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Kepper MM, Fowler LA, Kusters IS, Davis JW, Baqer M, Sagui-Henson S, Xiao Y, Tarfa A, Yi JC, Gibson B, Heron KE, Alberts NM, Burgermaster M, Njie-Carr VP, Klesges LM. Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity. J Med Internet Res 2024; 26:e51355. [PMID: 39088246 PMCID: PMC11327633 DOI: 10.2196/51355] [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: 07/28/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 08/02/2024] Open
Abstract
The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.
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Affiliation(s)
- Maura M Kepper
- Prevention Research Center, Washington University in St. Louis, St. Louis, MO, United States
| | - Lauren A Fowler
- Sexuality, Health, and Gender Center, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States
| | - Isabelle S Kusters
- Department of Health, Human, and Biomedical Sciences, University of Houston-Clear Lake, Houston, TX, United States
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, FL, United States
| | - Manal Baqer
- Neamah Health Consulting, Boston, MA, United States
| | - Sara Sagui-Henson
- Clinical Strategy and Research Team, Modern Health, San Francisco, CA, United States
| | - Yunyu Xiao
- Department of Population Health Science, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Adati Tarfa
- School of Medicine, Yale University, New Haven, CT, United States
| | - Jean C Yi
- Fred Hutchinson Cancer Center, Seattle, WA, United States
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kristin E Heron
- Psychology Department, Old Dominion University, Norfolk, VA, United States
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, United States
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Marissa Burgermaster
- Department of Nutritional Sciences, University of Texas at Austin, Austin, TX, United States
- Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, TX, United States
| | - Veronica Ps Njie-Carr
- Department of Organizational Systems and Adult Health, University of Maryland, Baltimore, MD, United States
| | - Lisa M Klesges
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
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Hill TG, Langley JE, Kervin EK, Pesut B, Duggleby W, Warner G. An Integrative Review on the Feasibility and Acceptability of Delivering an Online Training and Mentoring Module to Volunteers Working in Community Organizations. Front Digit Health 2021; 3:688982. [PMID: 34723241 PMCID: PMC8551809 DOI: 10.3389/fdgth.2021.688982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Volunteer programs that support older persons can assist them in accessing healthcare in an efficient and effective manner. Community-based initiatives that train volunteers to support patients with advancing illness is an important advance for public health. As part of implementing an effective community-based volunteer-based program, volunteers need to be sufficiently trained. Online training could be an effective and safe way to provide education for volunteers in both initial training and/or continuing education throughout their involvement as a volunteer. Method: We conducted an integrative review that synthesized literature on online training programs for volunteers who support older adults. The review included both a search of existing research literature in six databases, and an online search of online training programs currently being delivered in Canada. The purpose of this review was to examine the feasibility and acceptability of community-based organizations adopting an online training format for their volunteers. Results: The database search identified 13,626 records, these went through abstract and full text screen resulting in a final 15 records. This was supplemented by 2 records identified from hand searching the references, for a total of 17 articles. In addition to identifying Volunteers Roles and Responsibilities; Elements of Training; and Evaluation of Feasibility and Acceptability; a thematic analysis of the 17 records identified the categories: (1) Feasibility Promoting Factors; (2) Barriers to Feasibility; (3) Acceptability Promoting Factors; and (4) Barriers to Acceptability. Six programs were also identified in the online search of online training programs. These programs informed our understanding of delivery of existing online volunteer training programs. Discussion: Findings suggested that feasibility and acceptability of online training were promoted by (a) topic relevant training for volunteers; (b) high engagement of volunteers to prevent attrition; (c) mentorship or leadership component. Challenges to online training included a high workload; time elapsed between training and its application; and client attitude toward volunteers. Future research on online volunteer training should consider how online delivery can be most effectively paced to support volunteers in completing training and the technical skills needed to complete the training and whether teaching these skills can be integrated into programs.
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Affiliation(s)
- Taylor G. Hill
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jodi E. Langley
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Emily K. Kervin
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Barbara Pesut
- Nursing, University of British Columbia, Okanagan, BC, Canada
| | | | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
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Rassu FS, Sansgiry S, Hundt NE, Kunik ME, Cully JA. Presence of PTSD is Associated with Clinical and Functional Impact in Veterans with Depression Treated in Community-Based Clinics. J Clin Psychol Med Settings 2021; 29:220-229. [PMID: 34156589 DOI: 10.1007/s10880-021-09796-y] [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: 06/05/2021] [Indexed: 11/25/2022]
Abstract
Providers in non-traditional mental health settings (e.g., primary care, community medical clinics) face challenges involving patients who often present with multiple mental health conditions, but require rapid assessment and treatment. To help address this challenge, this study characterized differences in health symptom severity and mental health treatment perceptions between depressed Veterans with and without posttraumatic stress disorder (PTSD) served in community medical clinics. Relative to depressed Veterans without PTSD (N = 62), depressed Veterans with PTSD (N = 122) endorsed greater depression, suicidal ideation, anxiety, pain, and insomnia symptoms, as well as lower functioning. Veterans with depression and PTSD also reported greater mental health needs, prior utilization of mental health services, and higher perceived importance of mental health treatment. Results highlight the complexity of comorbid mental health conditions frequently seen in community medical care clinics and suggest that patients with comorbid mental health difficulties may present with a complex array of mental health symptoms.
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Affiliation(s)
- Fenan S Rassu
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 400, Houston, TX, 77030, USA.
| | - Shubhada Sansgiry
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Natalie E Hundt
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 400, Houston, TX, 77030, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Mark E Kunik
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 400, Houston, TX, 77030, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey A Cully
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd., Suite 400, Houston, TX, 77030, USA
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
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Gavarkovs AG, Blunt W, Petrella RJ. A protocol for designing online training to support the implementation of community-based interventions. EVALUATION AND PROGRAM PLANNING 2019; 72:77-87. [PMID: 30316943 DOI: 10.1016/j.evalprogplan.2018.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
Training program implementers through online methods represents a way of facilitating the widespread implementation of community-based interventions that is more financially and logistically feasible than traditional in-person training methods. However, there are few evidence-informed protocols or models that can guide the development of online training content in a way that is consistent with instructional best practices. This paper presents an evidence-informed protocol for developing a training website, or online training platform, to support the implementation of community-based interventions at scale, which was informed by a critical analysis of the instructional design literature and our experiences developing an online training platform for the HealtheStepsTM Lifestyle Prescription Program. The protocol is an operationalization of the ADDIE model of instructional design, and details the analysis, design, development, implementation, and evaluation stages of the process. Examples from the HealtheStepsTM program are used to illustrate the use of the protocol in practice. The protocol emphasizes the need for rigorous analysis of the target audience and a multidisciplinary literature base drawing from instructional design and implementation science. It can be used by researchers to guide the development of online training platforms to support the widespread implementation of evidence-based health interventions, thus increasing their public health impact.
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Affiliation(s)
| | - Wendy Blunt
- Center for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Robert J Petrella
- Center for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Faculty of Health Sciences, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
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