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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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Dunn RC, Stegall CJ, Creel C, Fuchs CJ, Menzies BE, Summers NA. Evaluating the delivery of care by telemedicine for incarcerated people living with HIV: a cohort study. BMC Infect Dis 2024; 24:717. [PMID: 39039476 PMCID: PMC11265178 DOI: 10.1186/s12879-024-09528-1] [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: 02/15/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The use of telemedicine has grown significantly since the COVID-19 pandemic and has the potential to improve access to specialized care for otherwise underserved populations. Incarcerated people living with HIV (PLWH) could potentially benefit from expanded access to HIV care through telemedicine. METHODS All PLWH who were incarcerated within the Tennessee Department of Corrections and received care through the HIV telemedicine clinic at Regional One Hospital between 5/1/2019 through 2/28/2022 were identified from the electronic health records (EHR). Demographics, laboratory data, vaccine history, and treatment outcomes were abstracted from the EHR. Retention in care and viral suppression were defined using Centers for Disease Control and Prevention definitions. RESULTS Of the 283 incarcerated PLWH receiving care from this telemedicine clinic, 78% remained retained in care and 94% achieved or maintaining viral suppression at 12 months. Many preventative care measures remained unperformed or undocumented, including vaccinations and testing for concurrent sexually transmitted infections. There were 56 patients (20%) found to have chronic hepatitis C in this population, with 71% either cured or still on treatment in this study period. CONCLUSIONS Retention in care and viral suppression rates were excellent among incarcerated PLWH receiving telemedicine care for their HIV. HIV related primary health care screenings and vaccinations, however, were less consistently documented and represent areas for improvement.
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Affiliation(s)
- Ruth C Dunn
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Cassidy J Stegall
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Colten Creel
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Christian J Fuchs
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Barbara E Menzies
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nathan A Summers
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.
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Lin C, Nguyen BD, Nguyen TT, Dang HT, Li L, Giang LM. Empowering Women Living with HIV/AIDS in Vietnam: A Hybrid Online-Offline Intervention to Combat Stigma. AIDS Behav 2024:10.1007/s10461-024-04439-3. [PMID: 38992226 DOI: 10.1007/s10461-024-04439-3] [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: 06/27/2024] [Indexed: 07/13/2024]
Abstract
Women living with HIV/AIDS (WLHA) encounter numerous challenges, such as stigma and gender disparities, that hinder their access to care, especially in patriarchal societies like Vietnam. We developed a hybrid intervention with online and offline (in-person) components to empower WLHA in Vietnam. The intervention was pilot tested with 91 WLHA in Hanoi. During baseline and 4-month, study investigators delivered two in-person sessions, one Zoom session, and 15 weeks of Zalo (social media platform) discussions to enhance positive coping strategies, treatment utilization and adherence, and engagement of support from family and peers. The participants continued their Zalo discussions from 4-month to 6-month without investigators' involvement. Intervention outcomes, including active coping and perceived barriers to care, were evaluated at baseline, 4-, and 6-month surveys. Mixed-effects regression models showed that the participants' active coping significantly increased from baseline (50.5 ± 9.4) to 4-month (53.8 ± 6.2; p = 0.0001), although there was a slight decrease at 6-month (52.8 ± 7.2), the change from 4-month to 6-month was not significantly significant (p = 0.3256). There was a significant reduction in participants' perceived barriers to care, from 19.8 ± 5.2 at baseline to 17.4 ± 5.2 at 4-month (p < 0.0001), which remained stable at 17.8 ± 4.3 at 6-month (p < 0.0001 compared to baseline). This intervention presents a promising model to empower WLHA in Vietnam and potentially in similar global contexts. Future interventions could benefit from leveraging natural peer leaders and adopting a more person-centered approach to meet WLHA's varying needs.
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Affiliation(s)
- Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 760 Westwood Plaza, 17-369E, Los Angeles, CA, 90024, USA.
| | - Bich Diep Nguyen
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Đống Đa, Vietnam
| | - Thu Trang Nguyen
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Đống Đa, Vietnam
| | - Huong Thi Dang
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Đống Đa, Vietnam
| | - Li Li
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California, Los Angeles, 760 Westwood Plaza, 17-369E, Los Angeles, CA, 90024, USA
| | - Le Minh Giang
- Center for Training and Research on Substance Use & HIV, Hanoi Medical University, Đống Đa, Vietnam
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Liang E, Nkwonta CA, Goldsamt LA, Navarra AMD. A qualitative assessment of retention in HIV care among adolescents and young adults (AYA) living with HIV in New York City. AIDS Care 2024:1-10. [PMID: 38976575 DOI: 10.1080/09540121.2024.2373402] [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: 11/15/2023] [Accepted: 06/21/2024] [Indexed: 07/10/2024]
Abstract
Retention in HIV care is a critical precursor to ending the epidemic yet remains suboptimal in the United States. Gaining an understanding of the challenges faced by adolescents and young adults (AYA) living with HIV is essential to improving retention in HIV care. This study explored the barriers and facilitators to retention in care among Black and Hispanic AYA living with HIV. Audio-recorded semi-structured interviews were conducted with 20 AYA living with HIV ages 16-29 years in New York City. Our methods entailed an inductive content analysis to explore key concepts, reconcile codes, and identify a theme, categories, and subcategories. Bronfenbrenner's socioecological model evolved as an organizing framework around barriers and facilitators to retention in care at the individual, interpersonal, healthcare system, and structural level. Data analysis yielded one overarching theme-the influence of psychosocial factors on retention in HIV care. Psychological struggles, powerlessness, clinic-level characteristics, and socioeconomic struggles were barriers reported by participants. Self-responsibility, social support, patient-friendly healthcare services, and socioeconomic resources emerged as facilitators. Retention in HIV care among AYA living with HIV is a multifaceted and complex phenomenon that involves multiple systems. Strengthening patients, healthcare system, and community partnerships can help address some of the HIV-related health disparities.
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Affiliation(s)
- Eva Liang
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Lloyd A Goldsamt
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Spaulding EM, Fang M, Chen Y, Commodore-Mensah Y, Himmelfarb CR, Martin SS, Coresh J. Satisfaction with Telehealth Care in the United States: Cross-Sectional Survey. Telemed J E Health 2024; 30:1549-1558. [PMID: 38452337 PMCID: PMC11302190 DOI: 10.1089/tmj.2023.0531] [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: 10/12/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 03/09/2024] Open
Abstract
Background: Telehealth use remains high following the COVID-19 pandemic, but patient satisfaction with telehealth care is unclear. Methods: We used cross-sectional data from the Health Information National Trends Survey (HINTS 6). 2,058 English and Spanish-speaking U.S. adults (≥18 years) with a telehealth visit in the 12 months before March-November 2022 were included in this study. The primary outcomes were telehealth visit modality and satisfaction in the 12 months before HINTS 6. We evaluated sociodemographic predictors of telehealth visit modality and satisfaction via Poisson regression. Analyses were weighted according to HINTS standards. Results: We included 2,058 participants (48.4 ± 16.8 years; 57% women; 66% White), of which 70% had an audio-video and 30% an audio-only telehealth visit. Adults with an audio-video visit were more likely to have health insurance (adjusted prevalence ratio [aPR]: 1.55, 95% confidence interval [CI]: 1.18-2.04) and have an annual household income of ≥$75,000 (aPR: 1.18, 95% CI: 1.00-1.39) and less likely to be ≥65 years (aPR: 0.79, 95% CI: 0.70-0.89), adjusting for sociodemographic characteristics. No further inequities were noted by telehealth modality. Seventy-five percent of participants felt that their telehealth visits were as good as in-person care. No significant differences in telehealth satisfaction were observed across sociodemographic characteristics, telehealth modality, or the participants' primary reason for their most recent telehealth visit in adjusted analysis. Conclusions: Among U.S. adults with a telehealth visit, the majority had an audio-video visit and were satisfied with their care. Telehealth should continue, being offered following COVID-19, as it is uniformly valued by patients.
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Affiliation(s)
- Erin M. Spaulding
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Digital Health Innovation Laboratory, Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael Fang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yuling Chen
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Health Equity, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cheryl R. Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
- Center for Health Equity, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Seth S. Martin
- Digital Health Innovation Laboratory, Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Health Equity, Johns Hopkins University, Baltimore, Maryland, USA
- Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
| | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Optimal Aging Institute and Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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Gaudine A, Parsons K, Smith-Young J. Older Adults' Experiences with Remote Care for Specialized Health Service During the COVID-19 Pandemic: A Descriptive Qualitative Study. Can J Aging 2024; 43:257-265. [PMID: 37869900 DOI: 10.1017/s0714980823000636] [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: 10/24/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic necessitated a rapid uptake of remote health care services. This qualitative descriptive study was designed to gain an understanding of older adults' experiences of remote care (telephone or online video conference appointments) for specialized health services during the COVID-19 pandemic. Twenty-one older adults (ages 65 years and older; 8 men and 13 women) living in eastern Canada participated in a semi-structured telephone interview. Data were analysed using qualitative content analysis. The vast majority of older adults were overall satisfied with their remote experiences of specialist care. Advantages to remote care for specialized services included convenience, safety during the pandemic, comfort, efficiency, and ease of visit. Disadvantages included communication not as effective, feeling depersonalized or disembodied, missing the human relationship, and wanting reassurance of physical assessment. It is important that health professionals understand the disadvantages for older adults of remote care visits in order to mitigate them.
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Affiliation(s)
- Alice Gaudine
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Karen Parsons
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Joanne Smith-Young
- Faculty of Nursing, Memorial University of Newfoundland, St. John's, NL, Canada
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Gass SJ, Yelverton V, Ostermann J, Weissman S, Albrecht H. Which Features of Telehealth in HIV Care Are Most Important? A Mixed-Methods Study With HIV Care Providers and People Living With HIV in South Carolina. Sex Transm Dis 2024; 51:e17-e25. [PMID: 38619229 DOI: 10.1097/olq.0000000000001945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
ABSTRACT Telehealth was rapidly implemented in HIV care during COVID-19 yet remains understudied. To assess the importance of telehealth features, we conducted a mixed-methods study with HIV care providers and people living with HIV. Qualitative interviews and ranking exercises revealed heterogeneity in preference-relevant features of telehealth in HIV care.
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Eaton LA, Huedo-Medina T, Earnshaw VA, Kalichman M, Watson RJ, Driver R, Chandler CJ, Kalinowski J, Kalichman SC. Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:650-660. [PMID: 37898978 DOI: 10.1007/s11121-023-01603-4] [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: 10/31/2023]
Abstract
Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA.
| | | | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | | | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristian J Chandler
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Seth C Kalichman
- Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Bratches RWR, Onsando W, Puga F, Odom JN, Barr PJ. Family Caregiver Comfort with Telehealth Technologies: Differences by Race and Ethnicity in a Cross-Sectional Survey. Telemed J E Health 2024; 30:685-691. [PMID: 37651216 PMCID: PMC11019774 DOI: 10.1089/tmj.2023.0314] [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: 09/02/2023] Open
Abstract
Background: Telehealth has seen widespread use since the onset of the COVID-19 pandemic, and 82% patients required assistance in accessing their telehealth appointments. This assistance commonly comes from a family caregiver who may or may not be comfortable using the technologies associated with telehealth. The objective of our study was to analyze a demographically representative survey of U.S. family caregivers to understand the level of comfort using telehealth technologies among family caregivers. Methods: A secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Level of caregiver comfort using computers, smartphones, and tablets was determined through three Likert-style questions. Proportional odds logistic regression was used to understand the associations between demographic variables and level of caregiver comfort using each technology, when adjusting for covariates. Results: A total of 340 caregivers were included in the analysis. Compared with non-Hispanic white caregivers, Asian caregivers had higher odds (odds ratio [OR] 3.14; 95% confidence interval [CI] 1.36, 8.02; p = 0.01) of expressing comfort using computers; black caregivers (OR 0.46; 95% CI 0.21, 0.98; p = 0.04) and Hispanic caregivers (OR 0.36; 95% CI 0.17, 0.79; p = 0.01) expressed lower odds of comfort using smartphones; and Asian caregivers had higher odds (OR 4.64; 95% CI 2.05, 11.69; p = 0.001) of expressing comfort using tablets. Conclusion and Implications: There are identified disparities in the level of technological comfort using computers, smartphones, and tablets by different racial and ethnic groups. Health systems should consider early stakeholder involvement in the design of telehealth technologies, culturally responsive training materials on telehealth technology use to reduce disparities in comfort using telehealth technologies.
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Affiliation(s)
- Reed W R Bratches
- School of Nursing, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Wambui Onsando
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
| | - Frank Puga
- School of Nursing, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J Nicholas Odom
- School of Nursing, the University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire, USA
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Chen S, Niu M, Ngai CSB. What is the next step of ICT development? The changes of ICT use in promoting elderly healthcare access: A systematic literature review. Heliyon 2024; 10:e25197. [PMID: 38371988 PMCID: PMC10873661 DOI: 10.1016/j.heliyon.2024.e25197] [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: 09/28/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024] Open
Abstract
The objective of this study was to undertake a comprehensive review of the evidence published, with a focus on understanding the experiences of the elderly in leveraging Information and Communication Technology (ICT) for their healthcare needs during the COVID-19 period. In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this review scrutinized all peer-reviewed articles in English sourced from PubMed, PsycINFO, Scopus, and Web of Science, targeting studies that focused exclusively on the elderly within the COVID-19 timeframe, incorporated ICT-based technology as intervention, and were associated with the assessment of the process of employing ICT for healthcare needs. The search strategy identified 1752 records, of which 34 studies met the inclusion criteria. The functionality of ICT was categorized, types of barriers were identified, and the subsequent changes that the elderly population underwent were synthesized and deliberated. This review offers valuable insights into the elderly's subjective experiences in utilizing ICT, which may offer guidance for future ICT development geared towards enhancing the well-being of the elderly. Future research should incorporate the perspectives of relevant healthcare providers in evaluating the effectiveness of ICT usage. Further studies are also needed on underserved elderly groups to provide a more holistic view.
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Affiliation(s)
- Sihui Chen
- The Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong
| | - Mengyuan Niu
- Division of Public Policy, The Hong Kong University of Science and Technology, Hong Kong
| | - Cindy Sing Bik Ngai
- The Department of Chinese and Bilingual Studies, The Hong Kong Polytechnic University, Hong Kong
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Johnsen HM, Øgård-Repål A, Martinez SG, Fangen K, Bårdsen Aas K, Ersfjord EMI. Patients' perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in a Norwegian outpatient clinic: a qualitative study. BMC Health Serv Res 2024; 24:209. [PMID: 38360650 PMCID: PMC10870609 DOI: 10.1186/s12913-024-10659-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] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Telemedicine in outpatient services for people living with human immunodeficiency virus (PLHIV) was scaled up during the COVID-19 pandemic as services transitioned to remote care. Many studies have reported on the challenges and advantages of telemedicine care during the pandemic. However, there is limited research on the provision of telemedicine human immunodeficiency virus (HIV) care beyond the COVID-19 pandemic, which entails different telemedicine components and focuses on ways to improve the telemedicine experience for patients. This study aimed to explore PLHIV's perceptions of use, needs, and preferences related to a telemedicine solution for HIV care in an outpatient clinic in Norway. The telemedicine solution included a pre-consultation questionnaire, asynchronous digital messages, and video consultation. METHODS Qualitative interviews were conducted with 12 PLHIV. The interviews were analysed using thematic analysis. RESULTS We identified four main themes that covered the participants' perceptions, needs, and preferences: (1) perceived usability, (2) maintaining confidentiality, (3) accommodating personal preferences, and (4) perceived usefulness. Some participants had difficulty logging into the telemedicine solution. Other participants suggested additional functionalities, such as picture sharing and access to test result. Telemedicine care enabled the avoidance of stigmatising clinic experiences, although a few participants reported concerns about confidentiality and data security. Accommodating personal preferences and needs in terms of the type of consultations (in-person or video) and frequency of visits was essential to the participants. With telemedicine care, participants felt more in control of their own lives, perceiving that it increased their perceived quality of life and saved them both time and money for travelling to the clinic. CONCLUSIONS Our study identified several specific needs and preferences related to the assessed technical solution and the provision of current and future telemedicine care services. Nevertheless, the telemedicine solution was perceived as a usable, flexible, and person-centred approach to HIV care, contributing to accommodating the participants' personal preferences. However, healthcare professionals need to ensure that individual requirements and preferences are consistent with evidence-based follow-up and supported by person-centred care. Thus, the practice of shared decision making is important in telemedicine care.
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Affiliation(s)
- Hege Mari Johnsen
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway.
| | - Anita Øgård-Repål
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
| | - Santiago Gil Martinez
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
| | - Kim Fangen
- Sørlandet Hospital, Kristiansand, Norway
| | | | - Ellen Margrete Iveland Ersfjord
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, 4898, Grimstad, PO Box 509, Norway
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Yelverton V, Gass SJ, Amoatika D, Cooke C, Ostermann J, Natafgi N, Hair NL, Olatosi B, Owens OL, Qiao S, Li X, Derrick C, Weissman S, Albrecht H. The Future of Telehealth in Human Immunodeficiency Virus Care: A Qualitative Study of Patient and Provider Perspectives in South Carolina. AIDS Patient Care STDS 2023; 37:459-468. [PMID: 37862076 PMCID: PMC10616939 DOI: 10.1089/apc.2023.0176] [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: 10/21/2023] Open
Abstract
To ensure care continuity during the COVID-19 pandemic, telehealth has been widely implemented in human immunodeficiency virus (HIV) care. However, participation in and benefits from telehealth were unequal. This study aims to assess the willingness of people living with HIV (PWH) and HIV care providers to use telehealth and perceptions of the future role of telehealth. In-depth interviews with 18 PWH and 10 HIV care providers from South Carolina assessed their willingness to use telehealth, their perspectives on the future of telehealth in HIV care, and recommendations to improve telehealth. Interviews were analyzed using thematic analysis. Most PWH were female (61%), Black/African American (67%), and non-Hispanic (78%). Most PWH (61%) and all providers had used telehealth for HIV care. Most PWH and all providers reported being willing to use or (re-)consider telehealth HIV care services in the future. Providers suggested that telehealth is most suitable for routine HIV care encounters and for established, clinically stable, generally healthy PWH. Attitudes toward telehealth were heterogeneous, with most interviewees valuing telehealth similarly or superior to in-person care, yet >20% perceiving it less valuable. Recommendations to improve telehealth included multilevel strategies to address challenges across four domains: technology, the virtual nature of telehealth, administrative processes, and the sociodemographic profile of PWH. Telehealth in HIV care is here to stay; however, it may not yet be suitable for all PWH and all care encounters. Decision processes related to telehealth versus in-person care need to involve providers and PWH. Existing telehealth options require multilevel adjustments addressing persistent challenges.
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Affiliation(s)
- Valerie Yelverton
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Salome-Joelle Gass
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Daniel Amoatika
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Christopher Cooke
- Department of Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nabil Natafgi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Nicole L. Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Otis L. Owens
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | - Shan Qiao
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Caroline Derrick
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Prisma Health Midlands, Columbia, South Carolina, USA
| | - Sharon Weissman
- South Carolina SmartState Center for Healthcare Quality (CHQ), Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Prisma Health Midlands, Columbia, South Carolina, USA
| | - Helmut Albrecht
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
- Prisma Health Midlands, Columbia, South Carolina, USA
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Sohail M, Long D, Kay E, Levitan EB, Batey DS, Reed-Pickens H, Rana A, Carodine A, Nevin C, Eady S, Parmar J, Turner K, Orakwue I, Miller T, Wynne T, Mugavero M. Role of Visit Modality in the HIV-Related No-Shows During the COVID-19 Pandemic: A Multisite Retrospective Cohort Study. AIDS Behav 2023:10.1007/s10461-022-03973-2. [PMID: 36633763 PMCID: PMC9838273 DOI: 10.1007/s10461-022-03973-2] [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] [Accepted: 12/22/2022] [Indexed: 01/13/2023]
Abstract
The emergence of the COVID-19 pandemic necessitated rapid expansion of telehealth as part of healthcare delivery. This study compared HIV-related no-shows by visit type (in-person; video; telephone) during the COVID-19 pandemic (April 2020-September 2021) from the Data for Care Alabama project. Using all primary care provider visits, each visit's outcome was categorized as no-show or arrived. A logistic regression model using generalized estimating equations accounting for repeat measures in individuals and within sites calculated odds ratios (OR) and their accompanying 95% confidence interval (CI) for no-shows by visit modality. The multivariable models adjusted for sociodemographic factors. In-person versus telephone visits [OR (95% CI) 1.64 (1.48-1.82)] and in-person versus video visits [OR (95% CI) 1.53 (1.25-1.85)] had higher odds of being a no-show. In-person versus telephone and video no-shows were significantly higher. This may suggest success of telehealth visits as a method for HIV care delivery even beyond COVID-19.
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Affiliation(s)
- Maira Sohail
- Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, AL USA
| | - Dustin Long
- Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, AL USA
| | - Emma Kay
- Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, AL USA
| | - Emily B. Levitan
- Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, AL USA
| | - D. Scott Batey
- Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, AL USA ,School of Social Work, Tulane University, New Orleans, LA USA
| | - Harriette Reed-Pickens
- Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, AL USA
| | - Aadia Rana
- Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, AL USA ,UAB, University of Alabama at Birmingham, 1917 Clinic, Birmingham, AL USA
| | - Alyssa Carodine
- Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, AL USA
| | - Christa Nevin
- UAB, University of Alabama at Birmingham, 1917 Clinic, Birmingham, AL USA
| | - Seqouya Eady
- UAB Family Clinic, University of Alabama at Birmingham, Birmingham, AL USA
| | | | | | | | | | | | - Michael Mugavero
- Center for AIDS Research (CFAR), University of Alabama at Birmingham, Birmingham, AL USA ,UAB, University of Alabama at Birmingham, 1917 Clinic, Birmingham, AL USA ,1808 7TH AVE SOUTH BDB 834, Birmingham, AL 35233 USA
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Lu M, Liao X. Access to care through telehealth among U.S. Medicare beneficiaries in the wake of the COVID-19 pandemic. Front Public Health 2022; 10:946944. [PMID: 36148338 PMCID: PMC9485666 DOI: 10.3389/fpubh.2022.946944] [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: 05/18/2022] [Accepted: 07/12/2022] [Indexed: 01/21/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) public health emergency has amplified the potential value of deploying telehealth solutions. Less is known about how trends in access to care through telehealth changed over time. Objectives To investigate trends in forgone care and telehealth coverage among Medicare beneficiaries during the COVID-19 pandemic. Methods A cross-sectional study design was used to analyze the outcomes of 31,907 Medicare beneficiaries using data from three waves of survey data from the Medicare Current Beneficiary Survey COVID-19 Supplement (Summer 2020, Fall 2020, and Winter 2021). We identified informative variables through a multivariate classification analysis utilizing Random Forest machine learning techniques. Findings The rate of reported forgone medical care because of COVID-19 decreased largely (22.89-3.31%) with a small increase in telehealth coverage (56.24-61.84%) from the week of June 7, 2020, to the week of April 4 to 25, 2021. Overall, there were 21.97% of respondents did not know whether their primary care providers offered telehealth services; the rates of forgone care and telehealth coverage were 11.68 and 59.52% (11.73 and 81.18% from yes and no responses). Our machine learning model predicted the outcomes accurately utilizing 43 variables. Informative factors included Medicare beneficiaries' age, Medicare-Medicaid dual eligibility, ability to access basic needs, certain mental and physical health conditions, and interview date. Conclusions This cross-sectional survey study found proliferation and utilization of telehealth services in certain subgroups during the COVID-19 pandemic, providing important access to care. There is a need to confront traditional barriers to the proliferation of telehealth. Policymakers must continue to identify effective means of maintaining continuity of care and growth of telehealth services.
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HIV Care Meets Telehealth: a Review of Successes, Disparities, and Unresolved Challenges. Curr HIV/AIDS Rep 2022; 19:446-453. [PMID: 36063284 PMCID: PMC9442586 DOI: 10.1007/s11904-022-00623-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 11/08/2022]
Abstract
Purpose of Review This review summarizes the current state of telehealth utilization in HIV care delivery by highlighting successes, gaps, and unresolved challenges related to access, disparities, care providers in and standardization of policies and protocol. Recent Findings Telehealth adoption in HIV care delivery in the USA has been successful. Despite this success, racial minority groups, older adults, and individuals with low telehealth literacy report low preference, dissatisfaction, and experience poorer health outcomes than other groups. Lack of broadband access, compatible devices, standardization, and government regulations of telehealth in HIV care contribute to poor patient-provider experience and utilization. Summary Telehealth remains a valuable tool in HIV care. However, disparities exist in access and health outcomes. Telehealth literacy, broadband access, protecting patients’ data, policies, and standardized protocols are critical in sustaining telehealth for HIV care. Further research is needed on preferences and how specific telehealth platforms influence HIV treatment outcomes.
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