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Hung CT, Hung YC. Telemedicine Use Among Adults with Asthma in the United States, 2021-2022. Telemed J E Health 2024; 30:1580-1587. [PMID: 38301206 PMCID: PMC11296146 DOI: 10.1089/tmj.2023.0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
Introduction: While previous studies have mainly focused on the impact of telemedicine on asthma management, little is known about the disparities in the use of telemedicine among individuals with asthma. This study aimed to investigate the factors associated with telemedicine use among adults with asthma in the United States using a nationally representative survey. Methods: Data from the 2021 and 2022 National Health Interview Survey were used. The multivariable logistic regression model was conducted to identify the factors associated with telemedicine use among adults with asthma. Results: In 2021-2022, the prevalence of telemedicine use among adults with asthma was 47.7%. Females, individuals who were obese, current smokers, those with educational levels of college and higher, health insurance coverage, a usual place for care, a history of asthma attacks, and coronavirus disease 2019 were more likely to use telemedicine. Non-Hispanic blacks, residents in the Midwest, South, and nonmetropolitan areas were less likely to use telemedicine. Conclusions: Disparities in telemedicine use were found among several characteristics in adults with asthma. It is crucial to identify the vulnerable populations in accessing telemedicine and ensure equality in telemedicine use among patients with asthma.
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Affiliation(s)
- Chun-Tse Hung
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chien Hung
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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2
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Azar R, Chan R, Sarkisian M, Burns RD, Marcin JP, Gotthardt C, De Guzman KR, Rosenthal JL, Haynes SC. Adapting telehealth to address health equity: Perspectives of primary care providers across the United States. J Telemed Telecare 2024:1357633X241238780. [PMID: 38515372 DOI: 10.1177/1357633x241238780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Telehealth has the potential to increase access to care for medically underserved patients. This qualitative study aimed to identify telecare practices used during the COVID-19 pandemic to meet the needs of patients experiencing homelessness, patients with disabilities, and patients with language preference other than English (LOE). METHODS We conducted a secondary qualitative data analysis of 47 clinician interviews at Federally Qualified Health Centers (FQHCs) around the country. Using thematic analysis, transcripts were coded by line-by-line by five qualitative researchers. A multidisciplinary team of telehealth experts, researchers and primary care clinicians reviewed memos and excerpts to generate major themes. RESULTS We identified six main areas demonstrating how community providers developed strategies or practices to improve access to care for vulnerable patients: reaching patients experiencing homelessness, serving deaf and hard of hearing patients, improving access for patients with disabilities, serving patients with LOE, improving access for mental and behavioral health services, and educating patients about telehealth. During the pandemic, FQHCs developed innovative solutions to provide access to care for the unhoused, including using telehealth in shelters, vans, and distributing devices like mobile phones and tablets. Telehealth reduced transportation burdens for patients with disabilities and reduced no-show rates for mental health services by adapting group therapy via telehealth features (like break-out rooms) and increasing provider capacity. CONCLUSION Our study identified strategies adopted by FQHCs to serve underserved populations during the COVID-19 pandemic. Our findings highlight the need for enduring strategies to improve health equity through telehealth..
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Affiliation(s)
- Rachel Azar
- UC Davis School of Medicine, Sacramento, CA, USA
| | - Rachel Chan
- UC Davis School of Medicine, Sacramento, CA, USA
| | | | | | - James P Marcin
- UC Davis School of Medicine, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Health, Sacramento, CA, USA
- Center for Health and Technology, UC Davis Health, Sacramento, CA, USA
| | | | - Keshia R De Guzman
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Jennifer L Rosenthal
- UC Davis School of Medicine, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Health, Sacramento, CA, USA
- Center for Health and Technology, UC Davis Health, Sacramento, CA, USA
| | - Sarah C Haynes
- UC Davis School of Medicine, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Health, Sacramento, CA, USA
- Center for Health and Technology, UC Davis Health, Sacramento, CA, USA
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3
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Chike-Harris KE, Miller S, Nichols M, McElligott J, Kelechi T. The Management of Pediatric Asthma Using Telehealth: An Integrative Review. Telemed J E Health 2024; 30:609-621. [PMID: 37624652 DOI: 10.1089/tmj.2023.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Introduction: Asthma is one of the most chronic noncommunicable diseases of childhood, affecting 1 in 12 children in the United States. The use of telemedicine for the management of pediatric asthma has shown improved health outcomes; however, it is important to understand what can impact its acceptance. The purpose of this review was to identify the facilitators and barriers to pediatric asthma management, as viewed by stakeholders. Methods: An electronic literature search was performed using PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature Complete. Articles included in the review contained perceptions of the use of telemedicine for the management of pediatric asthma, as viewed by stakeholders. The socioecological model was used as the theoretical framework to extract data based on its five levels. Results: After reviewing full texts of 143 articles, 118 were excluded, leaving 25 articles included in this review. A majority of included articles focused on mobile health (m-Health) studies for the management of pediatric asthma, with the remaining articles studying synchronous telemedicine or a combination of modalities. Common themes were identified; however, most were focused on the use of m-Health and few studies contained the viewpoints of the caregiver, children, or providers regarding synchronous telemedicine. Discussion: This integrative review identified a number of facilitators and barriers for the management of asthma using telemedicine. However, more qualitative studies are needed to evaluate the perceptions of caregivers, patients, and primary providers regarding synchronous telehealth. It was also recognized that telemedicine may increase instead of reduce health care disparities.
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Affiliation(s)
| | - Sarah Miller
- College of Nursing, University of South Carolina, Charleston, South Carolina, USA
| | - Michelle Nichols
- College of Nursing, University of South Carolina, Charleston, South Carolina, USA
| | - James McElligott
- Center for Telehealth Medical, University of South Carolina, Charleston, South Carolina, USA
| | - Teresa Kelechi
- College of Nursing, University of South Carolina, Charleston, South Carolina, USA
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4
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Stephenson N, Espaillat A, Loughlin CE. Pediatric pulmonology 2022 year in review: Asthma. Pediatr Pulmonol 2023; 58:3032-3037. [PMID: 37642280 DOI: 10.1002/ppul.26654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023]
Abstract
In 2022, new research studies influenced the field of pediatric asthma with improvements in diagnosis and evaluation; new treatment options including biologic therapies; changes in risk factors for asthma; and increased discussion about the impact of social determinants of health on asthma. Additionally, three years after the start of the COVID-19 pandemic, we continue to see the impact of SARS-CoV-2 virus on pediatric asthma care. In this review article, we summarize the significant findings from publications in Pediatric Pulmonology and other relevant journals from the last year. We hope this review will provide new insight within the field of pediatric asthma, as well as guidance for implementation into clinical practice.
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Affiliation(s)
- Nicole Stephenson
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andre Espaillat
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ceila E Loughlin
- Department of Pediatrics, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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5
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Ugalde IC, Ratigan A, Merriman C, Cui J, Ericson B, Busse P, Carroll JK, Casale T, Celedón JC, Coyne-Beasley T, Fagan M, Fuhlbrigge AL, Villarreal GG, Hernandez PA, Jariwala S, Kruse J, Maher NE, Manning B, Mosnaim G, Nazario S, Pace WD, Phipatanakul W, Pinto-Plata V, Riley I, Rodriguez-Louis J, Salciccioli J, Shenoy K, Shields JB, Tarabichi Y, Sosa BT, Wechsler ME, Wisnivesky J, Yawn B, Israel E, Cardet JC. Preference for and impact of telehealth vs in-person asthma visits among Black and Latinx adults. Ann Allergy Asthma Immunol 2023; 131:614-627.e2. [PMID: 37490981 PMCID: PMC10803643 DOI: 10.1016/j.anai.2023.07.012] [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] [Received: 03/20/2023] [Revised: 06/09/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Black and Latinx adults experience disproportionate asthma-related morbidity and limited specialty care access. The severe acute respiratory syndrome coronavirus 2 pandemic expanded telehealth use. OBJECTIVE To evaluate visit type (telehealth [TH] vs in-person [IP]) preferences and the impact of visit type on asthma outcomes among Black and Latinx adults with moderate-to-severe asthma. METHODS For this PREPARE trial ancillary study, visit type preference was surveyed by e-mail or telephone post-trial. Emergency medical record data on visit types and asthma outcomes were available for a subset (March 2020 to April 2021). Characteristics associated with visit type preferences, and relationships between visit type and asthma outcomes (control [Asthma Control Test] and asthma-related quality of life [Asthma Symptom Utility Index]), were tested using multivariable regression. RESULTS A total of 866 participants consented to be surveyed, with 847 respondents. Among the participants with asthma care experience with both visit types, 42.0% preferred TH for regular checkups, which associated with employment (odds ratio [OR] = 1.61; 95% confidence interval [CI], 1.09-2.39; P = .02), lower asthma medication adherence (OR = 1.06; 95% CI, 1.01-1.11; P = .03), and having more historical emergency department and urgent care asthma visits (OR = 1.10 for each additional visit; 95% CI, 1.02-1.18; P = .02), after adjustment. Emergency medical record data were available for 98 participants (62 TH, 36 IP). Those with TH visits were more likely Latinx, from the Southwest, employed, using inhaled corticosteroid-only controller therapy, with lower body mass index, and lower self-reported asthma medication adherence vs those with IP visits only. Both groups had comparable Asthma Control Test (18.4 vs 18.9, P = .52) and Asthma Symptom Utility Index (0.79 vs 0.84, P = .16) scores after adjustment. CONCLUSION TH may be similarly efficacious as and often preferred over IP among Black and Latinx adults with moderate-to-severe asthma, especially for regular checkups. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02995733.
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Affiliation(s)
- Israel C Ugalde
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | | | - Conner Merriman
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Jing Cui
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brianna Ericson
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Paula Busse
- Division of Allergy & Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer K Carroll
- CU Anschutz Department of Family Medicine, University of Colorado, Aurora, Colorado; American Academy of Family Physicians National Research Network, Leawood, Kansas
| | - Thomas Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Juan Carlos Celedón
- Division of Pediatric Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Maureen Fagan
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anne L Fuhlbrigge
- Department of Medicine, Pulmonary Science and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Paulina Arias Hernandez
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sunit Jariwala
- Division of Allergy & Immunology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Jean Kruse
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nancy E Maher
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian Manning
- American Academy of Family Physicians National Research Network, Leawood, Kansas
| | - Giselle Mosnaim
- Division of Allergy & Immunology, Department of Medicine, NorthShore University Health System, Evanston, Illinois
| | - Sylvette Nazario
- Division of Allergy and Immunology, Department of Internal Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Wilson D Pace
- DARTNet Institute, Aurora, Colorado; American Academy of Family Physicians National Research Network, Leawood, Kansas
| | - Wanda Phipatanakul
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victor Pinto-Plata
- Division of Pulmonary Critical Care, Department of Medicine, Lahey Hospital and Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Isaretta Riley
- Division of Pulmonary, Allergy & Critical Care Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Justin Salciccioli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kartik Shenoy
- Department of Thoracic Medicine and Surgery, Temple University Health Systems, Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Joel B Shields
- American Academy of Family Physicians National Research Network, Leawood, Kansas
| | - Yasir Tarabichi
- Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, Ohio
| | - Bonnie Telon Sosa
- Division of Allergy and Immunology, Department of Internal Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Michael E Wechsler
- Division of Pulmonology, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Juan Wisnivesky
- Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara Yawn
- Department of Family and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Juan Carlos Cardet
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Morsani College of Medicine, Tampa, Florida.
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6
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Bloom CI. Covid-19 pandemic and asthma: What did we learn? Respirology 2023; 28:603-614. [PMID: 37154075 DOI: 10.1111/resp.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023]
Abstract
This review addresses some of the major lessons we have learnt regarding asthma and the covid-19 pandemic, including susceptibility to SARS-CoV-2 infection and severe covid-19, potentially protective factors, comparison to other respiratory infections, changes in healthcare behaviour from the perspective of patients and clinicians, medications to treat or prevent covid-19, and post-covid syndrome.
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Affiliation(s)
- Chloe I Bloom
- Imperial College London, National Heart and Lung Institute, London, UK
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7
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Elliott J, Fernandes L, Watson M. Maintaining face-to-face appointments in asthma care. J Asthma 2023; 60:421. [PMID: 35315737 DOI: 10.1080/02770903.2022.2056700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Josephine Elliott
- Department of Paediatrics, Imperial College Healthcare NHS Trust, LondonUK
| | | | - Mando Watson
- Department of Paediatrics, Imperial College Healthcare NHS Trust, LondonUK
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8
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Haynes SC, Marcin JP. Pediatric Telemedicine: Lessons Learned During the Coronavirus Disease 2019 Pandemic and Opportunities for Growth. Adv Pediatr 2022; 69:1-11. [PMID: 35985702 PMCID: PMC8979775 DOI: 10.1016/j.yapd.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The accelerated uptake of telemedicine during the coronavirus disease 2019 pandemic has resulted in valuable experience and evidence on the delivery of telemedicine for pediatric patients. The pandemic has also highlighted inequities and opportunities for improvement. This review discusses lessons learned during the pandemic, focusing on provider-to-patient virtual encounters. Recent evidence on education and training, developing and adapting clinical workflows, patient assessment and treatment, and family-centered care is reviewed. Opportunities for future research in pediatric telemedicine are discussed, specifically with regard to engaging pediatric patients, improving and measuring access to care, addressing health equity, and expanding the evidence base.
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Affiliation(s)
- Sarah C Haynes
- Department of Pediatrics, UC Davis School of Medicine, UC Davis Center for Health and Technology, 4610 X Street, Suite 2300, Sacramento, CA 95817, USA.
| | - James P Marcin
- Department of Pediatrics, UC Davis School of Medicine, UC Davis Center for Health and Technology, 4610 X Street, Suite 2300, Sacramento, CA 95817, USA
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9
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Fossati A, Challier C, Dalhoumi AA, Rose J, Robinson A, Perisson C, Galode F, Luaces B, Fayon M. Telehome Monitoring of Symptoms and Lung Function in Children with Asthma. Healthcare (Basel) 2022; 10:healthcare10061131. [PMID: 35742182 PMCID: PMC9222427 DOI: 10.3390/healthcare10061131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The ability to perceive bronchial obstruction is variable in asthma. This is one of the main causes of inaccurate asthma control assessment, on which therapeutic strategies are based. Objective: Primary: To evaluate the ability of physicians to characterize the bronchial obstruction perception profile in asthmatic children using a clinical and spiro-metric telemonitoring device. Secondary: To evaluate its impact on asthma management (control, treatment, respiratory function variability) and the acceptability of this telemonitoring system. Methods: 26 asthmatic children aged 6−18 years equipped with a portable spirometer and a smartphone application were home-monitored remotely for 3 months. Clinical and spiro-metric data were automatically transmitted to a secure internet platform. By analyzing these data, three physicians blindly and independently classified the patients according to their perception profile. The impact of telemonitoring on the quantitative data was assessed at the beginning (T0) and end (T3 months) of telemonitoring, using matched statistical tests. Results: Patients could initially be classified according to their perception profile, with a concordance between the three observers of 64% (kappa coefficient: 0.55, 95%CI [0.39; 0.71]). After discussion among the observers, consensus was reached for all patients but one. There was a significant >40% decrease in FEV1 and PEF variability, with good acceptance of the device. Conclusions: Clinical and spiro-metric tele-home monitoring is applicable and can help define the perception profile of bronchial obstruction in asthmatic children. The device was generally well accepted.
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Affiliation(s)
- Audrey Fossati
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
- Correspondence:
| | - Caroline Challier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
| | - Aman Allah Dalhoumi
- Centre Hospitalier d’Agen-Nérac, Pediatrics Department, 47000 Agen, France; (A.A.D.); (B.L.)
| | - Javier Rose
- Paediatric Department, Seychelles Hospital, Victoria P.O. Box 52, Seychelles;
| | - Annick Robinson
- Centre Hospitalier Universitaire Mère Enfant Tsaralàlana, Department of Child Health, Teaching Hospital, Antananarivo 3GVF+76F, Madagascar;
| | - Caroline Perisson
- Centre Hospitalier Universitaire Réunion Sud, Service de Pédiatrie, 97410 Saint Pierre, France;
| | - François Galode
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
| | - Baptiste Luaces
- Centre Hospitalier d’Agen-Nérac, Pediatrics Department, 47000 Agen, France; (A.A.D.); (B.L.)
| | - Michael Fayon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Pediatrics Department, Pediatric Pulmonology, CEDEX, 33076 Bordeaux, France; (C.C.); (F.G.); (M.F.)
- Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM U1045, Université de Bordeaux, 33000 Bordeaux, France
- Centre d’Investigation Clinique (CIC1401), INSERM, 33076 Bordeaux, France
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10
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Simmons LA, Phipps JE, Whipps M, Smith P, Carbajal KA, Overstreet C, McLaughlin J, De Lombaert K, Noonan D. From hybrid to fully remote clinical trial amidst the COVID-19 pandemic: Strategies to promote recruitment, retention, and engagement in a randomized mHealth trial. Digit Health 2022; 8:20552076221129065. [PMID: 36185388 PMCID: PMC9515527 DOI: 10.1177/20552076221129065] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Clinical trials worldwide were disrupted when the COVID-19 pandemic began in early 2020. Most intervention trials moved to some form of remote implementation due to restrictions on in-person research activities. Although the proportion of remote trials is growing, they remain the vast minority of studies in part due to few successful examples. Our team transitioned Goals for Reaching Optimal Wellness ( GROWell), an NIH-funded (R01NR017659) randomized control trial (RCT; ClinicalTrials.gov identifier NCT04449432) originally designed as a hybrid intervention, into a fully remote clinical trial. GROWell is a digital dietary intervention for people who enter pregnancy with overweight or obesity. Primary outcomes include gestational weight gain and six-month postpartum weight retention. Strategies that we have tested, refined, and deployed include: (a) use of a HIPAA-compliant, web-based participant recruitment and engagement platform; (b) use of a HIPAA-compliant digital health platform to disseminate GROWell and conduct study visits (c) interconnectivity of these two platforms for seamless recruitment, consent, enrollment, intervention delivery, follow-up, and study team blinding; (d) detailed SMS messages to address initial challenges with protocol adherence; (e) email notifications alerting the study team about missed participant surveys so they can follow-up; (f) remuneration using email gift cards with recipient choice of vendor; and (g) geotargeting social media campaigns to improve participation of Black Indigenous and People of Color Communities. These strategies have resulted in screen failure rates improving by 7%, study task adherence improving by an average of 20–30% across study visits, and study completion rates of 82%. Researchers may consider some or all of these approaches in future remote mHealth trials.
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Affiliation(s)
- Leigh Ann Simmons
- Department of Human Ecology, University of California, Davis, Davis, CA, USA
| | - Jennifer E Phipps
- Department of Human Ecology, University of California, Davis, Davis, CA, USA
| | - Mackenzie Whipps
- Department of Human Ecology, University of California, Davis, Davis, CA, USA
| | - Paige Smith
- Department of Human Ecology, University of California, Davis, Davis, CA, USA
| | - Kathryn A Carbajal
- Department of Obstetrics and Gynecology, UC Davis Health, Sacramento, CA, USA
| | - Courtney Overstreet
- Department of Obstetrics and Gynecology, UC Davis Health, Sacramento, CA, USA
| | | | | | - Devon Noonan
- School of Nursing, Duke University, Durham, NC, USA
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