatory website was well used across all conditions (mean 34 min). Younger patients viewing the mode-tailored website were more satisfied before consultation (P=.02) and reported lower anxiety after consultation (P=.046; vs text only). This pattern was not found in older patients. Mode tailoring yielded no other significant differences in patient outcomes. Regression analyses showed that website involvement (beta=.15; P=.03) and, to a lesser extent, website satisfaction (beta=.15; P=.05) positively associated with knowledge before consultation (T1). In turn, higher knowledge before consultation (beta=.39; P<.001), together with time on the website (beta=.21; P=.002; T1), predicted information recall from consultations (T3). Patients with higher knowledge before consultation (T1) also reported higher knowledge from the website afterward (T3; beta=.22; P=.003). Conclusions Offering preparatory online information before consultations benefits information processing and patient outcomes of both younger and older newly diagnosed patients with cancer. Younger patients benefit even more when information is offered in a mode-tailored manner. We discuss the theoretical, methodological, and practical implications for patient-provider communication research in an electronic health era. Clinical Trial Netherlands Trial Register NTR5904; https://www.trialregister.nl/trial/5750
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Affiliation(s)
- Minh Hao Nguyen
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands.,Department of Communication and Media Research (IKMZ), University of Zurich, Zurich, Switzerland
| | - Ellen Ma Smets
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Nadine Bol
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands.,Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Eugène F Loos
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
| | - Hanneke Wm van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Debby Geijsen
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Kristien Maj Tytgat
- Department of Gastroenterology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Julia Cm van Weert
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands
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Thomas-Purcell KB, Jacobs RJ, Seidman TL, Acevedo A, Waldrop-Valverde D, Ownby RL. A mixed analysis approach to elucidate the multiple chronic condition experience of English- and Spanish-speaking older adults. Clin Interv Aging 2019; 14:407-418. [PMID: 30863035 PMCID: PMC6388757 DOI: 10.2147/cia.s193215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Having multiple chronic conditions (MCCs) is the most common health condition in older adults. The management of each condition presents many challenges. A key factor in patients’ ability to manage their own health care is their level of health literacy. Purpose The purpose of this mixed analysis study was to elucidate the experience of older adults living with MCCs and identify associations among the experiences to determine targets for future mobile health (mHealth) interventions focused on MCCs and health literacy. Participants and methods Using the Abilities, Skills, and Knowledge Model as a framework, semi-structured interviews were completed with 25 older adults in English and Spanish. Interviews were analyzed using inductive thematic analysis and hierarchical cluster analysis. Results The main themes from these results included 1) Reflections of chronic disease; 2) Emotional aspects of chronic disease; 3) Physical barriers to well-being; 4) Quality-of-care factors; and 5) Cognitive strategies for self-management. Qualitative results highlighted the importance of a multi-targeted approach to chronic disease self-management (CDSM). Cluster analysis identified associations within the qualitative data, revealing the importance of the subthemes related to coping with pain and the impact of the patient–provider relationship on treatment adherence. Conclusion Results support the utility of mHealth interventions to improve health literacy and promote CDSM.
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Affiliation(s)
- Kamilah B Thomas-Purcell
- Department of Health Science, College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA, .,Department of Psychiatry and Behavioral Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA,
| | - Robin J Jacobs
- Department of Medical Education, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Tyler L Seidman
- Department of Psychiatry and Behavioral Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA,
| | - Amarilis Acevedo
- Department of Psychiatry and Behavioral Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA,
| | | | - Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA,
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Jerant A, Duberstein P, Cipri C, Bullard B, Stone D, Paterniti D. Stakeholder views regarding a planned primary care office-based interactive multimedia suicide prevention tool. PATIENT EDUCATION AND COUNSELING 2019; 102:332-339. [PMID: 30220599 PMCID: PMC6886248 DOI: 10.1016/j.pec.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/11/2018] [Accepted: 09/07/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Nearly half of all men who die by suicide visit a primary care clinician (PCC) in the month before death, yet few disclose suicide thoughts. We solicited stakeholders' views to guide development of a tailored multimedia program to activate middle-aged men experiencing suicide thoughts to engage with PCCs. METHODS We conducted semi-structured interviews with 44 adults self-identifying as: suicide attempt survivor; family member/loved one of person(s) who attempted or died by suicide; PCC; non-PCC office staff; health administrator; and/or prevention advocate. We coded recorded interview transcripts and identified relevant themes using grounded theory. RESULTS Two thematic groupings emerged, informing program design: structure and delivery (including belief the program could be effective and desire for use of plain language and media over text); and informational and motivational content (including concerns about PCC preparedness; fear that disclosing suicide thoughts would necessitate hospitalization; and influence of male identity and masculinity, respectively, in care-seeking for and interpreting suicide thoughts). CONCLUSION Stakeholder input informed the design of a primary care tailored multimedia suicide prevention tool. PRACTICE IMPLICATIONS In revealing a previously unreported barrier to disclosing suicide thoughts to PCCs (fear of hospitalization), and underscoring known barriers, the findings may suggest additional suicide prevention approaches.
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Affiliation(s)
- Anthony Jerant
- Department of Family & Community Medicine, University of California Davis School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA, 95817, USA.
| | - Paul Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Camille Cipri
- Center for Healthcare Policy and Research, University of California, Davis, 2103 Stockton Blvd, Sacramento, CA, USA
| | - Bethany Bullard
- Department of Sociology, Sonoma State University, 1801 East Cotati Ave, Rohnert Park, California, USA
| | - Deborah Stone
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention, 4770 Buford Highway NE, Atlanta, GA, USA
| | - Debora Paterniti
- Department of Sociology, Sonoma State University, 1801 East Cotati Ave, Rohnert Park, California, USA; Department of Internal Medicine, University of California, Davis, School of Medicine, 4150 V St, Suite 3100, Sacramento, CA, USA
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Lincoln KD, Chow TW, Gaines BF. BrainWorks: A Comparative Effectiveness Trial to Examine Alzheimer's Disease Education for Community-Dwelling African Americans. Am J Geriatr Psychiatry 2019; 27:53-61. [PMID: 30409550 DOI: 10.1016/j.jagp.2018.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To test a culturally tailored intervention to improve Alzheimer's disease (AD) literacy among African Americans. DESIGN A 3-arm randomized comparative effectiveness trial. SETTING Community sites in Los Angeles, CA. PARTICIPANTS 193 African American community-dwelling adults, ages 45 to 95 years old. INTERVENTION All groups attended BrainWorks Live, a culturally tailored, 60-minute talk show and received standard printed educational materials on AD. From there: a) the BrainWorks Live group received no further contact until the post-test; b) one intervention group received a 1-month, culturally tailored, unidirectional, daily text-message program; and c) a second intervention group received daily text messages based on the printed educational materials that the general public would receive. AD literacy was measured at baseline and one month post intervention. MEASUREMENTS Alzheimer's disease literacy and demographic and health covariates. RESULTS At one month, participants who received culturally tailored text messages had the highest increase in AD literacy levels, followed by those in the BrainWorks Live arm. Participants who received general text messages had a lower overall increase in AD literacy levels compared to the other arms, but had higher mean AD literacy levels than the BrainWorks Live arm. There was a significantly greater increase in AD literacy levels among participants who received culturally tailored text messages compared with those who attended BrainWorks Live only. There were no other statistically significant differences between arms. CONCLUSIONS AD literacy among African Americans can be improved after only one month through culturally competent, economically feasible educational formats.
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Affiliation(s)
- Karen D Lincoln
- University of Southern California, Suzanne Dworak-Peck School of Social Work.
| | - Tiffany W Chow
- University of Southern California, Alzheimer's Therapeutic Research Institute
| | - Bryan F Gaines
- University of Southern California, Suzanne Dworak-Peck School of Social Work
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Ownby RL, Acevedo A, Waldrop-Valverde D. Enhancing the Impact of Mobile Health Literacy Interventions to Reduce Health Disparities. QUARTERLY REVIEW OF DISTANCE EDUCATION 2019; 20:15-34. [PMID: 31537979 PMCID: PMC6752043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Health literacy is a key factor in health outcomes that should be considered when creating mobile health promotion apps. In this paper, we detail our work over the past 10 years in developing the theory and practice of targeting the content of mobile apps at a level appropriate for the intended audience. We include a review of our theory of health literacy as expertise, the ASK model, and integrate it with the Theory of Planned Behavior. We then provide data that support both the model and its use. More recently, we have developed a predictive analytic model that uses demographic information and patient performance on a 10-item screening measure to determine patient level of health literacy at a high level of accuracy. The predictive model will enable apps to automatically provide content to users at an appropriate level of health literacy. This strategy, along with other aspects of tailoring, will allow apps to be more personally relevant to users, enhancing their effects in promoting health behavior change.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL
| | - Amarilis Acevedo
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL
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Ownby RL, Acevedo A, Waldrop-Valverde D, Caballero J, Simonson M, Davenport R, Kondwani K, Jacobs RJ. A Mobile App for Chronic Disease Self-Management: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e53. [PMID: 28381395 PMCID: PMC5399224 DOI: 10.2196/resprot.7272] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Health literacy is a critically important skill that helps people become active participants in their health care. Multiple studies in the United States and across the world have documented the association of health literacy with multiple health outcomes. In particular, the elderly and many members of minority groups have been shown to have low levels of health literacy; the same groups are disproportionately affected by chronic illnesses. These twin burdens affect the people most in need of the skills and knowledge required for coping with chronic illnesses. Chronic disease self-management (CDSM) is a logical target for a general health literacy intervention. In an approach that spans across specific diseases, CDSM targets problems and skills needed to cope with issues such as fatigue, pain, stress, depression, sleep disturbance, and treatment adherence. In a previous study, we showed that a computer-delivered tailored information intervention targeting health literacy could improve treatment and adherence and be cost effective, but it is not clear that this same strategy will be effective in persons with low health literacy and multiple chronic conditions. OBJECTIVE The purpose of this study is to develop a computer-delivered mobile intervention that will provide individuals with chronic conditions the necessary information to cope with their conditions. METHODS In this project, we will complete a qualitative study on the status and needs of individuals with more than one chronic condition. Results of this study will be used to develop a mobile tailored information app that will address self-management challenges in the areas of pain, sleep, fatigue, depression, anger, stress, memory problems, and treatment adherence. The impact of the intervention on patient quality of life, patient-provider relationships, health literacy, and patient activation will be assessed. We will also explore the extent to which health literacy mediates important outcomes, such as health-related quality of life and health service utilization. RESULTS We are currently completing the preliminary qualitative and usability studies that will inform the content and design of the intervention. We anticipate that the intervention will be complete in 2017, and the clinical trial of its efficacy will also commence in 2017. CONCLUSIONS Results will provide evidence on the usefulness of a mobile tailored information app for improving health literacy, patient activation, health-related quality of life, and self-reported health in patients with multiple chronic conditions. TRIAL REGISTRATION Clinicaltrials.gov NCT02922439; https://clinicaltrials.gov/ct2/show/NCT02922439 (Archived by WebCite at http://www.webcitation.org/6pTiqDAyN).
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Affiliation(s)
- Raymond L Ownby
- Nova Southeastern University, Department of Psychiatry and Behavioral Medicine, Fort Lauderdale, FL, United States
| | - Amarilis Acevedo
- Nova Southeastern University, College of Psychology, Fort Lauderdale, FL, United States
| | | | - Joshua Caballero
- Larkin Health Sciences Institute, Department of Clinical and Administrative Sciences, College of Pharmacy, Miami, FL, United States
| | - Michael Simonson
- Department of Instructional Design and Technology, Fischler College of Education, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Rosemary Davenport
- Nova Southeastern University, Department of Psychiatry and Behavioral Medicine, Fort Lauderdale, FL, United States
| | - Kofi Kondwani
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Robin J Jacobs
- Baylor College of Medicine, Department of Family and Community Medicine--Research Programs, Houston, TX, United States
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Sanders M, Fiscella K, Veazie P, Dolan JG, Jerant A. Does patient time spent viewing computer-tailored colorectal cancer screening materials predict patient-reported discussion of screening with providers? HEALTH EDUCATION RESEARCH 2016; 31:555-562. [PMID: 27343254 PMCID: PMC4945861 DOI: 10.1093/her/cyw032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
The main aim is to examine whether patients' viewing time on information about colorectal cancer (CRC) screening before a primary care physician (PCP) visit is associated with discussion of screening options during the visit. We analyzed data from a multi-center randomized controlled trial of a tailored interactive multimedia computer program (IMCP) to activate patients to undergo CRC screening, deployed in primary care offices immediately before a visit. We employed usage time information stored in the IMCP to examine the association of patient time spent using the program with patient-reported discussion of screening during the visit, adjusting for previous CRC screening recommendation and reading speed.On average, patients spent 33 minutes on the program. In adjusted analyses, 30 minutes spent using the program was associated with a 41% increase in the odds of the patient having a discussion with their PCP (1.04, 1.59, 95% CI). In a separate analysis of the tailoring modules; the modules encouraging adherence to the tailored screening recommendation and discussion with the patient's PCP yielded significant results. Other predictors of screening discussion included better self-reported physical health and increased patient activation. Time spent on the program predicted greater patient-physician discussion of screening during a linked visit.Usage time information gathered automatically by IMCPs offers promise for objectively assessing patient engagement around a topic and predicting likelihood of discussion between patients and their clinician.
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Affiliation(s)
- Mechelle Sanders
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin Fiscella
- Departments of Family Medicine and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Peter Veazie
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - James G Dolan
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Chen J, Mullins CD, Novak P, Thomas SB. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities. HEALTH EDUCATION & BEHAVIOR 2016; 43:25-34. [PMID: 25845376 PMCID: PMC4681678 DOI: 10.1177/1090198115579415] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making.
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Affiliation(s)
- Jie Chen
- University of Maryland, Baltimore, MD, USA
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Szabó C, Ócsai H, Csabai M, Kemény L. A randomised trial to demonstrate the effectiveness of electronic messages on sun protection behaviours. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2015; 149:257-64. [DOI: 10.1016/j.jphotobiol.2015.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/04/2015] [Accepted: 06/06/2015] [Indexed: 11/26/2022]
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Ownby RL, Acevedo A, Goodman K, Caballero J, Waldrop-Valverde D. Health literacy predicts participant understanding of orally-presented informed consent information. CLINICAL RESEARCH AND TRIALS 2015; 1:15-19. [PMID: 26767117 PMCID: PMC4709021 DOI: 10.15761/crt.1000105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Informed consent for participation in studies with human subjects is a critically important aspect of clinical research, but research has shown that many potential subjects do not understand information relevant to their participation. A better understanding of factors related to participant understanding of study-related information is thus important. As part of a study to develop a new measure of health literacy, participants viewed a 50 second video in their preferred language (Spanish or English) of a clinician presenting informed consent information. They then responded to six questions about it. In progressively more complicated regression models, we evaluated the relation of demographic variables, general cognitive ability, and health literacy to participants' recall of the information. In a model that only included demographic variables, Spanish language, black race and older age were associated with poorer performance. In a model that included the effects of general cognitive ability and health literacy as well as demographics, education and health literacy were related to performance. Informed consent interventions that take potential research subjects' levels of health literacy into account may result in better understanding of research-related information that can inform their decision to participate.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, USA
| | - Amarilis Acevedo
- Center for Psychological Studies, Nova Southeastern University, USA
| | - Kenneth Goodman
- Bioethics Programs, University of Miami School of Medicine, US
| | - Joshua Caballero
- College of Pharmacy, Department of Pharmacy Practice, Nova Southeastern University, USA
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Tzeng A, Tzeng TH, Vasdev S, Grindy A, Saleh JK, Saleh KJ. The Role of Patient Activation in Achieving Better Outcomes and Cost-Effectiveness in Patient Care. JBJS Rev 2015; 3:01874474-201501000-00004. [PMID: 27501025 DOI: 10.2106/jbjs.rvw.n.00048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alice Tzeng
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 500 Main Street, Cambridge, MA 02139
| | - Tony H Tzeng
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
| | - Sonia Vasdev
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
| | - Anna Grindy
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
| | - Jamal K Saleh
- Department of Orthopaedic Surgery, University of California, 500 Parnassus Avenue, MU 320W, San Francisco, San Francisco, CA 94143-0728
| | - Khaled J Saleh
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, 701 North First Street, Springfield, IL 62794
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Jerant A, To P, Franks P. The effects of tailoring knowledge acquisition on colorectal cancer screening self-efficacy. JOURNAL OF HEALTH COMMUNICATION 2015; 20:697-709. [PMID: 25928315 PMCID: PMC4418223 DOI: 10.1080/10810730.2015.1018562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Interventions tailored to psychological factors such as personal and vicarious behavioral experiences can enhance behavioral self-efficacy but are complex to develop and implement. Information seeking theory suggests tailoring acquisition of health knowledge (without concurrent psychological factor tailoring) could enhance self-efficacy, simplifying the design of tailored behavior change interventions. To begin to examine this issue, the authors conducted exploratory analyses of data from a randomized controlled trial, comparing the effects of an experimental colorectal cancer screening intervention tailoring knowledge acquisition with the effects of a nontailored control on colorectal cancer screening knowledge and self-efficacy in 1159 patients comprising three ethnicity/language strata (Hispanic/Spanish, 23.4%, Hispanic/English, 27.2%, non-Hispanic/English, 49.3%) and 5 recruitment center strata. Adjusted for study strata, the mean postintervention knowledge score was significantly higher in the experimental group than in the control group. Adjusted experimental intervention exposure (B = 0.22, 95% CI [0.14, 0.30]), preintervention knowledge (B = 0.11, 95% CI [0.05, 0.16]), and postintervention knowledge (B = 0.03, 95% CI [0.01, 0.05]) were independently associated with subsequent colorectal cancer screening self-efficacy (p < .001 all associations). These exploratory findings suggest that tailoring knowledge acquisition may enhance self-efficacy, with potential implications for tailored intervention design, but this implication requires confirmation in studies specifically designed to examine this issue.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, California, USA
- Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California, USA
| | - Patricia To
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Peter Franks
- Department of Family and Community Medicine, University of California Davis School of Medicine, Sacramento, California, USA
- Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, California, USA
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Multimedia psychoeducational interventions to support patient self-care in degenerative conditions: A realist review. Palliat Support Care 2014; 13:1473-86. [DOI: 10.1017/s1478951514001229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Multimedia interventions are increasingly used to deliver information in order to promote self-care among patients with degenerative conditions. We carried out a realist review of the literature to investigate how the characteristics of multimedia psychoeducational interventions combine with the contexts in which they are introduced to help or hinder their effectiveness in supporting self-care for patients with degenerative conditions.Method:Electronic databases (Medline, Science Direct, PSYCHinfo, EBSCO, and Embase) were searched in order to identify papers containing information on multimedia psychoeducational interventions. Using a realist review approach, we reviewed all relevant studies to identify theories that explained how the interventions work.Results:Ten papers were included in the review. All interventions sought to promote self-care behaviors among participants. We examined the development and content of the multimedia interventions and the impact of patient motivation and of the organizational context of implementation. We judged seven studies to be methodologically weak. All completed studies showed small effects in favor of the intervention.Significance of Results:Multimedia interventions may provide high-quality information in an accessible format, with the potential to promote self-care among patients with degenerative conditions, if the patient perceives the information as important and develops confidence about self-care. The evidence base is weak, so that research is needed to investigate effective modes of delivery at different resource levels. We recommend that developers consider how an intervention will reduce uncertainty and increase confidence in self-care, as well as the impact of the context in which it will be employed.
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Ownby RL, Acevedo A, Jacobs RJ, Caballero J, Waldrop-Valverde D. Quality of life, health status, and health service utilization related to a new measure of health literacy: FLIGHT/VIDAS. PATIENT EDUCATION AND COUNSELING 2014; 96:404-410. [PMID: 24856447 PMCID: PMC4700512 DOI: 10.1016/j.pec.2014.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/08/2014] [Accepted: 05/01/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Researchers have identified significant limitations in some currently used measures of health literacy. The purpose of this paper is to present data on the relation of health-related quality of life, health status, and health service utilization to performance on a new measure of health literacy in a nonpatient population. METHODS The new measure was administered to 475 English- and Spanish-speaking community-dwelling volunteers along with existing measures of health literacy and assessments of health-related quality of life, health status, and healthcare service utilization. Relations among measures were assessed via correlations and health status and utilization was tested across levels of health literacy using ANCOVA models. RESULTS The new health literacy measure is significantly related to existing measures of health literacy as well as to participants' health-related quality of life. Persons with lower levels of health literacy reported more health conditions, more frequent physical symptoms, and greater healthcare service utilization. CONCLUSION The new measure of health literacy is valid and shows relations to measures of conceptually related constructs such as quality of life and health behaviors. PRACTICE IMPLICATIONS FLIGHT/VIDAS may be useful to researchers and clinicians interested in a computer administered and scored measure of health literacy.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA.
| | - Amarilis Acevedo
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA
| | - Robin J Jacobs
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Joshua Caballero
- College of Pharmacy, Department of Pharmacy Practice, Nova Southeastern University, Fort Lauderdale, USA
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The effect of targeted and tailored patient depression engagement interventions on patient-physician discussion of suicidal thoughts: a randomized control trial. J Gen Intern Med 2014; 29:1148-54. [PMID: 24710994 PMCID: PMC4099444 DOI: 10.1007/s11606-014-2843-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 01/02/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite improvements in the diagnosis and treatment of depression, primary care provider (PCP) discussion regarding suicidal thoughts among patients with depressive symptoms remains low. OBJECTIVE To determine whether a targeted depression public service announcement (PSA) video or an individually tailored interactive multimedia computer program (IMCP) leads to increased primary care provider (PCP) discussion of suicidal thoughts in patients with elevated risk for clinical depression when compared to an attention control. DESIGN Randomized control trial at five different healthcare systems in Northern California; two academic, two Veterans Affairs (VA), and one group-model health maintenance organization (HMO). PARTICIPANTS Eight-hundred sixty-seven participants, with mean age 51.7; 43.9% women, 43.4% from a racial/ethnic minority group. INTERVENTION The PSA was targeted to gender and socio-economic status, and designed to encourage patients to seek depression care or request information regarding depression. The IMCP was an individually tailored interactive health message designed to activate patients to discuss possible depressive symptoms. The attention control was a sleep hygiene video. MAIN MEASURES Clinician reported discussion of suicidal thoughts. Analyses were stratified by depressive symptom level (Patient Health Questionnaire [PHQ-9] score < 9 [mild or lower] versus ≥ 10 [at least moderate]). KEY RESULTS Among patients with a PHQ-9 score ≥ 10, PCP discussion of suicidal thoughts was significantly higher in the IMCP group than in the control group (adjusted odds ratio = 2.33, 95% confidence interval = 1.5, 5.10, p = 0.03). There were no significant effects of either intervention on PCP discussion of suicidal thoughts among patients with a PHQ-9 score < 9. CONCLUSIONS Exposure of patients with at least moderate depressive symptoms to an individually tailored intervention designed to increase patient engagement in depression care led to increased PCP discussion of suicidal thoughts.
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Jacobs RJ, Lou JQ, Ownby RL, Caballero J. A systematic review of eHealth interventions to improve health literacy. Health Informatics J 2014; 22:81-98. [PMID: 24916567 DOI: 10.1177/1460458214534092] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Implementation of eHealth is now considered an effective way to address concerns about the health status of health care consumers. The purpose of this study was to review empirically based eHealth intervention strategies designed to improve health literacy among consumers in a variety of settings. A computerized search of 16 databases of abstracts (e.g. Biomedical Reference Collection, Cochrane Central Register of Controlled Trials, Computers & Applied Sciences Complete, Health Technology Assessments, MEDLINE) were explored in a systematic fashion to assess the presence of eHealth applications targeting health literacy. Compared to control interventions, the interventions using technology reported significant outcomes or showed promise for future positive outcomes regarding health literacy in a variety of settings, for different diseases, and with diverse samples. This review has indicated that it is feasible to deliver eHealth interventions specifically designed to improve health literacy skills for people with different health conditions, risk factors, and socioeconomic backgrounds.
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Jerant A, Kravitz RL, Sohler N, Fiscella K, Romero RL, Parnes B, Tancredi DJ, Aguilar-Gaxiola S, Slee C, Dvorak S, Turner C, Hudnut A, Prieto F, Franks P. Sociopsychological tailoring to address colorectal cancer screening disparities: a randomized controlled trial. Ann Fam Med 2014; 12:204-14. [PMID: 24821891 PMCID: PMC4018368 DOI: 10.1370/afm.1623] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Interventions tailored to sociopsychological factors associated with health behaviors have promise for reducing colorectal cancer screening disparities, but limited research has assessed their impact in multiethnic populations. We examined whether an interactive multimedia computer program (IMCP) tailored to expanded health belief model sociopsychological factors could promote colorectal cancer screening in a multiethnic sample. METHODS We undertook a randomized controlled trial, comparing an IMCP tailored to colorectal cancer screening self-efficacy, knowledge, barriers, readiness, test preference, and experiences with a nontailored informational program, both delivered before office visits. The primary outcome was record-documented colorectal cancer screening during a 12-month follow-up period. Secondary outcomes included postvisit sociopsychological factor status and discussion, as well as clinician recommendation of screening during office visits. We enrolled 1,164 patients stratified by ethnicity and language (49.3% non-Hispanic, 27.2% Hispanic/English, 23.4% Hispanic/Spanish) from 26 offices around 5 centers (Sacramento, California; Rochester and the Bronx, New York; Denver, Colorado; and San Antonio, Texas). RESULTS Adjusting for ethnicity/language, study center, and the previsit value of the dependent variable, compared with control patients, the IMCP led to significantly greater colorectal cancer screening knowledge, self-efficacy, readiness, test preference specificity, discussion, and recommendation. During the followup period, 132 (23%) IMCP and 123 (22%) control patients received screening (adjusted difference = 0.5 percentage points, 95% CI -4.3 to 5.3). IMCP effects did not differ significantly by ethnicity/language. CONCLUSIONS Sociopsychological factor tailoring was no more effective than nontailored information in encouraging colorectal cancer screening in a multiethnic sample, despite enhancing sociopsychological factors and visit behaviors associated with screening. The utility of sociopsychological tailoring in addressing screening disparities remains uncertain.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, University of California Davis, Sacramento, California (Jerant, Franks); Center for Healthcare Policy and Research, University of California Davis, Sacramento, California (Jerant, Kravitz, Tancredi, Franks); Division of General Internal Medicine, University of California Davis, Sacramento, California (Kravitz); Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education of The City College of New York, New York, New York (Sohler); Department of Family Medicine and Community and Preventive Medicine, University of Rochester, Rochester, New York (Fiscella); Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas (Romero); Department of Family Medicine, University of Colorado, Denver, Colorado (Parnes); Department of Pediatrics, University of California Davis, Sacramento, California (Tancredi); Department of Internal Medicine, University of California Davis, Sacramento, California (Aguilar-Gaxiola); Center for Reducing Health Disparities, University of California Davis, Sacramento, California (Aguilar-Gaxiola); University of California Davis Medical Center, Sacramento, California (Slee); IET-Academic Technology Services, University of California Davis, Davis, California (Dvorak, Turner); Sutter Medical Foundation, Sacramento, California (Hudnut, Prieto)
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Chen J, Mortensen K, Bloodworth R. Exploring contextual factors and patient activation: evidence from a nationally representative sample of patients with depression. HEALTH EDUCATION & BEHAVIOR 2014; 41:614-24. [PMID: 24786791 DOI: 10.1177/1090198114531781] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient activation has been considered as a "blockbuster drug of the century." Patients with mental disorders are less activated compared to patients with other chronic diseases. Low activation due to mental disorders can affect the efficiency of treatment of other comorbidities. Contextual factors are significantly associated with mental health care access and utilization. However, evidence of their association with patient activation is still lacking. Using data from the Health Tracking Household Survey 2007 and Area Health Resource File 2008, we examine the association between contextual factors and self-reported activation levels among patients with depression. We investigate two types of contextual factors--(a) site of usual source of care and (b) community characteristics, measured by mental health care resources availability, population demographics, and socioeconomic characteristics at the county level. Results show significant variation in activation levels by contextual factors. The availability of community mental health centers, lower proportion of foreign-born individuals, and higher income in the local community are associated with higher patient activation. Our results also show that depressed patients having a usual source of care at a physician's office have significantly higher patient activation levels than those with a usual source of care in the emergency department or hospital outpatient clinics. Results suggest that primary care setting is critical to having a sustained relationship between patients and physicians in order to enhance patient engagement in mental health care. Interventions in communities with low income and high immigrant populations are necessary.
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Affiliation(s)
- Jie Chen
- University of Maryland, College Park, MD, USA
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Turchik JA, Rafie S, Rosen CS, Kimerling R. Preferences for Gender-Targeted Health Information. Am J Mens Health 2013; 8:240-8. [DOI: 10.1177/1557988313508304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
No prior research has examined men’s opinions or preferences regarding receiving health education materials related to sexual violence. The objective of the current study was to investigate whether male veteran patients who have experienced military sexual trauma (MST) prefer gender-targeted versus gender-neutral printed health information and whether receipt of this information increased utilization of outpatient mental health services in the following 6-month period. In-person 45-minute interviews were conducted with 20 male veterans receiving health care services at a large Veterans Health Administration facility to evaluate opinions on a gender-targeted and a gender-neutral brochure about MST. An additional 153 veterans received psychoeducational materials through the mail and participated in the completion of a survey as part of a psychoeducational intervention. Our results demonstrate that male veterans prefer gender-targeted information about sexual trauma compared to gender-neutral information. Whereas veterans in the study had clear preferences for gender-targeted materials, receipt of information about MST (whether gender-targeted or gender-neutral) did not increase utilization of mental health care in the 6 months following receipt of these materials. These results demonstrated that materials about sexual trauma are acceptable to men and should be gender-targeted. Further research is needed to examine strategies to increase access to mental health care among male Veterans who have experienced MST.
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Affiliation(s)
- Jessica A. Turchik
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Samantha Rafie
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Palo Alto University, Palo Alto, CA, USA
| | - Craig S. Rosen
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Rachel Kimerling
- National Center for PTSD, VA Palo Health Care System, Palo Alto, CA, USA
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Kravitz RL, Franks P, Feldman MD, Tancredi DJ, Slee CA, Epstein RM, Duberstein PR, Bell RA, Jackson-Triche M, Paterniti DA, Cipri C, Iosif AM, Olson S, Kelly-Reif S, Hudnut A, Dvorak S, Turner C, Jerant A. Patient engagement programs for recognition and initial treatment of depression in primary care: a randomized trial. JAMA 2013; 310:1818-28. [PMID: 24193079 PMCID: PMC4493759 DOI: 10.1001/jama.2013.280038] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Encouraging primary care patients to address depression symptoms and care with clinicians could improve outcomes but may also result in unnecessary treatment. OBJECTIVE To determine whether a depression engagement video (DEV) or a tailored interactive multimedia computer program (IMCP) improves initial depression care compared with a control without increasing unnecessary antidepressant prescribing. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial comparing DEV, IMCP, and control among 925 adult patients treated by 135 primary care clinicians (603 patients with depression and 322 patients without depression, defined by Patient Health Questionnaire-9 [PHQ-9] score) conducted from June 2010 through March 2012 at 7 primary care clinical sites in California. INTERVENTIONS DEV targeted to sex and income, an IMCP tailored to individual patient characteristics, and a sleep hygiene video (control). MAIN OUTCOMES AND MEASURES Among depressed patients, superiority assessment of the composite measure of patient-reported antidepressant drug recommendation, mental health referral, or both (primary outcome); depression at 12-week follow-up, measured by the PHQ-8 (secondary outcome). Among nondepressed patients, noninferiority assessment of clinician- and patient-reported antidepressant drug recommendation (primary outcomes) with a noninferiority margin of 3.5%. Analyses were cluster adjusted. RESULTS Of the 925 eligible patients, 867 were included in the primary analysis (depressed, 559; nondepressed, 308). Among depressed patients, rates of achieving the primary outcome were 17.5% for DEV, 26% for IMCP, and 16.3% for control (DEV vs control, 1.1 [95% CI, -6.7 to 8.9], P = .79; IMCP vs control, 9.9 [95% CI, 1.6 to 18.2], P = .02). There were no effects on PHQ-8 measured depression score at the 12-week follow-up: DEV vs control, -0.2 (95% CI, -1.2 to 0.8); IMCP vs control, 0.9 (95% CI, -0.1 to 1.9). Among nondepressed patients, clinician-reported antidepressant prescribing in the DEV and IMCP groups was noninferior to control (mean percentage point difference [PPD]: DEV vs control, -2.2 [90% CI, -8.0 to 3.49], P = .0499 for noninferiority; IMCP vs control, -3.3 [90% CI, -9.1 to 2.4], P = .02 for noninferiority); patient-reported antidepressant recommendation did not achieve noninferiority (mean PPD: DEV vs control, 0.9 [90% CI, -4.9 to 6.7], P = .23 for noninferiority; IMCP vs control, 0.3 [90% CI, -5.1 to 5.7], P = .16 for noninferiority). CONCLUSIONS AND RELEVANCE A tailored IMCP increased clinician recommendations for antidepressant drugs, a mental health referral, or both among depressed patients but had no effect on mental health at the 12-week follow-up. The possibility that the IMCP and DEV increased patient-reported clinician recommendations for an antidepressant drug among nondepressed patients could not be excluded. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01144104.
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Affiliation(s)
- Richard L Kravitz
- Division of General Medicine, University of California at Davis, Sacramento2Center for Healthcare Policy and Research, University of California at Davis, Sacramento
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Ownby RL, Acevedo A, Waldrop-Valverde D, Jacobs RJ, Caballero J, Davenport R, Homs AM, Czaja SJ, Loewenstein D. Development and initial validation of a computer-administered health literacy assessment in Spanish and English: FLIGHT/VIDAS. PATIENT-RELATED OUTCOME MEASURES 2013; 4:21-35. [PMID: 23990736 PMCID: PMC3753170 DOI: 10.2147/prom.s48384] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Current measures of health literacy have been criticized on a number of grounds, including use of a limited range of content, development on small and atypical patient groups, and poor psychometric characteristics. In this paper, we report the development and preliminary validation of a new computer-administered and -scored health literacy measure addressing these limitations. Items in the measure reflect a wide range of content related to health promotion and maintenance as well as care for diseases. The development process has focused on creating a measure that will be useful in both Spanish and English, while not requiring substantial time for clinician training and individual administration and scoring. The items incorporate several formats, including questions based on brief videos, which allow for the assessment of listening comprehension and the skills related to obtaining information on the Internet. In this paper, we report the interim analyses detailing the initial development and pilot testing of the items (phase 1 of the project) in groups of Spanish and English speakers. We then describe phase 2, which included a second round of testing of the items, in new groups of Spanish and English speakers, and evaluation of the new measure’s reliability and validity in relation to other measures. Data are presented that show that four scales (general health literacy, numeracy, conceptual knowledge, and listening comprehension), developed through a process of item and factor analyses, have significant relations to existing measures of health literacy.
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Affiliation(s)
- Raymond L Ownby
- Department of Psychiatry and Behavioral Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
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Tancredi DJ, Slee CK, Jerant A, Franks P, Nettiksimmons J, Cipri C, Gottfeld D, Huerta J, Feldman MD, Jackson-Triche M, Kelly-Reif S, Hudnut A, Olson S, Shelton J, Kravitz RL. Targeted versus tailored multimedia patient engagement to enhance depression recognition and treatment in primary care: randomized controlled trial protocol for the AMEP2 study. BMC Health Serv Res 2013; 13:141. [PMID: 23594572 PMCID: PMC3637592 DOI: 10.1186/1472-6963-13-141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 04/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression in primary care is common, yet this costly and disabling condition remains underdiagnosed and undertreated. Persisting gaps in the primary care of depression are due in part to patients' reluctance to bring depressive symptoms to the attention of their primary care clinician and, when depression is diagnosed, to accept initial treatment for the condition. Both targeted and tailored communication strategies offer promise for fomenting discussion and reducing barriers to appropriate initial treatment of depression. METHODS/DESIGN The Activating Messages to Enhance Primary Care Practice (AMEP2) Study is a stratified randomized controlled trial comparing two computerized multimedia patient interventions -- one targeted (to patient gender and income level) and one tailored (to level of depressive symptoms, visit agenda, treatment preferences, depression causal attributions, communication self-efficacy and stigma)-- and an attention control. AMEP2 consists of two linked sub-studies, one focusing on patients with significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores ≥ 5), the other on patients with few or no depressive symptoms (PHQ-9 < 5). The first sub-study examined effectiveness of the interventions; key outcomes included delivery of components of initial depression care (antidepressant prescription or mental health referral). The second sub-study tracked potential hazards (clinical distraction and overtreatment). A telephone interview screening procedure assessed patients for eligibility and oversampled patients with significant depressive symptoms. Sampled, consenting patients used computers to answer survey questions, be randomized, and view assigned interventions just before scheduled primary care office visits. Patient surveys were also collected immediately post-visit and 12 weeks later. Physicians completed brief reporting forms after each patient's index visit. Additional data were obtained from medical record abstraction and visit audio recordings. Of 6,191 patients assessed, 867 were randomized and included in analysis, with 559 in the first sub-study and 308 in the second. DISCUSSION Based on formative research, we developed two novel multimedia programs for encouraging patients to discuss depressive symptoms with their primary care clinicians. Our computer-based enrollment and randomization procedures ensured that randomization was fully concealed and data missingness minimized. Analyses will focus on the interventions' potential benefits among depressed persons, and the potential hazards among the non-depressed. TRIAL REGISTRATION ClinicialTrials.gov Identifier: NCT01144104.
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Affiliation(s)
- Daniel J Tancredi
- UC Davis Department of Pediatrics and Center for Healthcare Policy and Research, 2103 Stockton Blvd Suite 2224, Sacramento, CA 95817, USA.
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Jerant A, Kravitz RL, Fiscella K, Sohler N, Romero RL, Parnes B, Aguilar-Gaxiola S, Turner C, Dvorak S, Franks P. Effects of tailored knowledge enhancement on colorectal cancer screening preference across ethnic and language groups. PATIENT EDUCATION AND COUNSELING 2013; 90:103-110. [PMID: 22985627 PMCID: PMC3522756 DOI: 10.1016/j.pec.2012.08.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 08/11/2012] [Accepted: 08/25/2012] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Tailoring to psychological constructs (e.g. self-efficacy, readiness) motivates behavior change, but whether knowledge tailoring alone changes healthcare preferences--a precursor of behavior change in some studies--is unknown. We examined this issue in secondary analyses from a randomized controlled trial of a tailored colorectal cancer (CRC) screening intervention, stratified by ethnicity/language subgroups (Hispanic/Spanish, Hispanic/English, non-Hispanic/English). METHODS Logistic regressions compared effects of a CRC screening knowledge-tailored intervention versus a non-tailored control on preferences for specific test options (fecal occult blood or colonoscopy), in the entire sample (N=1164) and the three ethnicity/language subgroups. RESULTS Pre-intervention, preferences for specific tests did not differ significantly between study groups (experimental, 64.5%; control 62.6%). Post-intervention, more experimental participants (78.6%) than control participants (67.7%) preferred specific tests (P<0.001). Adjusting for pre-intervention preferences, more experimental group participants than control group participants preferred specific tests post-intervention [average marginal effect (AME)=9.5%, 95% CI 5.3-13.6; P<0.001]. AMEs were similar across ethnicity/language subgroups. CONCLUSION Knowledge tailoring increased preferences for specific CRC screening tests across ethnic and language groups. PRACTICE IMPLICATIONS If the observed preference changes are found to translate into behavior changes, then knowledge tailoring alone may enhance healthy behaviors.
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Affiliation(s)
- Anthony Jerant
- Department of Family and Community Medicine, Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA 95817, USA.
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Rawl SM, Skinner CS, Perkins SM, Springston J, Wang HL, Russell KM, Tong Y, Gebregziabher N, Krier C, Smith-Howell E, Brady-Watts T, Myers LJ, Ballard D, Rhyant B, Willis DR, Imperiale TF, Champion VL. Computer-delivered tailored intervention improves colon cancer screening knowledge and health beliefs of African-Americans. HEALTH EDUCATION RESEARCH 2012; 27:868-85. [PMID: 22926008 PMCID: PMC3442380 DOI: 10.1093/her/cys094] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We conducted a randomized controlled trial among African-American patients attending a primary-care provider visit to compare efficacy of a computer-delivered tailored intervention to increase colorectal cancer (CRC) screening (n = 273) with non-tailored print material-an American Cancer Society brochure on CRC screening (n = 283). Health Belief Model constructs were used to develop tailored messages and examined as outcomes. Analysis of covariance models were used to compare changes between CRC knowledge and health belief scores at baseline and 1 week post-intervention. At 1 week, patients who received the computer-delivered tailored intervention had greater changes in CRC knowledge scores (P < 0.001), perceived CRC risk scores (P = 0.005), FOBT barriers scores (P = 0.034) and colonoscopy benefit scores (P < 0.001). Findings show that computer-delivered tailored interventions are an effective adjunct to the clinical encounter that can improve knowledge and health beliefs about CRC screening, necessary precursors to behavior change.
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Affiliation(s)
- Susan M Rawl
- Indiana University School of Nursing, Indiana University Simon Cancer Center, Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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Thompson DA, Joshi A, Hernandez RG, Bair-Merritt MH, Arora M, Luna R, Ellen JM. Nutrition education via a touchscreen: a randomized controlled trial in Latino immigrant parents of infants and toddlers. Acad Pediatr 2012; 12:412-9. [PMID: 22682718 DOI: 10.1016/j.acap.2012.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/26/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate whether educational modules presented on a touchscreen computer increase immediate nutrition and feeding knowledge in low-income, Spanish-speaking Latino immigrant parents. METHODS This was a randomized controlled trial conducted in an urban pediatric clinic with a sample of low-income, Spanish-speaking Latino parents of children <3 years randomly assigned to the intervention (n = 80) and control groups (n = 80). Intervention group members viewed 5 modules on nutrition and feeding presented on an interactive platform using a touchscreen computer. Modules contained text, pictures, and audio. Content was drawn from Bright Futures Guidelines. The primary outcome was a parental total summed knowledge score based on correct responses to 19 questions related to module content. Domain-specific scores were also analyzed. RESULTS Intervention and control groups did not differ on demographic characteristics. Participants were of varied Latino origins, mean age was 27.5 years, 41% reported a <7th grade education, and 65% reported that they rarely/never use a computer. Compared with the control group, the intervention group had a superior mean total summed knowledge score (72.3% vs 90.8%, P < .001). Mean domain-specific summed knowledge scores were also greater in the intervention arm compared with the control for all 5 domains. These results did not differ on the basis of participant education level. 71% (n = 57) of intervention arm participants planned to change something based on what they learned from the computer program, and 80% reported that they will (n = 49) or may (n = 15) talk to their child's doctor about what they learned in the modules. CONCLUSIONS Results of this pilot study add to the growing literature on the use of this technology for health education in low-income Latino immigrants. Despite low education levels and computer experience, findings suggest that immediate parental knowledge was enhanced supporting the need for a more rigorous evaluation of this technology and its impact on health behaviors.
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Affiliation(s)
- Darcy A Thompson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA.
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