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Badr J, Motulsky A, Denis JL. Digital health technologies and inequalities: A scoping review of potential impacts and policy recommendations. Health Policy 2024; 146:105122. [PMID: 38986333 DOI: 10.1016/j.healthpol.2024.105122] [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: 10/19/2023] [Revised: 05/17/2024] [Accepted: 06/29/2024] [Indexed: 07/12/2024]
Abstract
Digital health technologies hold promises for reducing health care costs, enhancing access to care, and addressing labor shortages. However, they risk exacerbating inequalities by disproportionately benefitting a subset of the population. Use of digital technologies accelerated during the Covid-19 pandemic. Our scoping review aimed to describe how inequalities related to their use were conceptually assessed during and after the pandemic and understand how digital strategies and policies might support digital equity. We used the PRISMA Extension for scoping reviews, identifying 2055 papers through an initial search of 3 databases in 2021 and complementary search in 2022, of which 41 were retained. Analysis was guided by the eHealth equity framework. Results showed that digital inequalities were reported in the U.S. and other high-income countries and were mainly assessed through differences in access and use according to individual sociodemographic characteristics. Health disparities related to technology use and the interaction between context and technology implementation were more rarely documented. Policy recommendations stressed the adoption of an equity lens in strategy development and multilayered and intersectoral collaboration to align interventions with the needs of specific subgroups. Finally, findings suggested that evaluations of health and wellbeing distribution related to the use of digital technologies should inform digital strategies and health policies.
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Affiliation(s)
- Janine Badr
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, 7101 Av du Parc, H3N 1 × 9, Montréal, QC, Canada; Research Center, Centre hospitalier de l'Université de Montréal, 900 R. Saint-Denis, Montréal, QC H2 × 0A9, Montreal, Canada.
| | - Aude Motulsky
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, 7101 Av du Parc, H3N 1 × 9, Montréal, QC, Canada; Research Center, Centre hospitalier de l'Université de Montréal, 900 R. Saint-Denis, Montréal, QC H2 × 0A9, Montreal, Canada
| | - Jean-Louis Denis
- Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montréal, 7101 Av du Parc, H3N 1 × 9, Montréal, QC, Canada; Research Center, Centre hospitalier de l'Université de Montréal, 900 R. Saint-Denis, Montréal, QC H2 × 0A9, Montreal, Canada
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Gunn R, Watkins SL, Boston D, Rosales AG, Massimino S, Navale S, Fitzpatrick SL, Dickerson J, Gold R, Lee G, McMullen CK. Evaluation of a Remote Patient Monitoring Program During the COVID-19 Pandemic: Retrospective Case Study With a Mixed Methods Explanatory Sequential Design. JMIR Form Res 2024; 8:e55732. [PMID: 38980716 DOI: 10.2196/55732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Community health center (CHC) patients experience a disproportionately high prevalence of chronic conditions and barriers to accessing technologies that might support the management of these conditions. One such technology includes tools used for remote patient monitoring (RPM), the use of which surged during the COVID-19 pandemic. OBJECTIVE The aim of this study was to assess how a CHC implemented an RPM program during the COVID-19 pandemic. METHODS This retrospective case study used a mixed methods explanatory sequential design to evaluate a CHC's implementation of a suite of RPM tools during the COVID-19 pandemic. Analyses used electronic health record-extracted health outcomes data and semistructured interviews with the CHC's staff and patients participating in the RPM program. RESULTS The CHC enrolled 147 patients in a hypertension RPM program. After 6 months of RPM use, mean systolic blood pressure (BP) was 13.4 mm Hg lower and mean diastolic BP 6.4 mm Hg lower, corresponding with an increase in hypertension control (BP<140/90 mm Hg) from 33.3% of patients to 81.5%. Considerable effort was dedicated to standing up the program, reinforced by organizational prioritization of chronic disease management, and by a clinician who championed program implementation. Noted barriers to implementation of the RPM program were limited initial training, lack of sustained support, and complexities related to the RPM device technology. CONCLUSIONS While RPM technology holds promise for addressing chronic disease management, successful RPM program requires substantial investment in implementation support and technical assistance.
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Affiliation(s)
- Rose Gunn
- OCHIN, Inc, Portland, OR, United States
| | | | | | - A Gabriela Rosales
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | - Stefan Massimino
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | | | - Stephanie L Fitzpatrick
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | - John Dickerson
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | - Rachel Gold
- OCHIN, Inc, Portland, OR, United States
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
| | - George Lee
- Asian Health Services, Oakland, CA, United States
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, Kaiser Permanente, Portland, OR, United States
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Mesa-Castrillon CI, Beckenkamp PR, Ferreira M, Simic M, Davis PR, Michell A, Pappas E, Luscombe G, Noronha MD, Ferreira P. Global prevalence of musculoskeletal pain in rural and urban populations. A systematic review with meta-analysis. Musculoskeletal pain in rural and urban populations. Aust J Rural Health 2024. [PMID: 38963186 DOI: 10.1111/ajr.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/10/2024] [Accepted: 06/16/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION To systematically compare the global prevalence of musculoskeletal pain and care-seeking in rural and urban populations. METHODS A systematic review with meta-analysis of observational studies reporting a direct comparison of rural and urban populations was conducted worldwide and included back, knee, hip, shoulder, neck pain and a broad diagnosis of 'musculoskeletal pain'. A search strategy combining terms related to 'prevalence', 'musculoskeletal pain' and 'rural' was used on the following databases: MEDLINE, Embase, CINAHL, Scopus, and rural and remote health from their inception to 1 June 2022. Random-effects meta-analysis was used to pool the data. Results were presented as odds ratios (OR) along with 95% confidence intervals (95% CI). RESULTS A total of 42 studies from 24 countries were included with a total population of 489 439 participants. The quality scores for the included studies, using the modified Newcastle Ottawa Scale tool, showed an average score of 0.78/1, which represents an overall good quality. The pooled analysis showed statistically greater odds of hip (OR = 1.62, 95% CI = 1.23-2.15), shoulder (OR = 1.42, 95% CI = 1.06-1.90) and overall musculoskeletal pain (OR = 1.26, 95% CI = 1.08-1.47) in rural populations compared to urban populations. Although the odds of seeking treatment were higher in rural populations this relationship was not statistically significant (OR = 0.76, 95% CI = 0.55-1.03). CONCLUSION Very low-certainty evidence suggests that musculoskeletal, hip and shoulder pain are more prevalent in rural than urban areas, although neck, back and knee pain, along with care-seeking, showed no significant difference between these populations. Strategies aimed to reduce the burden of musculoskeletal pain should consider the specific needs and limited access to quality evidence-based care for musculoskeletal pain of rural populations.
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Affiliation(s)
- Carlos I Mesa-Castrillon
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange Campus, Orange, New South Wales, Australia
| | - Paula R Beckenkamp
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Manuela Ferreira
- School of Health Sciences, Faculty of Medicine and Health, Sydney Musculoskeletal Health, The Kolling Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Milena Simic
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Phillip R Davis
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Antonio Michell
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- The University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgina Luscombe
- School of Rural Health, Faculty of Medicine and Health, The University of Sydney, Orange Campus, Orange, New South Wales, Australia
| | - Marcos De Noronha
- Rural Department of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Paulo Ferreira
- Faculty of Medicine and Health, Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
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Williamson BD, Coley RY, Hsu C, McCracken CE, Cook AJ. Considerations for Subgroup Analyses in Cluster-Randomized Trials Based on Aggregated Individual-Level Predictors. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:421-432. [PMID: 37897553 PMCID: PMC11239773 DOI: 10.1007/s11121-023-01606-1] [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] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
In research assessing the effect of an intervention or exposure, a key secondary objective often involves assessing differential effects of this intervention or exposure in subgroups of interest; this is often referred to as assessing effect modification or heterogeneity of treatment effects (HTE). Observed HTE can have important implications for policy, including intervention strategies (e.g., will some patients benefit more from intervention than others?) and prioritizing resources (e.g., to reduce observed health disparities). Analysis of HTE is well understood in studies where the independent unit is an individual. In contrast, in studies where the independent unit is a cluster (e.g., a hospital or school) and a cluster-level outcome is used in the analysis, it is less well understood how to proceed if the HTE analysis of interest involves an individual-level characteristic (e.g., self-reported race) that must be aggregated at the cluster level. Through simulations, we show that only individual-level models have power to detect HTE by individual-level variables; if outcomes must be defined at the cluster level, then there is often low power to detect HTE by the corresponding aggregated variables. We illustrate the challenges inherent to this type of analysis in a study assessing the effect of an intervention on increasing COVID-19 booster vaccination rates at long-term care centers.
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Affiliation(s)
- Brian D Williamson
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
- Department of Biostatistics, University of Washington, Seattle, WA, USA.
| | - R Yates Coley
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Clarissa Hsu
- Investigative Science Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Andrea J Cook
- Biostatistics Division, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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Tunis R, West E, Clifford N, Horner S, Radhakrishnan K. Leveraging digital health technologies in heart failure self-care interventions to improve health equity. Nurs Outlook 2024; 72:102225. [PMID: 38944905 DOI: 10.1016/j.outlook.2024.102225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/06/2024] [Accepted: 06/09/2024] [Indexed: 07/02/2024]
Abstract
For patients with heart failure, self-care is crucial, but recommendations for self-care are often not adhered to. Digital health interventions have the potential to help patients improve their self-care and, ultimately, their health outcomes, but without careful examination, digital interventions may generate further inequality. In this study, we use a digital health equity framework to examine challenges and opportunities related to digital health interventions across many domains of influence that may affect health equity. We draw from our own experience in conducting a decentralized clinical trial with multiple sensors and apps to help patients with heart failure improve adherence to key self-care behaviors. Finally, we provide recommendations for leveraging digital health interventions in research and practice to address health equity.
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Affiliation(s)
- Rachel Tunis
- School of Information, The University of Texas at Austin, Austin, TX; School of Nursing, The University of Texas at Austin, Austin, TX.
| | - Emily West
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Namuun Clifford
- School of Nursing, The University of Texas at Austin, Austin, TX
| | - Sharon Horner
- School of Nursing, The University of Texas at Austin, Austin, TX
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Li T, Mayo-Wilson E, Shaughnessy D, Qureshi R. Studying harms of interventions with an equity lens in randomized trials. Trials 2024; 25:403. [PMID: 38902776 PMCID: PMC11191320 DOI: 10.1186/s13063-024-08239-x] [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: 02/22/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
Equity and health equity are fundamental pillars in fostering a just and inclusive society. While equity underscores fairness in resource allocation and opportunity, health equity aims to eradicate avoidable health disparities among social groups. The concept of harms in interventions-undesirable consequences associated with the use of interventions-often varies across populations due to biological and social factors, necessitating a nuanced understanding. An equity lens reveals disparities in harm distribution, urging researchers and policymakers to address these differences in their decision-making processes. Furthermore, interventions, even well-intentioned ones, can inadvertently exacerbate disparities, emphasizing the need for comprehensive harm assessment. Integrating equity considerations in research practices and trial methodologies, through study design or through practices such as inclusive participant recruitment, is pivotal in advancing health equity. By prioritizing interventions that address disparities and ensuring inclusivity in research, we can foster a more equitable healthcare system.
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Affiliation(s)
- Tianjing Li
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
| | - Evan Mayo-Wilson
- Department of Epidemiology, University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Daniel Shaughnessy
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Riaz Qureshi
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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van den Bekerom L, van Gestel LC, Schoones JW, Bussemaker J, Adriaanse MA. Health behavior interventions among people with lower socio-economic position: a scoping review of behavior change techniques and effectiveness. Health Psychol Behav Med 2024; 12:2365931. [PMID: 38903803 PMCID: PMC11188964 DOI: 10.1080/21642850.2024.2365931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/04/2024] [Indexed: 06/22/2024] Open
Abstract
Background Behavior change interventions can unintendedly widen existing socio-economic health inequalities. Understanding why interventions are (in)effective among people with lower socio-economic position (SEP) is essential. Therefore, this scoping review aims to describe what is reported about the behavior change techniques (BCTs) applied within interventions and their effectiveness in encouraging physical activity and healthy eating, and reducing smoking and alcohol consumption according to SEP. Methods A systematic search was conducted in 12 electronic databases, and 151 studies meeting the eligibility criteria were included and coded for health behavioral outcomes, SEP-operationalization, BCTs (type and number) and effectiveness. Results Findings suggest that approaches for measuring, defining and substantiating lower SEP vary. Current studies of behavior change interventions for people of different SEP do not systematically identify BCTs, making systematic evaluation of BCT effectiveness impossible. The effectiveness of interventions is mainly evaluated by overall intervention outcomes and SEP-moderation effects are mostly not assessed. Conclusion Using different SEP-operationalizations and not specifying BCTs hampers systematic evidence accumulation regarding effective (combinations of) BCTs for the low SEP population. To learn which BCTs effectively improve health behaviors among people with lower SEP, future intervention developers should justify how SEP is operationalized and must systematically describe and examine BCTs.
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Affiliation(s)
- Loes van den Bekerom
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
| | - Laurens C. van Gestel
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Jan W. Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, the Netherlands
| | - Jet Bussemaker
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- The Institute of Public Administration, Leiden University, Leiden, the Netherlands
| | - Marieke A. Adriaanse
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague/Leiden, the Netherlands
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
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Srinivasan Y, Andreadis K, Ballakur SS, Rameau A. Access to Otolaryngologic Telemedicine Care Across the COVID-19 Pandemic at an Urban Tertiary Hospital System. EAR, NOSE & THROAT JOURNAL 2024; 103:76S-84S. [PMID: 38488168 DOI: 10.1177/01455613241240560] [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: 05/31/2024] Open
Abstract
Objective: To describe associations between patients' demographic characteristics and access to telemedicine services in an urban tertiary academic medical system across the COVID-19 pandemic, and to identify potential barriers to access. Methods: This was a retrospective cohort study conducted at a single-center tertiary academic medical center. The study included adult patients undergoing outpatient otolaryngologic care in person or via telemedicine during 8 week timeframes: before the pandemic, at the onset of the pandemic, and during later parts of the pandemic. Patients were characterized by age, sex, race, insurance type, primary language, portal activation status, income estimate, and visit type. Where appropriate, chi-squared tests, Wilcoxon signed-rank tests, and logistic regression were used to compare demographic factors between the cohorts. Results: A total of 14,240 unique patients [median age, 58 years (range, 18-107 years); 56.5% were female] resulting in a total of 29,457 visits (94.8% in-person and 5.2% telemedicine) were analyzed. Patients seen in person were older than those using telemedicine. Telemedicine visits included a higher proportion of patients with private insurance, and fewer patients with government or no insurance compared to in-person visits. Race, income, and English as primary language were not found to have a significant effect on telemedicine use. Conclusion: In an urban tertiary medical center, we found significant differences in sociodemographic characteristics between patients who accessed otolaryngologic care in person versus via telemedicine through different phases of the COVID pandemic, reflecting possible barriers to care associated with telemedicine. Further studies are needed to develop interventions to improve access.
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Affiliation(s)
- Yashes Srinivasan
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Sarita S Ballakur
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, USA
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Bear Don't Walk OJ, Paullada A, Everhart A, Casanova-Perez R, Cohen T, Veinot T. Opportunities for incorporating intersectionality into biomedical informatics. J Biomed Inform 2024; 154:104653. [PMID: 38734158 PMCID: PMC11146624 DOI: 10.1016/j.jbi.2024.104653] [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: 11/18/2023] [Revised: 04/06/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Many approaches in biomedical informatics (BMI) rely on the ability to define, gather, and manipulate biomedical data to support health through a cyclical research-practice lifecycle. Researchers within this field are often fortunate to work closely with healthcare and public health systems to influence data generation and capture and have access to a vast amount of biomedical data. Many informaticists also have the expertise to engage with stakeholders, develop new methods and applications, and influence policy. However, research and policy that explicitly seeks to address the systemic drivers of health would more effectively support health. Intersectionality is a theoretical framework that can facilitate such research. It holds that individual human experiences reflect larger socio-structural level systems of privilege and oppression, and cannot be truly understood if these systems are examined in isolation. Intersectionality explicitly accounts for the interrelated nature of systems of privilege and oppression, providing a lens through which to examine and challenge inequities. In this paper, we propose intersectionality as an intervention into how we conduct BMI research. We begin by discussing intersectionality's history and core principles as they apply to BMI. We then elaborate on the potential for intersectionality to stimulate BMI research. Specifically, we posit that our efforts in BMI to improve health should address intersectionality's five key considerations: (1) systems of privilege and oppression that shape health; (2) the interrelated nature of upstream health drivers; (3) the nuances of health outcomes within groups; (4) the problematic and power-laden nature of categories that we assign to people in research and in society; and (5) research to inform and support social change.
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Affiliation(s)
- Oliver J Bear Don't Walk
- Department of Biomedical Informatics and Medical Education, University of Washington, United States.
| | - Amandalynne Paullada
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Avery Everhart
- Department of Geography, Faculty of Arts, University of British Columbia, Canada
| | - Reggie Casanova-Perez
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Tiffany Veinot
- School of Information and School of Public Health, University of Michigan, United States
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Coetzer JA, Loukili I, Goedhart NS, Ket JCF, Schuitmaker-Warnaar TJ, Zuiderent-Jerak T, Dedding C. The potential and paradoxes of eHealth research for digitally marginalised groups: A qualitative meta-review. Soc Sci Med 2024; 350:116895. [PMID: 38710135 DOI: 10.1016/j.socscimed.2024.116895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
Whilst the transformation towards digital healthcare is accelerating, there is still a substantial risk of excluding people with a distance to the online world. Groups like people with a low socioeconomic position, people with a migrant background or the elderly, who are already most at risk of experiencing health inequalities, are simultaneously experiencing increased digital exclusion. Researchers play a role in determining how eHealth access is framed and can thus impact how the barriers to its use are addressed. This qualitative meta-review critically evaluates the way researchers (as authors) discuss eHealth use in digitally marginalised groups. Specifically, it seeks to understand how eHealth is framed to address existing health systems problems; how the barriers to eHealth use are presented and which solutions are provided in response; and who authors suggest should be responsible for making eHealth work. The results of this review found four paradoxes in how current literature views eHealth use. Firstly, that health systems problems are complex and nuanced, yet eHealth is seen as a simple answer. Secondly, that there are many political, social and health systems-based solutions suggested to address eHealth use, however most of the identified barriers are individually framed. This focus on personal deficits results in misallocating responsibility for making these systemic improvements. Thirdly, although eHealth is meant to simplify the tasks of patients and healthcare workers, these are the groups most often burdened with the responsibility of ensuring its success. Lastly, despite tailoring eHealth to the user being the most suggested solution, researchers generally speak about groups as a homogenous entity - thus rendering tailoring difficult. Ultimately, this review finds that a shift to focus research on addressing systemic issues on a systems level is necessary to prevent further exacerbating existing health inequalities.
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Affiliation(s)
- Jessica A Coetzer
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081HV, Amsterdam, the Netherlands.
| | - Ibrahim Loukili
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
| | - Nicole S Goedhart
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
| | - Johannes C F Ket
- VUmc, Medische Bibliotheek, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands.
| | | | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081HV, Amsterdam, the Netherlands.
| | - Christine Dedding
- Department of Ethics, Law & Humanities, Amsterdam UMC, De Boelelaan 1089a, F-vleugel medische faculteit, Amsterdam, The Netherlands.
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Katzow MW, Steinway C, Capossela E, Chen J, Chen V, Fenster T, Galagedera N, Hamill M, Lin E, Mamauag E, Moriarty S, Pathania S, Pliskin L, Ripp A, Ronay A, Santiago MT, Yang M, Jan S. Utilization and Patient-Reported Outcomes of Direct-to-Consumer Telemedicine During the First 6 Weeks of the COVID-19 Pandemic in the Largest Pediatric Ambulatory Network in New York State. Telemed J E Health 2024; 30:e1944-e1953. [PMID: 38597957 DOI: 10.1089/tmj.2023.0483] [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: 04/11/2024] Open
Abstract
Objective: We aimed to (1) describe telemedicine utilization and usability during the first 6 weeks of the pandemic and (2) determine if usability varied by individual- or visit-level characteristics. Methods: We conducted a retrospective cohort study of ambulatory pediatric telemedicine visits occurring between March 10, 2020, and April 18, 2020, across a large academic health system. We performed manual chart review to assess individual- and visit-level characteristics and invited caregivers to respond to an adapted Telehealth Usability Questionnaire (TUQ). We used multiple logistic regression to determine predictors of high usability. Results: There were 3,197 ambulatory pediatric telemedicine visits, representing 2,967 unique patients. Patients were racially/ethnically diverse (42.5% non-Hispanic White) and primarily English-speaking (89.2%). Surveys were completed by 441 (17%) of those invited. Every item of the TUQ had agreement or strong agreement from the majority of respondents. Compared with non-Hispanic White, non-Hispanic Asian identity was associated with lower usability in three domains and overall, and non-Hispanic Black identity was associated with higher satisfaction and future use. As compared with caregivers of infants younger than 1 year, caregivers of older patients reported lower usability in the three domains. Conclusions: Telemedicine was successfully implemented across 18 ambulatory pediatric specialties in the largest health system in New York State at the onset of COVID-19, and caregivers found it usable and acceptable. Usability scores did not vary by visit-level characteristics but did vary by race/ethnicity and age. Further research is necessary to identify modifiable drivers of the patient experience, particularly in non-Hispanic Asian communities and older adolescents.
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Affiliation(s)
- Michelle W Katzow
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Institute for Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Caren Steinway
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Errica Capossela
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital, La Jolla, California, USA
| | - Jack Chen
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Victoria Chen
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Talia Fenster
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Nirupa Galagedera
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Megan Hamill
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Elaine Lin
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Gastroenterology, NYU Langone Health, New York, New York, USA
| | - Erica Mamauag
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shannon Moriarty
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Shivany Pathania
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Gastroenterology, Brown University/Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - Lyndsey Pliskin
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Asher Ripp
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Avy Ronay
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Maria T Santiago
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
| | - Margaret Yang
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
- Department of Pediatric Critical Care Medicine, Mount Sinai Kravis Children's Hospital, New York, New York, USA
| | - Sophia Jan
- Department of Pediatrics, Northwell Health, New Hyde Park, New York, USA
- Department of Pediatrics, Cohen Children's Medical Center, Queens, New York, USA
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12
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Claudio MC, Rehany Z, Stachtari K, Guadagno E, Osmanlliu E, Poenaru D. Exploring the digital divide: results of a survey informing mobile application development. Front Digit Health 2024; 6:1382507. [PMID: 38800096 PMCID: PMC11116677 DOI: 10.3389/fdgth.2024.1382507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Mobile health apps risk widening health disparities if they overlook digital inclusion. The digital divide, encompassing access, familiarity, and readiness, poses a significant barrier to medical interventions. Existing literature lacks exploration of the digital divide's contributing factors. Hence, data are needed to comprehend the challenges in developing inclusive health apps. Methods We created a survey to gauge internet and smartphone access, smartphone familiarity, and readiness for using mobile health apps among caregivers of pediatric patients in tertiary care. Open-ended questions solicited feedback and suggestions on mobile health applications. Responses were categorized by similarity and compared. Developed with patient partners, the survey underwent cognitive testing and piloting for accuracy. Results Data from 209 respondents showed that 23% were affected by the digital divide, mainly due to unfamiliarity with digital skills. Among 49 short text responses about health app concerns, 31 mentioned security and confidentiality, with 7 mentioning the impersonal nature of such apps. Desired features included messaging healthcare providers, scheduling, task reminders, and simplicity. Conclusions This study underscores a digital divide among caregivers of pediatric patients, with nearly a quarter affected primarily due to a lack of digital comfort. Respondents emphasized user-friendliness and online security for health apps. Future apps should prioritize digital inclusion by addressing the significant barriers and carefully considering patient and family concerns.
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Affiliation(s)
| | - Zachary Rehany
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Katerina Stachtari
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Esli Osmanlliu
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Dan Poenaru
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada
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Cruz S, Lu C, Ulloa M, Redding A, Hester J, Jacobs M. Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study. JMIR Mhealth Uhealth 2024; 12:e50826. [PMID: 38717816 PMCID: PMC11112471 DOI: 10.2196/50826] [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: 07/14/2023] [Revised: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low-socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. OBJECTIVE This study's aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. METHODS We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. RESULTS Through qualitative analysis, we identified 4 main themes. Participants' perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants' interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. CONCLUSIONS The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices.
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Affiliation(s)
- Stefany Cruz
- Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Claire Lu
- Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Mara Ulloa
- Department of Computer Science, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Alexander Redding
- Department of Computer Science and Engineering, Irwin & Joan Jacobs School of Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Josiah Hester
- Interactive Computing and Computer Science, College of Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Maia Jacobs
- Department of Computer Science, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
- Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
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14
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Bassett E, Broadbent J, Gill D, Burgess S, Mason AM. Inconsistency in UK Biobank Event Definitions From Different Data Sources and Its Impact on Bias and Generalizability: A Case Study of Venous Thromboembolism. Am J Epidemiol 2024; 193:787-797. [PMID: 37981722 PMCID: PMC11074710 DOI: 10.1093/aje/kwad232] [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: 04/05/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023] Open
Abstract
The UK Biobank study contains several sources of diagnostic data, including hospital inpatient data and data on self-reported conditions for approximately 500,000 participants and primary-care data for approximately 177,000 participants (35%). Epidemiologic investigations require a primary disease definition, but whether to combine data sources to maximize statistical power or focus on only 1 source to ensure a consistent outcome is not clear. The consistency of disease definitions was investigated for venous thromboembolism (VTE) by evaluating overlap when defining cases from 3 sources: hospital inpatient data, primary-care reports, and self-reported questionnaires. VTE cases showed little overlap between data sources, with only 6% of reported events for persons with primary-care data being identified by all 3 sources (hospital, primary-care, and self-reports), while 71% appeared in only 1 source. Deep vein thrombosis-only events represented 68% of self-reported VTE cases and 36% of hospital-reported VTE cases, while pulmonary embolism-only events represented 20% of self-reported VTE cases and 50% of hospital-reported VTE cases. Additionally, different distributions of sociodemographic characteristics were observed; for example, patients in 46% of hospital-reported VTE cases were female, compared with 58% of self-reported VTE cases. These results illustrate how seemingly neutral decisions taken to improve data quality can affect the representativeness of a data set.
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Affiliation(s)
| | | | | | | | - Amy M Mason
- Correspondence to Dr. Amy M. Mason, Victor Phillip Dahdaleh Heart and Lung Research Institute, Biomedical Campus, Papworth Road, Trumpington, Cambridge CB2 0BB, United Kingdom (e-mail: )
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15
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Idnay B, Cordoba E, Ramirez SO, Xiao E, Wood OR, Batey DS, Garofalo R, Schnall R. Social Marketing Perspective on Participant Recruitment in Informatics-Based Intervention Studies. AIDS Behav 2024:10.1007/s10461-024-04355-6. [PMID: 38703337 DOI: 10.1007/s10461-024-04355-6] [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] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
Effective recruitment strategies are pivotal for informatics-based intervention trials success, particularly for people living with HIV (PLWH), where engagement can be challenging. Although informatics interventions are recognized for improving health outcomes, the effectiveness of their recruitment strategies remains unclear. We investigated the application of a social marketing framework in navigating the nuances of recruitment for informatics-based intervention trials for PLWH by examining participant experiences and perceptions. We used qualitative descriptive methodology to conduct semi-structured interviews with 90 research participants from four informatics-based intervention trials. Directed inductive and deductive content analyses were guided by Howcutt et al.'s social marketing framework on applying the decision-making process to research recruitment. The majority were male (86.7%), living in the Northeast United States (56%), and identified as Black (32%) or White (32%). Most participants (60%) completed the interview remotely. Sixteen subthemes emerged from five themes: motivation, perception, attitude formation, integration, and learning. Findings from our interview data suggest that concepts from Howcutt et al.'s framework informed participants' decisions to participate in an informatics-based intervention trial. We found that the participants' perceptions of trust in the research process were integral to the participants across the four trials. However, the recruitment approach and communication medium preferences varied between older and younger age groups. Social marketing framework can provide insight into improving the research recruitment process. Future work should delve into the complex interplay between the type of informatics-based interventions, trust in the research process, and communication preferences, and how these factors collectively influence participants' willingness to engage.
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Affiliation(s)
- Betina Idnay
- School of Nursing, Columbia University, New York, NY, USA.
- Department of Biomedical Informatics, Columbia University, New York, NY, USA.
| | - Evette Cordoba
- School of Nursing, Columbia University, New York, NY, USA
| | | | - Eugenia Xiao
- School of Nursing, Columbia University, New York, NY, USA
| | - Olivia R Wood
- School of Nursing, Columbia University, New York, NY, USA
| | - D Scott Batey
- School of Social Work, Tulane University, New Orleans, LA, USA
| | - Robert Garofalo
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine Northwestern University, Chicago, IL, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
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16
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Liang JH, Liu ML, Pu YQ, Wang C, Huang S, Jiang N, Hu LX, Zhang YS, Gui ZH, Pu XY, Huang SY, Chen YJ. Contribution of individual and cumulative social determinants of health underlying gender disparities in periodontitis in a representative US population: A cross-sectional NHANES study. J Clin Periodontol 2024; 51:558-570. [PMID: 38200631 DOI: 10.1111/jcpe.13941] [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: 08/14/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
AIM To examine the impact of both individual and cumulative social determinants of health (SDoH) on the likelihood of developing periodontitis, while also exploring any gender disparities in this relationship. MATERIALS AND METHODS Data of self-reported SDoH domains and sub-items based on Healthy People 2030 were obtained from the U.S. National Health and Nutrition Examination Surveys between 1999 and 2014. Logistic regression models, weighted by survey responses, were used to examine the relationship between SDoH (including eight sub-items and the cumulative number of unfavourable SDoH) and periodontitis. The results were further analysed by gender. RESULTS A total of 18,075 participants (8867 males and 9208 females) were included in the main analysis, of which 5814 (32.2%) had periodontitis. The study found that certain unfavourable SDoH were individually associated with higher odds of periodontitis, and the cumulative number of unfavourable SDoH was positively linked to the odds of developing periodontitis. Furthermore, males exposed to more unfavourable SDoH appeared to be more susceptible to developing periodontitis than females. CONCLUSIONS The findings suggest that unfavourable SDoH, especially when they accumulate, are associated with an increased odds of periodontitis and contribute to gender disparities within the U.S. POPULATION
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Affiliation(s)
- Jing-Hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Mei-Ling Liu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ying-Qi Pu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Cong Wang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, People's Republic of China
| | - Shan Huang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Nan Jiang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Li-Xin Hu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yu-Shan Zhang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhao-Huan Gui
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Guangdong Provincial Engineering Technology Research Center of Environmental and Health risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Guangzhou, People's Republic of China
| | - Xue-Ya Pu
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shao-Yi Huang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ya-Jun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
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Khatib R, Glowacki N, Chang E, Lauffenburger J, Pletcher MJ, Siddiqi A. Disparities in Patient Portal Engagement Among Patients With Hypertension Treated in Primary Care. JAMA Netw Open 2024; 7:e2411649. [PMID: 38748420 PMCID: PMC11096988 DOI: 10.1001/jamanetworkopen.2024.11649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/28/2024] [Indexed: 05/18/2024] Open
Abstract
Importance Patient portals are increasingly used for patient-clinician communication and to introduce interventions aimed at improving blood pressure control. Objective To characterize patient portal use among patients with hypertension managed in primary care. Design, Settings, and Participants This retrospective cohort study used electronic health records linked with patient portal log file data from a large, diverse Midwestern health care system. Patients with hypertension who had a primary care visit from January 1, 2021, to December 31, 2021, were included. The first visit in 2021 was considered the baseline visit; patient portal engagement was evaluated during the following year. Multivariate logistic regressions, presented as odds ratios (ORs) and 95% CIs, were used to evaluate associations between patient characteristics and patient portal engagement, adjusting for potential confounders. Exposures Primary exposures included 4 sociodemographic factors routinely collected in the electronic health record: race and ethnicity, insurance, preferred language, and smoking status. Main Outcomes and Measures Indicators of patient engagement with the patient portal included accessing the patient portal at least once, accessing the portal within 7 days of at least 50.0% of primary care physician (PCP) visits, frequent logins (<28 vs ≥28), messaging (<2 vs ≥2), and sharing home blood pressure readings. Results Among 366 871 patients (mean [SD], 63.5 [12.6] years), 52.8% were female, 3.4% were Asian, 7.8% were Hispanic, 19.7% were non-Hispanic Black, 66.9% were non-Hispanic White, and 2.3% were of other race or ethnicity. During the 1-year study period starting in 2021, 70.5% accessed the patient portal at least once, 60.2% accessed around the time of their PCP visits, 35.7% accessed the portal frequently, 28.9% engaged in messaging, and 8.7% shared home blood pressure readings. Compared with White patients, non-Hispanic Black and Hispanic patients had lower odds of any access (Black: OR, 0.53; 95% CI, 0.52-0.54; Hispanic: OR, 0.66; 95% CI, 0.64-0.68), access around PCP visit time (Black: OR, 0.49; 95% CI, 0.48-0.50; Hispanic: OR, 0.62; 95% CI, 0.60-0.64), frequent access (Black: OR, 0.56; 95% CI, 0.55-0.57; Hispanic: OR, 0.71; 95% CI, 0.69-0.73), and messaging (Black: OR, 0.63; 95% CI, 0.61-0.64); Hispanic: OR, 0.71; 95% CI, 0.69-0.73). Conclusions and Relevance This cohort study of patients with hypertension found clear sociodemographic disparities in patient portal engagement among those treated in primary care. Without special efforts to engage patients with portals, interventions that use patient portals to target hypertension may exacerbate disparities.
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Affiliation(s)
- Rasha Khatib
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Eva Chang
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, Wisconsin
| | - Julie Lauffenburger
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark J. Pletcher
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Alvia Siddiqi
- Enterprise Population Health, Advocate Health, Rolling Meadows, Illinois
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18
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Groom LL, Schoenthaler AM, Mann DM, Brody AA. Construction of the Digital Health Equity-Focused Implementation Research Conceptual Model - Bridging the Divide Between Equity-focused Digital Health and Implementation Research. PLOS DIGITAL HEALTH 2024; 3:e0000509. [PMID: 38776354 PMCID: PMC11111026 DOI: 10.1371/journal.pdig.0000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/10/2024] [Indexed: 05/24/2024]
Abstract
Digital health implementations and investments continue to expand. As the reliance on digital health increases, it is imperative to implement technologies with inclusive and accessible approaches. A conceptual model can be used to guide equity-focused digital health implementations to improve suitability and uptake in diverse populations. The objective of this study is expand an implementation model with recommendations on the equitable implementation of new digital health technologies. The Digital Health Equity-Focused Implementation Research (DH-EquIR) conceptual model was developed based on a rigorous review of digital health implementation and health equity literature. The Equity-Focused Implementation Research for Health Programs (EquIR) model was used as a starting point and merged with digital equity and digital health implementation models. Existing theoretical frameworks and models were appraised as well as individual equity-sensitive implementation studies. Patient and program-related concepts related to digital equity, digital health implementation, and assessment of social/digital determinants of health were included. Sixty-two articles were analyzed to inform the adaption of the EquIR model for digital health. These articles included digital health equity models and frameworks, digital health implementation models and frameworks, research articles, guidelines, and concept analyses. Concepts were organized into EquIR conceptual groupings, including population health status, planning the program, designing the program, implementing the program, and equity-focused implementation outcomes. The adapted DH-EquIR conceptual model diagram was created as well as detailed tables displaying related equity concepts, evidence gaps in source articles, and analysis of existing equity-related models and tools. The DH-EquIR model serves to guide digital health developers and implementation specialists to promote the inclusion of health-equity planning in every phase of implementation. In addition, it can assist researchers and product developers to avoid repeating the mistakes that have led to inequities in the implementation of digital health across populations.
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Affiliation(s)
- Lisa L. Groom
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
- Medical Center Information Technology Department of Health Informatics, New York University Langone Health, New York, New York, United States of America
| | - Antoinette M. Schoenthaler
- Institute for Excellence in Health Equity, New York University Langone Health, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Devin M. Mann
- Medical Center Information Technology Department of Health Informatics, New York University Langone Health, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Abraham A. Brody
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
- Division of Geriatric Medicine and Palliative Care, New York University Grossman School of Medicine, New York, New York, United States of America
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Hellem AK, Casetti A, Bowie K, Golbus JR, Merid B, Nallamothu BK, Dorsch MP, Newman MW, Skolarus L. A Community Participatory Approach to Creating Contextually Tailored mHealth Notifications: myBPmyLife Project. Health Promot Pract 2024; 25:417-427. [PMID: 36704967 DOI: 10.1177/15248399221141687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Just-in-time adaptive interventions (JITAIs) are a novel approach to mobile health (mHealth) interventions, sending contextually tailored behavior change notifications to participants when they are more likely to engage, determined by data from wearable devices. We describe a community participatory approach to JITAI notification development for the myBPmyLife Project, a JITAI focused on decreasing sodium consumption and increasing physical activity to reduce blood pressure. Eighty-six participants were interviewed, 50 at a federally qualified health center (FQHC) and 36 at a university clinic. Participants were asked to provide encouraging physical activity and low-sodium diet notifications and provided feedback on researcher-generated notifications to inform revisions. Participant notifications were thematically analyzed using an inductive approach. Participants noted challenging vocabulary, phrasing, and culturally incongruent suggestions in some of the researcher-generated notifications. Community-generated notifications were more direct, used colloquial language, and contained themes of grace. The FQHC participants' notifications expressed more compassion, religiosity, and addressed health-related social needs. University clinic participants' notifications frequently focused on office environments. In summary, our participatory approach to notification development embedded a distinctive community voice within our notifications. Our approach may be generalizable to other communities and serve as a model to create tailored mHealth notifications to their focus population.
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Affiliation(s)
| | | | | | | | - Beza Merid
- Arizona State University, Tempe, AZ, USA
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20
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Oewel B, Areán PA, Agapie E. Approaches to Tailoring Between-Session Mental Health Therapy Activities. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2024; 2024:696. [PMID: 38919830 PMCID: PMC11197942 DOI: 10.1145/3613904.3642856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Mental health activities conducted by patients between therapy sessions (or "therapy homework") are a component of addressing anxiety and depression. However, to be effective, therapy homework must be tailored to the client's needs to address the numerous barriers they encounter in everyday life. In this study, we analyze how therapists and clients tailor therapy homework to their client's needs. We interviewed 13 therapists and 14 clients about their experiences tailoring and engaging in therapy homework. We identify criteria for tailoring homework, such as client skills, discomfort, and external barriers. We present how homework gets adapted, such as through changes in difficulty or by identifying alternatives. We discuss how technologies can better use client information for personalizing mental health interventions, such as adapting to client barriers, adjusting homework to these barriers, and creating a safer environment to support discomfort.
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Affiliation(s)
- Bruna Oewel
- University of California, Irvine Irvine, USA
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21
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Dakin FH, Rybczynska-Bunt S, Rosen R, Clarke A, Greenhalgh T. Access and triage in contemporary general practice: A novel theory of digital candidacy. Soc Sci Med 2024; 349:116885. [PMID: 38640742 DOI: 10.1016/j.socscimed.2024.116885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 03/13/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
To access contemporary healthcare, patients must find and navigate a complex socio-technical network of human and digital actors linked in multi-modal pathways. Asynchronous, digitally-mediated triage decisions have largely replaced synchronous conversations between humans. In this paper, we draw on a large qualitative dataset from a multi-site study of remote and digital technologies in general practice to understand widening inequities of access. We theorise our data by bringing together traditional candidacy theory (in particular, concepts of self-assessment, help-seeking, adjudication and negotiation) and socio-technical and technology structuration theories (in particular, concepts of user configuration, articulation, distanciation, disembedding, and recursivity), thus producing a novel theory of digital candidacy. We propose that both human and technological actors (in different ways) embody social structures which affect how they 'act' in social situations. Digital technologies contain inbuilt assumptions about users' capabilities, needs, rights, and skills. Patients' ability to self-assess as sick, access digital platforms, self-advocate, and navigate multiple stages in the pathway, including adapting to and compensating for limitations in the technology, vary widely and are markedly patterned by disadvantage. Not every patient can craft an accurate digital facsimile on which the subsequent adjudication decision will be made; those who create incomplete, flawed or unpersuasive digital facsimiles may be deprioritised or misdirected. Staff who know about such patients may use articulation measures to ensure a personalised and appropriate access package, but they cannot identify or fully mitigate all such cases. The decisions and actions of human and technological agents at the time of an attempt to access care can significantly influence, disrupt, and reconstitute candidacy both immediately and recursively over time, and also recursively shape the system itself. These findings underscore the need for services to be (co-)designed with attention to the exclusionary tendencies of digital technologies and technology-supported processes and pathways.
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Affiliation(s)
- Francesca H Dakin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | | | - Aileen Clarke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Choi S. Comparison of Self-Tracking Health Practices, eHealth Literacy, and Subjective Well-Being Between College Students With and Without Disabilities: Cross-Sectional Survey. JMIR Form Res 2024; 8:e48783. [PMID: 38598285 PMCID: PMC11043924 DOI: 10.2196/48783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND College students with disabilities need to transition from pediatric-centered care to adult care. However, they may become overwhelmed by multiple responsibilities, such as academic activities, peer relationships, career preparation, job seeking, independent living, as well as managing their health and promoting healthy behaviors. OBJECTIVE As the use of smartphones and wearable devices for collecting personal health data becomes popular, this study aimed to compare the characteristics of self-tracking health practices between college students with disabilities and their counterparts. In addition, this study examined the relationships between disability status, self-tracking health practices, eHealth literacy, and subjective well-being among college students. METHODS The web-based questionnaire was designed using Qualtrics for the cross-sectional online survey. The survey data were collected from February 2023 to April 2023 and included responses from 702 participants. RESULTS More than 80% (563/702, 80.2%) of the respondents participated voluntarily in self-tracking health practices. College students with disabilities (n=83) showed significantly lower levels of eHealth literacy and subjective well-being compared with college students without disabilities (n=619). The group with disabilities reported significantly lower satisfaction (t411=-5.97, P<.001) and perceived efficacy (t411=-4.85, P<.001) when using smartphone health apps and wearable devices. Finally, the study identified a significant correlation between subjective well-being in college students and disability status (β=3.81, P<.001), self-tracking health practices (β=2.22, P=.03), and eHealth literacy (β=24.29, P<.001). CONCLUSIONS Given the significant relationships among disability status, self-tracking health practices, eHealth literacy, and subjective well-being in college students, it is recommended to examine their ability to leverage digital technology for self-care. Offering learning opportunities to enhance eHealth literacy and self-tracking health strategies within campus environments could be a strategic approach to improve the quality of life and well-being of college students.
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Affiliation(s)
- Soyoung Choi
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, United States
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23
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Kim KK, Backonja U. Perspectives of community-based organizations on digital health equity interventions: a key informant interview study. J Am Med Inform Assoc 2024; 31:929-939. [PMID: 38324738 PMCID: PMC10990549 DOI: 10.1093/jamia/ocae020] [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: 06/09/2023] [Revised: 12/14/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Health and healthcare are increasingly dependent on internet and digital solutions. Medically underserved communities that experience health disparities are often those who are burdened by digital disparities. While digital equity and digital health equity are national priorities, there is limited evidence about how community-based organizations (CBOs) consider and develop interventions. METHODS We conducted key informant interviews in 2022 purposively recruiting from health and welfare organizations engaged in digital equity work. Nineteen individuals from 13 organizations serving rural and/or urban communities from the local to national level participated in semi-structured interviews via Zoom regarding their perspectives on digital health equity interventions. Directed content analysis of verbatim interview transcripts was conducted to identify themes. RESULTS Themes emerged at individual, organizational, and societal levels. Individual level themes included potential benefits from digital health equity, internet access challenges, and the need for access to devices and digital literacy. Organizational level themes included leveraging community assets, promising organizational practices and challenges. For the societal level, the shifting complexity of the digital equity ecosystem, policy issues, and data for needs assessment and evaluation were described. Several example case studies describing these themes were provided. DISCUSSION AND CONCLUSION Digital health equity interventions are complex, multi-level endeavors. Clear elucidation of the individual, organizational, and societal level factors that may impact digital health equity interventions are necessary to understanding if and how CBOs participate in such initiatives. This study presents unique perspectives directly from CBOs driving programs in this new arena of digital health equity.
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Affiliation(s)
- Katherine K Kim
- MITRE Corporation, Health Innovation Center, McLean, VA 22102, United States
- Department of Public Health Sciences/Division of Health Informatics, School of Medicine, University of California Davis, Sacramento, CA 95817, United States
| | - Uba Backonja
- MITRE Corporation, Health Innovation Center, McLean, VA 22102, United States
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Darrah T, Herbert S, Chambers T. A thematic analysis of alcohol and alcohol-related harm across health and social policy in Aotearoa New Zealand. Aust N Z J Public Health 2024; 48:100143. [PMID: 38626567 DOI: 10.1016/j.anzjph.2024.100143] [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: 07/09/2023] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVE This study aims to: 1) explore how alcohol and alcohol harm are framed in New Zealand national policy, strategy, and action plan documents; and 2) examine how these documents align with the WHO SAFER framework. METHODS Keyword searches across government websites and Google were conducted in January 2021. Inclusion and exclusion criteria were applied to all identified documents, resulting in 22 being included for analysis in this study. An inductive and deductive thematic analysis of those documents was performed. RESULTS Our inductive thematic analysis identified three themes, of which one is detailed in this study: 'Location of responsibility for addressing alcohol harms' with a focus on individuals and non-specific government agencies. Thematic results from the deductive analysis found that the most consistently referenced SAFER policies included brief interventions (68% of documents), followed by drink driving measures (45%), alcohol marketing (36%), alcohol availability (27%), and alcohol price (23%). The conversion rate from a document mentioning a SAFER framework policy area to making specific policy recommendations was usually less than or around 50%. CONCLUSIONS The lack of alignment between New Zealand alcohol policy and the SAFER framework can be partially attributable to the absence of an updated national alcohol strategy (NAS). An updated NAS should identify responsible agencies, create a systematic monitoring and evaluation mechanism, and be consistent with the WHO SAFER framework. IMPLICATIONS FOR PUBLIC HEALTH The analysis supports the need to update a national alcohol strategy to guide alcohol policy development.
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Affiliation(s)
- Tayla Darrah
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | | | - Timothy Chambers
- University of Canterbury, Ngāi Tahu Research Centre, Christchurch, New Zealand
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25
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Nguyen L, Phan TL, Falini L, Chang D, Cottrell L, Dawley E, Hockett CW, VanWagoner T, Darden PM, Davis AM. Rural Family Satisfaction With Telehealth Delivery of an Intervention for Pediatric Obesity and Associated Family Characteristics. Child Obes 2024; 20:147-154. [PMID: 37036783 PMCID: PMC10979670 DOI: 10.1089/chi.2022.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Objective: To describe satisfaction with the telehealth aspect of a pediatric obesity intervention among families from multiple rural communities and assess differences in satisfaction based on sociodemographic factors. Methods: This is a secondary analysis of data from a pilot randomized controlled trial of a 6-month intensive lifestyle intervention (iAmHealthy) delivered through telehealth to children 6-11 years old with BMI ≥85th%ile and their parents from rural communities. Parents completed a sociodemographic survey and a validated survey to assess satisfaction with the telehealth intervention across four domains (technical functioning, comfort of patient and provider with technology and perceived privacy, timely and geographic access to care, and global satisfaction) on a 5-point Likert scale. Kruskal-Wallis nonparametric rank test were used to compare mean satisfaction scores based on parent sociodemographics. Results: Forty-two out of 52 parents (67% White, 29% Black, 5% multiracial, and 50% with household income <$40,000) completed the survey. Mean satisfaction scores ranged from 4.16 to 4.54 (standard deviation 0.44-0.61). Parents without a college degree reported higher satisfaction across all domains compared with parents with a college degree, including global satisfaction (mean 4.64 vs. 4.31, p = 0.03). Parents reporting a household income <$40,000 (mean 4.70) reported higher scores in the comfort with technology and perceived privacy domain compared with parents with higher incomes (mean 4.30-4.45, p = 0.04). Discussion: Parents from rural communities, especially those from lower socioeconomic backgrounds, were highly satisfied with the iAmHealthy telehealth intervention. These findings can be used to inform future telehealth interventions among larger more diverse populations. ClinicalTrials.gov Identifier: NCT04142034.
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Affiliation(s)
- Linhda Nguyen
- Department of Pediatrics, Healthy Weight and Wellness Clinic, Nemours Children's Health, DE, Wilmington, DE, USA
| | - Thao-Ly Phan
- Department of Pediatrics, Healthy Weight and Wellness Clinic, Nemours Children's Health, DE, Wilmington, DE, USA
- Center for Healthcare Delivery Science, Nemours Children's Health, DE, Wilmington, DE, USA
| | - Lauren Falini
- Department of Pediatrics, Healthy Weight and Wellness Clinic, Nemours Children's Health, DE, Wilmington, DE, USA
| | - Di Chang
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lesley Cottrell
- Department of Pediatrics, West Virginia University, Morgantown, WV, USA
- West Virginia University Center for Excellence in Disabilities, Morgantown, WV, USA
| | - Erin Dawley
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Christine W. Hockett
- Avera Research Institute, Sioux Falls, SD, USA
- Department of Pediatrics, School of Medicine, University of South Dakota, Vermillion, SD, USA
| | - Timothy VanWagoner
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paul M. Darden
- Population Health Research Program, Arkansas Children's Research Institute, Little Rock, Arkansas, USA
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ann M. Davis
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS, USA
- Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO, USA
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Shaw J, Glover W. The Political Economy of Digital Health Equity: Structural Analysis. J Med Internet Res 2024; 26:e46971. [PMID: 38530341 PMCID: PMC11005444 DOI: 10.2196/46971] [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: 03/03/2023] [Revised: 06/30/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wiljeana Glover
- Technology, Operations, and Information Management Division, Babson College, Wellesley, MA, United States
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Kim MK, Rouphael C, McMichael J, Welch N, Dasarathy S. Challenges in and Opportunities for Electronic Health Record-Based Data Analysis and Interpretation. Gut Liver 2024; 18:201-208. [PMID: 37905424 PMCID: PMC10938158 DOI: 10.5009/gnl230272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/15/2023] [Indexed: 11/02/2023] Open
Abstract
Electronic health records (EHRs) have been increasingly adopted in clinical practices across the United States, providing a primary source of data for clinical research, particularly observational cohort studies. EHRs are a high-yield, low-maintenance source of longitudinal real-world data for large patient populations and provide a wealth of information and clinical contexts that are useful for clinical research and translation into practice. Despite these strengths, it is important to recognize the multiple limitations and challenges related to the use of EHR data in clinical research. Missing data are a major source of error and biases and can affect the representativeness of the cohort of interest, as well as the accuracy of the outcomes and exposures. Here, we aim to provide a critical understanding of the types of data available in EHRs and describe the impact of data heterogeneity, quality, and generalizability, which should be evaluated prior to and during the analysis of EHR data. We also identify challenges pertaining to data quality, including errors and biases, and examine potential sources of such biases and errors. Finally, we discuss approaches to mitigate and remediate these limitations. A proactive approach to addressing these issues can help ensure the integrity and quality of EHR data and the appropriateness of their use in clinical studies.
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Affiliation(s)
- Michelle Kang Kim
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Carol Rouphael
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John McMichael
- Department of Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicole Welch
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Srinivasan Dasarathy
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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28
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Husain L, Finlay T, Husain A, Wherton J, Hughes G, Greenhalgh T. Developing user personas to capture intersecting dimensions of disadvantage in older patients who are marginalised: a qualitative study. Br J Gen Pract 2024:BJGP.2023.0412. [PMID: 38242714 PMCID: PMC10947364 DOI: 10.3399/bjgp.2023.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/11/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Remote and digital services must be equitable, but some patients have difficulty using these services. Designing measures to overcome digital disparities can be challenging for practices. Personas (fictional cases) are a potentially useful tool in this regard. AIM To develop and test a set of personas to reflect the lived experiences and challenges that older people who are disadvantaged face when navigating remote and digital primary care services. DESIGN AND SETTING Qualitative study of digital disparities in NHS community health services offering video appointments. METHOD Following familiarisation visits and interviews with service providers, 17 older people with multiple markers of disadvantage (limited English, health conditions, and poverty) were recruited and interviewed using narrative prompts. Data were analysed using an intersectionality lens, underpinned by sociological theory. Combining data across all participant interviews, we produced personas and refined these following focus groups involving health professionals, patients, and advocates (n = 12). RESULTS Digital services create significant challenges for older patients with limited economic, social, and linguistic resources and low digital, health, or system literacy. Four contrasting personas were produced, capturing the variety and complexity of how dimensions of disadvantage intersected and influenced identity and actions. The personas illustrate important themes including experience of racism and discrimination, disorientation, discontinuity, limited presence, weak relationships, loss of agency, and mistrust of services and providers. CONCLUSION Personas can illuminate the multiple and intersecting dimensions of disadvantage in patient populations who are marginalised and may prove useful when designing or redesigning digital primary care services. Adopting an intersectional lens may help practices address digital disparities.
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Affiliation(s)
- Laiba Husain
- The Healthcare Improvement Studies Institute research fellow
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Arqam Husain
- School of Medicine, Wayne State University, Detroit, MI, US
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gemma Hughes
- School of Business, University of Leicester, Leicester, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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29
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Hash JB, Walker AJ, Ward TM, Oxford ML, Spieker SJ. Trying to Do What's Best: Maternal Perspectives About Toddler Sleep Health Among an Underresourced Sample of Mothers With Diverse Racial and Ethnic Identities. J Pediatr Health Care 2024; 38:160-171. [PMID: 38429028 PMCID: PMC10987074 DOI: 10.1016/j.pedhc.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This study describes mothers' knowledge, attitudes, beliefs, and practices about their toddler's sleep health among an underresourced sample of mothers with diverse racial and ethnic identities. METHOD This was a descriptive qualitative study with 16 mothers and their 12- to 36-month-old child. Mothers completed a semistructured, audio-recorded interview about their toddler's sleep health. Data were analyzed using inductive content analysis on the basis of established methods. RESULTS Mothers self-identified as 18.8% Black, 43.8% White, 12.5% multiracial, 25.0% other race, and 37.5% Hispanic. Of the mothers, 80.0% reported a past year household income of ≤ $40,000. A core construct, "Trying to do What's Best," emerged from the interview data, and this construct included three domains: Getting Good Sleep, Getting Thrown Off, and Rolling With It. DISCUSSION Findings support future strengths-based and multilevel sleep health-promoting interventions.
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30
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Gonzalez C, Graves JM, Ramos J, Vavilala MS, Moore M. Language access research for community health: provider perspectives on language access techniques and the role of communication technology. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024; 17:7-14. [PMID: 37470760 DOI: 10.1080/17538068.2023.2237351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND In the United States, 66 million people speak a language other than English at home. Patients with diverse language needs often face significant health disparities. Information and communication technologies have expanded the realm of modalities for patient-provider communication. However, the extent to which digital language access tools are utilized by healthcare providers is unknown. This research examines provider perspectives on language assistance techniques and the role of communication technology when serving patients with non-English language preference (NELP). METHODS Between April and July 2019, an online survey was administered to 3,033 healthcare providers (doctors, nurse practitioners, pharmacists, and dentists) in Washington State. Providers reported on their language access practices and perspectives on communication technology. RESULTS Most providers reported using ad hoc language access techniques when engaging patients with NELP, such as a patient's family member or friend (75.8%), a patient's child specifically (61.9%), or a bilingual staff member (64.3%). Professional techniques, such as in-person interpretation (53.5%), phone interpretation (57%), and video remote interpretation (38.8%), were used less often. Dissatisfaction with the language access processes of healthcare providers' place of work was associated with a higher reliance on a patient's family or friend for language interpretation. CONCLUSIONS Findings suggest that providers might be under-utilizing professional and digital interpreter services while relying on ad hoc techniques. Such practices reveal systemic constraints on language access that might make it difficult for providers to access timely and reliable options for professional language interpretation, despite federal regulations that mandate such services for patients with NELP.
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Affiliation(s)
- Carmen Gonzalez
- Department of Communication, University of Washington, Seattle, Washington, USA
| | - Janessa M Graves
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Joana Ramos
- Washington State Coalition for Language Access (WASCLA), Seattle, Washington, USA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine and Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Megan Moore
- School of Social Work, University of Washington, Seattle, Washington, USA
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Ryan DK, Maclean RH, Balston A, Scourfield A, Shah AD, Ross J. Artificial intelligence and machine learning for clinical pharmacology. Br J Clin Pharmacol 2024; 90:629-639. [PMID: 37845024 DOI: 10.1111/bcp.15930] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023] Open
Abstract
Artificial intelligence (AI) will impact many aspects of clinical pharmacology, including drug discovery and development, clinical trials, personalized medicine, pharmacogenomics, pharmacovigilance and clinical toxicology. The rapid progress of AI in healthcare means clinical pharmacologists should have an understanding of AI and its implementation in clinical practice. As with any new therapy or health technology, it is imperative that AI tools are subject to robust and stringent evaluation to ensure that they enhance clinical practice in a safe and equitable manner. This review serves as an introduction to AI for the clinical pharmacologist, highlighting current applications, aspects of model development and issues surrounding evaluation and deployment. The aim of this article is to empower clinical pharmacologists to embrace and lead on the safe and effective use of AI within healthcare.
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Affiliation(s)
- David K Ryan
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rory H Maclean
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Alfred Balston
- Department of Clinical Pharmacology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Scourfield
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anoop D Shah
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Health Informatics, University College London, London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - Jack Ross
- Department of Clinical Pharmacology, University College London Hospitals NHS Foundation Trust, London, UK
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Bell SK, Amat MJ, Anderson TS, Aronson MD, Benneyan JC, Fernandez L, Ricci DA, Salant T, Schiff GD, Shafiq U, Singer SJ, Sternberg SB, Zhang C, Phillips RS. Do patients who read visit notes on the patient portal have a higher rate of "loop closure" on diagnostic tests and referrals in primary care? A retrospective cohort study. J Am Med Inform Assoc 2024; 31:622-630. [PMID: 38164964 PMCID: PMC10873783 DOI: 10.1093/jamia/ocad250] [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: 10/05/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES The 2021 US Cures Act may engage patients to help reduce diagnostic errors/delays. We examined the relationship between patient portal registration with/without note reading and test/referral completion in primary care. MATERIALS AND METHODS Retrospective cohort study of patients with visits from January 1, 2018 to December 31, 2021, and order for (1) colonoscopy, (2) dermatology referral for concerning lesions, or (3) cardiac stress test at 2 academic primary care clinics. We examined differences in timely completion ("loop closure") of tests/referrals for (1) patients who used the portal and read ≥1 note (Portal + Notes); (2) those with a portal account but who did not read notes (Portal Account Only); and (3) those who did not register for the portal (No Portal). We estimated the predictive probability of loop closure in each group after adjusting for socio-demographic and clinical factors using multivariable logistic regression. RESULTS Among 12 849 tests/referrals, loop closure was more common among Portal+Note-readers compared to their counterparts for all tests/referrals (54.2% No Portal, 57.4% Portal Account Only, 61.6% Portal+Notes, P < .001). In adjusted analysis, compared to the No Portal group, the odds of loop closure were significantly higher for Portal Account Only (OR 1.2; 95% CI, 1.1-1.4), and Portal+Notes (OR 1.4; 95% CI, 1.3-1.6) groups. Beyond portal registration, note reading was independently associated with loop closure (P = .002). DISCUSSION AND CONCLUSION Compared to no portal registration, the odds of loop closure were 20% higher in tests/referrals for patients with a portal account, and 40% higher in tests/referrals for note readers, after controlling for sociodemographic and clinical factors. However, important safety gaps from unclosed loops remain, requiring additional engagement strategies.
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Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Maelys J Amat
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Timothy S Anderson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Mark D Aronson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, Boston, MA 02115, United States
| | - Leonor Fernandez
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Dru A Ricci
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
| | - Talya Salant
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
- Bowdoin Street Health Center, Dorchester, MA 02122, United States
| | - Gordon D Schiff
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Umber Shafiq
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Sara J Singer
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Scot B Sternberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Cancan Zhang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Russell S Phillips
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
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Tse G, Kuzma N, Khan A. Perspective: Artificial intelligence and patient communication. J Hosp Med 2024. [PMID: 38340353 DOI: 10.1002/jhm.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/21/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Gabriel Tse
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas Kuzma
- Section of Hospital Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Alisa Khan
- Department of Pediatrics, Divison of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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Skolarus LE, Farhan Z, Mishra SR, Rao N, Bowie K, Bailey S, Dorsch MP, Newman MW, Nallamothu BK, Golbus JR. Resource Requirements for Participant Enrollment From a University Health System and a Federally Qualified Health Center Network in a Mobile Health Study: The myBPmyLife Trial. J Am Heart Assoc 2024; 13:e030825. [PMID: 38226521 PMCID: PMC10926785 DOI: 10.1161/jaha.123.030825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/26/2023] [Indexed: 01/17/2024]
Affiliation(s)
| | - Zahera Farhan
- Department of Emergency MedicineUniversity of MichiganAnn ArborMI
| | | | - Nikhila Rao
- Department of CardiologyUniversity of MichiganAnn ArborMI
| | - Kaitlyn Bowie
- Department of Emergency MedicineUniversity of MichiganAnn ArborMI
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Ribaut J, DeVito Dabbs A, Dobbels F, Teynor A, Mess EV, Hoffmann T, De Geest S. Developing a Comprehensive List of Criteria to Evaluate the Characteristics and Quality of eHealth Smartphone Apps: Systematic Review. JMIR Mhealth Uhealth 2024; 12:e48625. [PMID: 38224477 PMCID: PMC10825776 DOI: 10.2196/48625] [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: 05/01/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND The field of eHealth is growing rapidly and chaotically. Health care professionals need guidance on reviewing and assessing health-related smartphone apps to propose appropriate ones to their patients. However, to date, no framework or evaluation tool fulfills this purpose. OBJECTIVE Before developing a tool to help health care professionals assess and recommend apps to their patients, we aimed to create an overview of published criteria to describe and evaluate health apps. METHODS We conducted a systematic review to identify existing criteria for eHealth smartphone app evaluation. Relevant databases and trial registers were queried for articles. Articles were included that (1) described tools, guidelines, dimensions, or criteria to evaluate apps, (2) were available in full text, and (3) were written in English, French, German, Italian, Portuguese, or Spanish. We proposed a conceptual framework for app evaluation based on the dimensions reported in the selected articles. This was revised iteratively in discussion rounds with international stakeholders. The conceptual framework was used to synthesize the reported evaluation criteria. The list of criteria was discussed and refined by the research team. RESULTS Screening of 1258 articles yielded 128 (10.17%) that met the inclusion criteria. Of these 128 articles, 30 (23.4%) reported the use of self-developed criteria and described their development processes incompletely. Although 43 evaluation instruments were used only once, 6 were used in multiple studies. Most articles (83/128, 64.8%) did not report following theoretical guidelines; those that did noted 37 theoretical frameworks. On the basis of the selected articles, we proposed a conceptual framework to explore 6 app evaluation dimensions: context, stakeholder involvement, features and requirements, development processes, implementation, and evaluation. After standardizing the definitions, we identified 205 distinct criteria. Through consensus, the research team relabeled 12 of these and added 11 more-mainly related to ethical, legal, and social aspects-resulting in 216 evaluation criteria. No criteria had to be moved between dimensions. CONCLUSIONS This study provides a comprehensive overview of criteria currently used in clinical practice to describe and evaluate apps. This is necessary as no reviewed criteria sets were inclusive, and none included consistent definitions and terminology. Although the resulting overview is impractical for use in clinical practice in its current form, it confirms the need to craft it into a purpose-built, theory-driven tool. Therefore, in a subsequent step, based on our current criteria set, we plan to construct an app evaluation tool with 2 parts: a short section (including 1-3 questions/dimension) to quickly disqualify clearly unsuitable apps and a longer one to investigate more likely candidates in closer detail. We will use a Delphi consensus-building process and develop a user manual to prepare for this undertaking. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42021227064; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227064.
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Affiliation(s)
- Janette Ribaut
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Annette DeVito Dabbs
- School of Nursing, Department of Acute & Tertiary Care, University of Pittsburgh, Pittsburgh, PA, United States
- Clinical Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Fabienne Dobbels
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Alexandra Teynor
- Department of Computer Science, University of Applied Sciences, Augsburg, Germany
| | | | - Theresa Hoffmann
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Department Pflege und Betreuung, Genossenschaft Alterszentrum Kreuzlingen, Kreuzlingen, Switzerland
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Ma Z, Mei Y, Su Z. Understanding the Benefits and Challenges of Using Large Language Model-based Conversational Agents for Mental Well-being Support. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1105-1114. [PMID: 38222348 PMCID: PMC10785945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Conversational agents powered by large language models (LLM) have increasingly been utilized in the realm of mental well-being support. However, the implications and outcomes associated with their usage in such a critical field remain somewhat ambiguous and unexplored. We conducted a qualitative analysis of 120 posts, encompassing 2917 user comments, drawn from the most popular subreddit focused on mental health support applications powered by large language models (u/Replika). This exploration aimed to shed light on the advantages and potential pitfalls associated with the integration of these sophisticated models in conversational agents intended for mental health support. We found the app (Replika) beneficial in offering on-demand, non-judgmental support, boosting user confidence, and aiding self-discovery. Yet, it faced challenges in filtering harmful content, sustaining consistent communication, remembering new information, and mitigating users' overdependence. The stigma attached further risked isolating users socially. We strongly assert that future researchers and designers must thoroughly evaluate the appropriateness of employing LLMs for mental well-being support, ensuring their responsible and effective application.
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Affiliation(s)
- Zilin Ma
- Harvard University, Cambridge, MA
| | | | - Zhaoyuan Su
- University of California, Irvine, Irvine, CA
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Yang C, Coney L, Mohanraj D, Casanova-Perez R, Bascom E, Efrem N, Garcia JT, Sabin J, Pratt W, Weibel N, Hartzler AL. Imagining Improved Interactions: Patients' Designs To Address Implicit Bias. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:774-783. [PMID: 38222327 PMCID: PMC10785874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Implicit biases may negatively influence healthcare providers' behaviors toward patients from historically marginalized communities, impacting providers' communication style, clinical decision-making, and delivery of quality care. Existing interventions to mitigate negative experiences of implicit biases are primarily designed to increase recognition and management of stereotypes and prejudices through provider-facing tools and resources. However, there is a gap in understanding and designing interventions from patient perspectives. We conducted seven participatory co-design workshops with 32 Black, Indigenous, People of Color (BIPOC), Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+), and Queer, Transgender, Black, Indigenous, People of Color (QTBIPOC) individuals to design patient-centered interventions that help them address and recover from provider implicit biases in primary care. Participants designed four types of solutions: accountability measures, real-time correction, patient enablement tools, and provider resources. These informatics interventions extend the research on implicit biases in healthcare through inclusion of valuable, firsthand patient perspectives and experiences.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nadir Weibel
- University of California San Diego, San Diego, CA
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Suresh U, Ancker JS, Zikmund-Fisher BJ, Benda NC. Designing Support to help Health Communication Professionals Convey Numbers Clearly to the Public - A Needs Assessment and Formative Usability Evaluation. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1277-1286. [PMID: 38222428 PMCID: PMC10785911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Communicating health-related probabilities to patients and the public presents challenges, although multiple studies have demonstrated that we can promote comprehension and appropriate application of numbers by matching presentation formats (e.g., percentage, bar charts, icon arrays) to communication goal (e.g., improving recall, decreasing worry, taking action). We used this literature to create goal-driven, evidence-based guidance to support health communicators in conveying probabilities. We then conducted semi-structured interviews with 39 health communicators to understand: communicators' goals for expressing probabilities, formats they choose to convey probabilities, and perceptions of prototypes of our "communicating numbers clearly" guidance. We found that communicators struggled to articulate granular goals for their communication, impeding their ability to select appropriate guidance. Future work should consider how best to support health communicators in selecting granular, differentiable goals to support broadly comprehensible information design.
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Affiliation(s)
- Uday Suresh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, Department of Internal Medicine, and the Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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Shaw G, Castro BA, Gunn LH, Norris K, Thorpe RJ. The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data. JMIR Mhealth Uhealth 2024; 12:e46656. [PMID: 38198196 PMCID: PMC10809169 DOI: 10.2196/46656] [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: 02/22/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. OBJECTIVE The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (≥18 years of age) with obesity (BMI ≥30 kg/m2). METHODS Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. RESULTS A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor's office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. CONCLUSIONS This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps.
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Affiliation(s)
- George Shaw
- Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Bianca A Castro
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Laura H Gunn
- Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Keith Norris
- The University of California Los Angeles Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, United States
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Stead WW, Miller RA, Ohno-Machado L, Bakken S. JAMIA at 30: looking back and forward. J Am Med Inform Assoc 2023; 31:1-9. [PMID: 38134400 PMCID: PMC10746314 DOI: 10.1093/jamia/ocad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 12/24/2023] Open
Affiliation(s)
- William W Stead
- Department of Biomedical Informatics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Randolph A Miller
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Alexandria, VA 37232, United States
| | - Lucila Ohno-Machado
- Section of Biomedical Informatics & Data Science, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Suzanne Bakken
- School of Nursing, Department of Biomedical Informatics, Data Science Institute, Columbia University, New York, NY 10032, United States
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Fournier V, Duprez C, Grynberg D, Antoine P, Lamore K. Are digital health interventions valuable to support patients with cancer and caregivers? An umbrella review of web-based and app-based supportive care interventions. Cancer Med 2023; 12:21436-21451. [PMID: 37937812 PMCID: PMC10726780 DOI: 10.1002/cam4.6695] [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: 08/02/2023] [Revised: 09/28/2023] [Accepted: 10/27/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Digital health technologies have expanded tremendously in the last two decades, creating an emerging research and clinical field. They are regarded as cost-effective, and their use in healthcare is prioritized by many countries. However, the constant evolution of these technologies has led to an abundance of related literature. Thus, we conducted an umbrella review to identify and characterize digital supportive care interventions for patients with cancer and their relatives. METHODS A preregistered umbrella review was conducted (PROSPERO registration number CRD42022333110). Five databases were searched (Embase, PsycINFO, PubMed, CINAHL, and the Cochrane Library). To be considered, studies had to be systematic reviews or meta-analyses, be performed on pediatric or adult patients with cancer or survivors or their relatives, report results on web-based or app-based supportive care interventions, and measure psychological, functional, or behavioral variables or quality of life related to cancer. The methodological quality of the studies was assessed using the AMSTAR-2 tool. FINDINGS Twenty eligible studies were identified. Most of the included studies reported results from adult patients with cancer. Globally, digital interventions were shown to be effective for physical activity in patients with cancer but had mixed results regarding emotional outcomes and quality of life. Additionally, a lack of methodological quality was noted for most of the included reviews. DISCUSSION Digital supportive care interventions could be an effective tool in cancer care for some outcomes. Recommendations have been formulated for further research in this field using adapted methodologies for the development of digital health interventions.
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Affiliation(s)
- Valentyn Fournier
- Universite de Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences AffectivesLilleFrance
| | - Christelle Duprez
- Universite de Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences AffectivesLilleFrance
| | - Delphine Grynberg
- Universite de Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences AffectivesLilleFrance
- Institut Universitaire de FranceParisFrance
| | - Pascal Antoine
- Universite de Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences AffectivesLilleFrance
| | - Kristopher Lamore
- Universite de Lille, CNRS, UMR 9193—SCALab—Sciences Cognitives et Sciences AffectivesLilleFrance
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Toulany A, Kurdyak P, Stukel TA, Strauss R, Fu L, Guan J, Fiksenbaum L, Cohen E, Guttmann A, Vigod S, Chiu M, Moore Hepburn C, Moran K, Gardner W, Cappelli M, Sundar P, Saunders N. Sociodemographic Differences in Physician-Based Mental Health and Virtual Care Utilization and Uptake of Virtual Care Among Children and Adolescents During the COVID-19 Pandemic in Ontario, Canada: A Population-Based Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:904-915. [PMID: 36855797 PMCID: PMC9982398 DOI: 10.1177/07067437231156254] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic. METHODS This population-based repeated cross-sectional study of children and adolescents (3-17 years; N = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status. RESULTS Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata. CONCLUSION During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.
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Affiliation(s)
- Alene Toulany
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Paul Kurdyak
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Therese A. Stukel
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | | | - Lisa Fiksenbaum
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
| | - Eyal Cohen
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
| | - Simone Vigod
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital and Women's College Research Institute, Toronto, Canada
| | - Maria Chiu
- ICES, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Charlotte Moore Hepburn
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - William Gardner
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Mario Cappelli
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Purnima Sundar
- Knowledge Institute on Child and Youth Mental Health and Addictions, Ottawa, Canada
| | - Natasha Saunders
- The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Canada
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Fabian KE, Foster KT, Chwastiak L, Turner M, Wagenaar BH. Adapting a transdiagnostic digital mental health intervention for use among immigrant and refugee youth in Seattle: a human-centered design approach. Transl Behav Med 2023; 13:867-875. [PMID: 37418614 PMCID: PMC11009687 DOI: 10.1093/tbm/ibad041] [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: 07/09/2023] Open
Abstract
Digital mental health interventions show promise in addressing mental health needs, especially among youth and marginalized communities. This study adapted the World Health Organization -developed STARS (Sustainable Technology for Adolescents to Reduce Stress) digital mental health intervention for use among youth and young adults aged 14-25 from immigrant and refugee communities in Seattle, Washington. Human-centered design methods centered around qualitative semi-structured interviews were used to contextually and culturally adapt the intervention and prioritize the needs and preferences of the intended end user. Intervention prototypes were modified and then presented to the target groups in iterative cycles until saturation was achieved. Qualitative interviews occurred in three iterations of five participants each. Modifications were documented according to the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) implementation science framework. Modifications aligned with the FRAME process elements: (a) tailoring/refining, which included adapting language to less resemble digital phishing scams; (b) changes in packaging or materials, which included naming the chatbot and adopting a corresponding avatar; (c) adding/removing, which included changing existing emojis and adding additional media types including graphics interchange format images, pictures, and voice memos; (d) shortening/condensing, which included shortening the length of individual text sections as well as deleting redundant language; (e) lengthening/extending, which included allowing the user to choose to receive content catered to teenagers or to adults; and (f) loosening structure, including giving users options to skip parts of modules or to engage with additional material. The modified STARS intervention shows promise for engagement with immigrant and refugee youth in Seattle and can be examined for clinical effectiveness. Adaptations increased the relevance of content to the intended end user, expanded options for personalization and customization of the user experience, and utilized language that was age appropriate, engaging, and did not invoke feelings of stigma or distrust. Adaptations of digital mental health interventions should focus on modifications that maximize acceptability and appropriateness to intended audiences.
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Affiliation(s)
- Katrin E Fabian
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Katherine T Foster
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Morgan Turner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Masterson Creber R, Benda N, Dimagli A, Myers A, Niño de Rivera S, Omollo S, Sharma Y, Goyal P, Turchioe MR. Using Patient Decision Aids for Cardiology Care in Diverse Populations. Curr Cardiol Rep 2023; 25:1543-1553. [PMID: 37943426 PMCID: PMC10914300 DOI: 10.1007/s11886-023-01953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE OF REVIEW Patient decision aids (PDAs) are tools that help guide treatment decisions and support shared decision-making when there is equipoise between treatment options. This review focuses on decision aids that are available to support cardiac treatment options for underrepresented groups. RECENT FINDINGS PDAs have been developed to support multiple treatment decisions in cardiology related to coronary artery disease, valvular heart disease, cardiac arrhythmias, heart failure, and cholesterol management. By considering the unique needs and preferences of diverse populations, PDAs can enhance patient engagement and promote equitable healthcare delivery in cardiology. In this review, we examine the benefits, challenges, and current trends in implementing PDAs, with a focus on improving decision-making processes and outcomes for patients from underrepresented racial and ethnic groups. In addition, the article highlights key considerations when implementing PDAs and potential future directions in the field.
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Affiliation(s)
- Ruth Masterson Creber
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA.
| | - Natalie Benda
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Arnaldo Dimagli
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Annie Myers
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Stephanie Niño de Rivera
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Shalom Omollo
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Yashika Sharma
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | | | - Meghan Reading Turchioe
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
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Boguslawski SM, Joseph NT, Stanhope KK, Ti AJ, Geary FH, Boulet SL. Impact of the COVID-19 Pandemic on Prenatal Care Utilization at a Public Hospital. Am J Perinatol 2023; 40:1484-1494. [PMID: 35709724 DOI: 10.1055/a-1877-7951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of the study is to compare rates of prenatal care utilization before and after implementation of a telehealth-supplemented prenatal care model due to the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN Using electronic medical record data, we identified two cohorts of pregnant persons that initiated prenatal care prior to and during the COVID-19 pandemic following the implementation of telehealth (from March 1, 2019 through August 31, 2019, and from March 1, 2020, through August 31, 2020, respectively) at Grady Memorial Hospital. We used Pearson's Chi-square and two-tailed t-tests to compare rates of prenatal care utilization, antenatal screening and immunizations, emergency department and obstetric triage visits, and pregnancy complications for the prepandemic versus pandemic-exposed cohorts. RESULTS We identified 1,758 pregnant patients; 965 entered prenatal care prior to the COVID-19 pandemic and 793 entered during the pandemic. Patients in the pandemic-exposed cohort were more likely to initiate prenatal care in the first trimester (46.1 vs. 39.0%, p = 0.01), be screened for gestational diabetes (74.4 vs. 67.0%, p <0.001), and receive dating and anatomy ultrasounds (17.8 vs. 13.0%, p = 0.006 and 56.9 vs. 47.3%, p <0.001, respectively) compared with patients in the prepandemic cohort. There was no difference in mean number of prenatal care visits between the two groups (6.9 vs. 7.1, p = 0.18). Approximately 41% of patients in the pandemic-exposed cohort had one or more telehealth visits. The proportion of patients with one or more emergency department visits was higher in the pandemic-exposed cohort than the prepandemic cohort (32.8 vs. 12.3%, p < 0.001). Increases in rates of labor induction were also observed among the pandemic-exposed cohort (47.1 vs. 38.2%, p <0.001). CONCLUSION Rates of prenatal care utilization were similar before and during the COVID-19 pandemic. However, pregnant persons receiving prenatal care during the pandemic entered care earlier and had higher utilization of certain antenatal screening services than those receiving prenatal care prior to the pandemic. KEY POINTS · Patients initiated prenatal care earlier during the COVID-19 pandemic.. · Uptake of telehealth services was low.. · Rates of diabetes screening and ultrasound use increased during the pandemic..
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Affiliation(s)
- Shae M Boguslawski
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Naima T Joseph
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kaitlyn K Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Angeline J Ti
- Department of Family Medicine, Wellstar Atlanta Medical Center, Atlanta, Georgia
| | - Franklyn H Geary
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta, Georgia
| | - Sheree L Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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Bourgeois FC, Hart NJ, Dong Z, Ngo LH, DesRoches CM, Thomas EJ, Bell SK. Partnering with Patients and Families to Improve Diagnostic Safety through the OurDX Tool: Effects of Race, Ethnicity, and Language Preference. Appl Clin Inform 2023; 14:903-912. [PMID: 37967936 PMCID: PMC10651368 DOI: 10.1055/s-0043-1776055] [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: 03/02/2023] [Accepted: 07/24/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Patients and families at risk for health disparities may also be at higher risk for diagnostic errors but less likely to report them. OBJECTIVES This study aimed to explore differences in race, ethnicity, and language preference associated with patient and family contributions and concerns using an electronic previsit tool designed to engage patients and families in the diagnostic process (DxP). METHODS Cross-sectional study of 5,731 patients and families presenting to three subspecialty clinics at an urban pediatric hospital May to December 2021 who completed a previsit tool, codeveloped and tested with patients and families. Prior to each visit, patients/families were invited to share visit priorities, recent histories, and potential diagnostic concerns. We used logistic regression to determine factors associated with patient-reported diagnostic concerns. We conducted chart review on a random subset of visits to review concerns and determine whether patient/family contributions were included in the visit note. RESULTS Participants provided a similar mean number of contributions regardless of patient race, ethnicity, or language preference. Compared with patients self-identifying as White, those self-identifying as Black (odds ratio [OR]: 1.70; 95% confidence interval [CI]: [1.18, 2.43]) or "other" race (OR: 1.48; 95% CI: [1.08, 2.03]) were more likely to report a diagnostic concern. Participants who preferred a language other than English were more likely to report a diagnostic concern than English-preferring patients (OR: 2.53; 95% CI: [1.78, 3.59]. There were no significant differences in physician-verified diagnostic concerns or in integration of patient contributions into the note based on race, ethnicity, or language preference. CONCLUSION Participants self-identifying as Black or "other" race, or those who prefer a language other than English were 1.5 to 2.5 times more likely than their counterparts to report potential diagnostic concerns when proactively asked to provide this information prior to a visit. Actively engaging patients and families in the DxP may uncover opportunities to reduce the risk of diagnostic errors and potential safety disparities.
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Affiliation(s)
- Fabienne C. Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Nicholas J. Hart
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Zhiyong Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Long H. Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Catherine M. DesRoches
- Harvard Medical School, Boston, Massachusetts, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Eric J. Thomas
- Department of Medicine, University of Texas at Houston Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, United States
- McGovern Medical School at the University of Texas Health Science Center Houston, Houston, Texas, United States
| | - Sigall K. Bell
- Harvard Medical School, Boston, Massachusetts, United States
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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Vázquez-Otero C, Bekalu MA, Dhawan D, Viswanath K. Tobacco-control policy support among people from low socioeconomic positions in Massachusetts. Prev Med Rep 2023; 35:102336. [PMID: 37564123 PMCID: PMC10410238 DOI: 10.1016/j.pmedr.2023.102336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 06/14/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023] Open
Abstract
People from low socioeconomic positions (SEP) are at a higher risk of smoking, face greater barriers to smoking cessation, and have lower access to health information. To improve tobacco-related health outcomes, policies requiring altering labeling on cigarette packs could be implemented. However, public support is needed to influence the policymaking process. We assessed factors associated with supporting tobacco-control communication policies. We analyzed data from Project CLEAR, a study conducted in Massachusetts. The analytic sample included participants who answered questions on their support for three policies: 1) graphic health warnings (GHWs), 2) Quitline number, and 3) smoking cessation information on cigarette packs (n = 357). Binomial logistic regression modeling was conducted by policy. Independent variables included demographic characteristics and smoking status. We found that younger vs. older individuals (aOR = 0.41, 95 %CI:0.23-0.72), males vs. females (aOR = 0.58, 95 %CI:0.35-0.96), and people who smoke vs. those who don't smoke (aOR = 0.41, 95 %CI:0.24-0.70) were less likely to support a law requiring GHWs. Participants with a low vs. higher level of education (aOR = 0.55, 95 %CI:0.32-0.95) were less likely to support a law requiring a Quitline number. Younger (18-39) vs. older individuals (aOR = 0.53, 95 %CI:0.29-0.94), males vs. females (aOR = 0.57, 95 %CI:0.34-0.96), and participants with a low vs. higher level of education (aOR = 0.56, 95 %CI:0.32-0.98) were less likely to support a law requiring cessation information on cigarette packs. Findings suggest that targeted theory-based public health and communication strategies should be developed to increase awareness and support towards policies that would help reduce cigarette smoking among people from low SEP to eliminate tobacco-related health inequities in the US.
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Affiliation(s)
- Coralia Vázquez-Otero
- Department of Public Health, College for Health, Community and Policy, University of Texas at San Antonio, TX, USA
| | - Mesfin A. Bekalu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Dhriti Dhawan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
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Garrood A, Bjornstad G, Borek A, Gillett A, Lloyd J, Brand S, Tarrant M, Ball S, Hawton A, McDonald A, Fredlund M, Boyle F, Berry V, Logan S, Morris C. Healthy Parent Carers: Acceptability and practicability of online delivery and learning through implementation by delivery partner organisations. Health Expect 2023; 26:2050-2063. [PMID: 37401625 PMCID: PMC10485339 DOI: 10.1111/hex.13812] [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: 11/16/2022] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Parent carers of disabled children are at increased risk of physical and mental health problems. The Healthy Parent Carers (HPC) programme is a manualised peer-led group-based programme that aims to promote parent carer health and wellbeing. Previously, the programme had been delivered in person, with recruitment and delivery managed in a research context. This study explored implementation by two delivery partner organisations in the United Kingdom. Facilitator Training and Delivery Manuals were modified for online delivery using Zoom due to COVID-19. METHODS The study methodology utilised the Replicating Effective Programs framework. A series of stakeholder workshops informed the development of the Implementation Logic Model and an Implementation Package. After delivering the programme, delivery partner organisations and facilitators participated in a workshop to discuss experiences of implementing the programme. A wider group of stakeholders, including commissioners, Parent Carer Forums and charity organisations representatives and researchers subsequently met to consider the sustainability and potential barriers to delivering the programme outside the research context. RESULTS This study explored implementation by two delivery partner organisations in the United Kingdom that were able to recruit facilitators, who we trained, and they recruited participants and delivered the programme to parent carers in different localities using Zoom. The co-created Implementation Logic Model and Implementation Package were subsequently refined to enable the further roll-out of the programme with other delivery partner organisations. CONCLUSIONS This study provides insight and understanding of how the HPC programme can be implemented sustainably outside of the research context. Further research will evaluate the effectiveness of the programme and refine the implementation processes. PATIENT AND PUBLIC CONTRIBUTION Parent carers, delivery partner organisation staff and service commissioners were consulted on the design, delivery and reporting of the research.
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Affiliation(s)
- Alice Garrood
- Peninsula Childhood Disability Research Unit (PenCRU) and NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical School, University of ExeterExeterUK
| | - Gretchen Bjornstad
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Aleksandra Borek
- Nuffield Department of Primary Care Health Sciences, Medical Sciences DivisionUniversity of Oxford, Radcliffe Observatory QuarterOxfordUK
| | - Annette Gillett
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Jenny Lloyd
- Relational Health Group and NIHR Applied Research Collaboration (PenARC) South West Peninsula, Department of Health and Community Sciences, Institute of Health Research, University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Sarah Brand
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Mark Tarrant
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Susan Ball
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Annie Hawton
- Health Economics Group and NIHR Applied Research Collaboration (PenARC) South West PeninsulaUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Annabel McDonald
- Peninsula Childhood Disability Research Unit (PenCRU) and NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical School, University of ExeterExeterUK
| | - Mary Fredlund
- Peninsula Childhood Disability Research Unit (PenCRU) and NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical School, University of ExeterExeterUK
| | - Fleur Boyle
- Peninsula Childhood Disability Research Unit (PenCRU) and NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical School, University of ExeterExeterUK
| | - Vashti Berry
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Stuart Logan
- Peninsula Childhood Disability Research Unit (PenCRU) and NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical School, University of ExeterExeterUK
| | - Christopher Morris
- Peninsula Childhood Disability Research Unit (PenCRU) and NIHR Applied Research Collaboration South West Peninsula (PenARC)University of Exeter Medical School, University of ExeterExeterUK
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Paik KE, Hicklen R, Kaggwa F, Puyat CV, Nakayama LF, Ong BA, Shropshire JNI, Villanueva C. Digital Determinants of Health: Health data poverty amplifies existing health disparities-A scoping review. PLOS DIGITAL HEALTH 2023; 2:e0000313. [PMID: 37824445 PMCID: PMC10569513 DOI: 10.1371/journal.pdig.0000313] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/02/2023] [Indexed: 10/14/2023]
Abstract
Artificial intelligence (AI) and machine learning (ML) have an immense potential to transform healthcare as already demonstrated in various medical specialties. This scoping review focuses on the factors that influence health data poverty, by conducting a literature review, analysis, and appraisal of results. Health data poverty is often an unseen factor which leads to perpetuating or exacerbating health disparities. Improvements or failures in addressing health data poverty will directly impact the effectiveness of AI/ML systems. The potential causes are complex and may enter anywhere along the development process. The initial results highlighted studies with common themes of health disparities (72%), AL/ML bias (28%) and biases in input data (18%). To properly evaluate disparities that exist we recommend a strengthened effort to generate unbiased equitable data, improved understanding of the limitations of AI/ML tools, and rigorous regulation with continuous monitoring of the clinical outcomes of deployed tools.
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Affiliation(s)
- Kenneth Eugene Paik
- MIT Critical Data, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Rachel Hicklen
- Research Medical Library, MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Fred Kaggwa
- Department of Computer Science, Mbarara University of Science & Technology, Mbarara, Uganda
| | | | - Luis Filipe Nakayama
- MIT Critical Data, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Ophthalmology, São Paulo Federal University, São Paulo, Brazil
| | - Bradley Ashley Ong
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | | | - Cleva Villanueva
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Mexico City, Mexico
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50
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Buis LR, Brown LK, Plegue MA, Kadri R, Laurie AR, Guetterman TC, Vydiswaran VGV, Li J, Veinot TC. Identifying Inequities in Video and Audio Telehealth Services for Primary Care Encounters During COVID-19: Repeated Cross-Sectional, Observational Study. J Med Internet Res 2023; 25:e49804. [PMID: 37773609 PMCID: PMC10544805 DOI: 10.2196/49804] [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: 06/09/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. OBJECTIVE The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. METHODS We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). RESULTS In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8%-74.1%), be female (58.8%-61.8%), be White (75.6%-76.7%), and have no significant comorbidities (63.2%-66.8%) or disabilities (53.2%-61.1%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. CONCLUSIONS Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future.
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Affiliation(s)
- Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Lindsay K Brown
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Melissa A Plegue
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Anna R Laurie
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Timothy C Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - V G Vinod Vydiswaran
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Jiazhao Li
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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