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Goodman KS, Locke E. Health Impact of a Mobile-Delivered Diabetes Intervention to Control Blood Pressure in Older Adults. AJPM FOCUS 2024; 3:100244. [PMID: 39034932 PMCID: PMC11259934 DOI: 10.1016/j.focus.2024.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
Introduction Patient education is an effective modality to reinforce self-care practices for chronic disease management. The purpose of this study was twofold: (1) to assess the health impact of a phone-delivered diabetes intervention and (2) to identify predictors of telehealth message use among adults aged 18-65 years with diabetes in a primary care setting using the Technology Acceptance Model theoretical framework. Methods A pretest-posttest experimental study design was employed. Participants were randomized to receive 7 weeks of telehealth self-care messages or to the routine care group. Outcome measures included (1) telehealth use among patients who received weekly telehealth messages, (2) self-care behavior management derived from the Behavior Score Instrument, and (3) clinical outcomes measures. Results The study team enrolled 150 patients, and of these, 138 (aged 18-65 years) completed the study. Participants aged 53±9.6 (mean±SD) years were mainly females (n=93; 76%), and the majority received government-sponsored health insurance (n=75; 54%). Age was a strong predictor of telehealth use (p<0.001). Among patients who received telehealth messages, systolic and diastolic blood pressure measures (140/78 mmHg vs 134/74 mmHg) were statistically significant at follow-up (p=0.001 and p=0.007, respectively). Conclusions Digital support tools can play a valuable role in supporting lifestyle modification changes and reinforcing good diabetes self-care practices in older adults. Providing accessible tools and resources empowers adults to take an active role in their own health.
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Affiliation(s)
- Koren S. Goodman
- Department of Health and Human Performance, College of Health Professions and Human Services, Kean University, Union, New Jersey
| | - Elizabeth Locke
- Department of Physical Therapy, College of Health Professions and Human Services, Kean University, Union, New Jersey
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Child CE, Ho LA, Lachant D, Gupta N, Moss J, Jones A, Krishna R, Holland AE, Han MK, McCarthy C, Ataya A, Baqir M, Dilling D, Swigris J, Swenson ER, Brown MB. Unsupervised Exercise in Interstitial Lung Disease: A Delphi Study to Develop a Consensus Preparticipation Screening Tool for Lymphangioleiomyomatosis. Chest 2024:S0012-3692(24)04613-0. [PMID: 39025205 DOI: 10.1016/j.chest.2024.06.3803] [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: 02/26/2024] [Revised: 06/13/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Little research is available to provide practical guidance to health-care providers for exercise preparticipation screening and referral of patients with interstitial lung diseases (ILDs), including lymphangioleiomyomatosis (LAM), to participate in remote, unsupervised exercise programs. RESEARCH QUESTION What exercise preparticipation screening steps are essential to determine whether a patient with LAM is medically appropriate to participate in a remote, unsupervised exercise program? STUDY DESIGN AND METHODS Sixteen experts in LAM and ILD participated in a two-round modified Delphi study, ranking their level of agreement for 10 statements related to unsupervised exercise training in LAM, with an apriori definition of consensus. Additionally, 60 patients with LAM completed a survey of the perceived risks and benefits of remote exercise training in LAM. RESULTS Seven of the 10 statements reached consensus among experts. Experts agreed that an in-person clinical exercise test is indicated to screen for exercise-induced hypoxemia and prescribe supplemental oxygen therapy as indicated prior to initiating a remote exercise program. Patients with recent pneumothorax should wait to start an exercise program for at least 4 weeks until after resolution of pneumothorax and clearance by a physician. Patients with high cardiovascular risk for event during exercise, severe resting pulmonary hypertension, or risk for falls may be more appropriate for referral to a rehabilitation center. A LAM-specific remote exercise preparticipation screening tool was developed from the consensus statements and agreed upon by the panelists. INTERPRETATION A modified Delphi study approach was useful to develop disease-specific recommendations for safety and preparticipation screening prior to unsupervised, remotely administered exercise in LAM. The primary product of this study is a clinical decision aid for providers to use when medically screening patients prior to participation in the newly launched LAMFit remote exercise program.
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Affiliation(s)
- Claire E Child
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle, WA
| | | | | | | | - Joel Moss
- Critical Care Medicine and Pulmonology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Amanda Jones
- Critical Care Medicine and Pulmonology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Anne E Holland
- Monash University and Alfred Health, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | | | - Cormac McCarthy
- St. Vincent's University Hospital Dublin, Dublin, Ireland; University College Dublin, Dublin, Ireland
| | - Ali Ataya
- University of Florida, Gainesville, FL
| | | | - Daniel Dilling
- Loyola University Chicago, Chicago, IL; Loyola University Medical Center, Maywood, IL
| | | | | | - Mary Beth Brown
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle, WA.
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Hernandez AM, Khoong EC, Kanwar N, Lopez-Solano N, Rodriguez JA, De Marchis E, Nguyen OK, Casillas A. Lessons learned from a multi-site collaborative working toward a digital health use screening tool. Front Public Health 2024; 12:1421129. [PMID: 39040864 PMCID: PMC11260723 DOI: 10.3389/fpubh.2024.1421129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
Digital health has the potential to expand health care and improve outcomes for patients-particularly for those with challenges to accessing in-person care. The acceleration of digital health (and particularly telemedicine) prompted by the Coronavirus-19 (COVID-19) pandemic facilitated continuity of care in some settings but left many health systems ill-prepared to address digital uptake among patients from underserved backgrounds, who already experience health disparities. As use of digital health grows and the digital divide threatens to widen, healthcare systems must develop approaches to evaluate patients' needs for digital health inclusion, and consequentially equip patients with the resources needed to access the benefits of digital health. However, this is particularly challenging given the absence of any standardized, validated multilingual screening instrument to assess patients' readiness for digital healthcare that is feasible to administer in already under-resourced health systems. This perspective is structured as follows: (1) the need for digital health exclusion risk screening, (2) our convening as a group of stakeholders, (3) our review of the known digital health screening tools and our assessment, (4) formative work with patients regarding their perceptions on language and concepts in the digital health screening tools, and (5) conclusion with recommendations for digital health advocates generated by this collaborative of digital health researchers and operations leaders. There is a need to develop a brief, effective tool to screen for digital health use that can be widely implemented in diverse populations. We include lessons learned from our experiences in developing and testing risk of digital health exclusion screening questions in our respective health systems (e.g., patient perception of questions and response options). Because we recognize that health systems across the country may be facing similar challenges and questions, this perspective aims to inform ongoing efforts in developing health system digital exclusion screening tools and advocate for their role in advancing digital health equity.
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Affiliation(s)
- Ann M. Hernandez
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Elaine C. Khoong
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- UCSF Action Research Center (ARC) for Health Equity, University of California, San Francisco, San Francisco, CA, United States
| | - Neytali Kanwar
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Naomi Lopez-Solano
- Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jorge A. Rodriguez
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Emilia De Marchis
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Oanh Kieu Nguyen
- UCSF Action Research Center (ARC) for Health Equity, University of California, San Francisco, San Francisco, CA, United States
- Division of Hospital Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Chan Zuckerberg Biohub, San Francisco, CA, United States
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
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Wallis KE, Kennelly A, Wozniak SN, Craig S, Flaherty CM, Cacia J, Christiansen A, Cordero L, Ortiz P, Kellom KS, Stefanski K. Disparities in Telehealth Uptake for Developmental-Behavioral Pediatric Assessments by Preferred Family Language: A Developmental Behavioral Pediatrics Research Network Study. J Dev Behav Pediatr 2024; 45:e378-e383. [PMID: 39259268 DOI: 10.1097/dbp.0000000000001290] [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: 11/09/2023] [Accepted: 04/22/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE Owing to the coronavirus disease 2019 (COVID-19) pandemic, many developmental-behavioral pediatric (DBP) practices adopted telehealth for care delivery. However, telehealth access and use for families with a preferred language other than English (PLOE) is an equity concern. Therefore, our study objective is to compare rates of telehealth utilization and visit completion by preferred family language among patients seen for DBP assessments during the COVID-19 pandemic. METHODS We completed a descriptive chart review using electronic health record data at 4 academic DBP practices to examine visits for patients up to 5 years seen for new-patient appointments between April 2020 and April 2021. We compared rates of in-person and telehealth visits by preferred family language and visit outcome (completed or missed). RESULTS A total of 3241 visits were scheduled between April 2020 and April 2021; 48.2% were for in-person and 51.8% for telehealth. Families reported the following languages: 90.5% English, 6.2% Spanish, and 3.3% other language. Missed visits accounted for 7.6% of scheduled visits. The relative percentage of in-person versus telehealth visits varied significantly by site (p < 0.001) and preferred family language (p < 0.001). English-speaking patients had 2.10 times the odds of being scheduled for telehealth compared with patients with PLOE, adjusting for site. Statistically significant differences were not found for visit outcome (completed or missed) by visit type (in-person or telehealth) (p = 0.79), including after accounting for PLOE status (p = 0.83). CONCLUSION At the height of the pandemic, most English-speaking families were scheduled for new DBP evaluations by telehealth, but fewer families with PLOE were. Attention to language to ensure telehealth access equity is critical.
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Affiliation(s)
- Kate E Wallis
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Annie Kennelly
- Meyer Center for Developmental Pediatrics & Autism, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Sarah N Wozniak
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sansanee Craig
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Carina M Flaherty
- PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jaclyn Cacia
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Audrey Christiansen
- Division of Developmental-Behavioral Pediatrics Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
| | - Lucero Cordero
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Priscilla Ortiz
- Language Services Department, Children's Hospital of Philadelphia, Philadelphia, PA; and
| | | | - Kristen Stefanski
- Division of Developmental and Behavioral Pediatrics, Akron Children's Hospital, Akron, OH
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Andree R, Mujcic A, den Hollander W, van Laar M, Boon B, Engels R, Blankers M. Digital Smoking Cessation Intervention for Cancer Survivors: Analysis of Predictors and Moderators of Engagement and Outcome Alongside a Randomized Controlled Trial. JMIR Cancer 2024; 10:e46303. [PMID: 38901028 PMCID: PMC11229662 DOI: 10.2196/46303] [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: 02/07/2023] [Revised: 01/26/2024] [Accepted: 02/25/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Recent studies have shown positive, though small, clinical effects of digital smoking cessation (SC) interventions for cancer survivors. However, research on associations among participant characteristics, intervention engagement, and outcomes is limited. OBJECTIVE This study aimed to explore the predictors and moderators of engagement and outcome of MyCourse-Quit Smoking (in Dutch: "MijnKoers-Stoppen met Roken"), a digital minimally guided intervention for cancer survivors. METHODS A secondary analysis of data from the randomized controlled trial was performed. The number of cigarettes smoked in the past 7 days at 6-month follow-up was the primary outcome measure. We analyzed interactions among participant characteristics (11 variables), intervention engagement (3 variables), and outcome using robust linear (mixed) modeling. RESULTS In total, 165 participants were included in this study. Female participants accessed the intervention less often than male participants (B=-11.12; P=.004). A higher Alcohol Use Disorders Identification Test score at baseline was associated with a significantly higher number of logins (B=1.10; P<.001) and diary registrations (B=1.29; P<.001). A higher Fagerström Test for Nicotine Dependence score at baseline in the intervention group was associated with a significantly larger reduction in tobacco use after 6 months (B=-9.86; P=.002). No other associations and no moderating effects were found. CONCLUSIONS Overall, a limited number of associations was found between participant characteristics, engagement, and outcome, except for gender, problematic alcohol use, and nicotine dependence. Future studies are needed to shed light on how this knowledge can be used to improve the effects of digital SC programs for cancer survivors. TRIAL REGISTRATION Netherlands Trial register NTR6011/NL5434; https://onderzoekmetmensen.nl/nl/trial/22832.
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Affiliation(s)
- Rosa Andree
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Ajla Mujcic
- PsyQ, Parnassia Groep, The Hague, Netherlands
| | - Wouter den Hollander
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Margriet van Laar
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Brigitte Boon
- Siza, Center for Long-term Care for People with Disabilities, Arnhem, Netherlands
- Academy Het Dorp, Research & Advisory on Technology in Long-term Care, Arnhem, Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Rutger Engels
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Matthijs Blankers
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
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Mhando F, Olughu K, Nyankomo M, Ngocho JS, Teri I, Mbita G, Conserve DF. Men's Willingness to Receive Text Messages and Talk with an HIV counselor from the National HIV Hotline in Tanzania for Support with Linkage to Care Following HIV self-testing. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.01.24308312. [PMID: 38883795 PMCID: PMC11177922 DOI: 10.1101/2024.06.01.24308312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Tanzania faces a significant burden of HIV, with particular challenges in reaching men and ensuring timely linkage to care. To address these issues, HIV self-testing (HIVST) has been implemented to increase HIV testing and the National HIV Hotlines are being considered as a strategy to facilitate linkage to care. This study aimed to assess the willingness of Tanzanian men to receive support from use the National HIV Hotline via mobile phones for HIVST and linkage to care. Methods Data from 505 men from the baseline survey of a cluster-randomized controlled trial conducted in June 2019 with 18 social networks or "camps" in Dar es Salaam, Tanzania. Participants were 18-year-old or older male camp members who were HIV-negative at the time of enrolment. Logistic regression models were used to assess factors associated with men's comfort with talking with an HIV counselor over the phone. Results There were 505 heterosexual male participants enrolled in the study with an average age of 29 years. Logistic regression demonstrated that comfortability texting a friend about HIV self-testing (OR =3.37, 95% CI [1.97 - 5.76], being comfortable texting a friend about HIV (OR = 3.84, 95% CI [2.20 - 6.72], previous history of receiving HIV related text messages (aOR = 0.55, 95% CI [0.31 - 0.99] were significantly associated with men's s comfortability talking to a HIV counselor on the National HIV Hotline following HIVST. The factors such as participants' comfortability texting friend about HIVST (OR = 2.52, 95% CI [1.49 - 4.25]) and comfortability texting friend about HIV (OR = 2.96, 95% CI [1.83 - 4.80] were significantly associated with the probability of participant's comfortability receiving text message from HIV counselor following HIVST. Conclusion These findings suggest an effort to develop and implement a user-friendly digital health intervention that promote comfortability, address private concerns, and deliver tailored support and information to individuals following HIV self-testing.
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Affiliation(s)
- Frank Mhando
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
- Johannesburg Business School, University of Johannesburg, Johannesburg, South Africa
| | - Kelia Olughu
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Marwa Nyankomo
- Ifakara Health Institute, Bagamoyo Research and Training Centre, Bagamoyo, United Republic of Tanzania
| | - James S. Ngocho
- Department of Epidemiology and Applied Biostatistics, Kilimanjaro Christian Medical University College, Moshi Tanzania
| | - Ivan Teri
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA
| | | | - BRIDGE Africa Team
- Building Research Implementation to Drive Growth and Equity (BRIDGE) Africa, Dar es Salaam, Tanzania
| | - Donaldson F. Conserve
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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Charlly N, Swedlund M. Can You Hear Me Now? Patient Perceptions of Telehealth in a Rural Primary Care Population. Telemed J E Health 2024; 30:e1719-e1726. [PMID: 38452338 DOI: 10.1089/tmj.2023.0554] [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: 03/09/2024] Open
Abstract
Background: The COVID-19 pandemic significantly increased telehealth adoption. Rural communities experience challenges relating to telehealth, including a shortage of clinicians, low health literacy, mistrust of medicine, and limited technology access, yet rural perceptions have not been a subject of robust study. The setting of this study was a rural Midwestern family medicine clinic within an academic health system. Methods: Surveys were given to all patients of age 18 or older visiting the clinic over a one-week period. Those who expressed interest were contacted for a semistructured interview. Descriptive statistics and chi-square testing were used to analyze survey results for significant relationships, while interview transcripts were analyzed for themes. Results: Of respondents, 27% indicated prior telehealth use and were more likely to prefer telehealth visits (p = 0.03). Perceptions of telehealth were sorted into themes, including scope of care, convenience, and technology. Telehealth was preferred for discussing test results or mental health. Barriers such as travel time and transportation access favored telehealth. Although more convenient, telehealth was found to be less effective for relationship building. The absence of physical examination during phone visits was a concern. Phone visits were more prevalent due to failure of video-based technology. Conclusions: Despite the potential to address these unique challenges in rural communities, telehealth acceptance is poor. Barriers such as accessibility of technology can be improved through governmental and health systemwide measures. Future work can help develop interventions that counter negative perceptions of telehealth while increasing interest and uptake in rural communities.
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Affiliation(s)
- Nithin Charlly
- Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew Swedlund
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Margulies SL, Bernard A, Leone AM, Geller EJ. A Randomized Clinical Trial: Patient Satisfaction of Paper Versus Electronic Provider Feedback. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:181-187. [PMID: 38484230 DOI: 10.1097/spv.0000000000001437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Minimal data compare patient satisfaction with completing paper versus electronic evaluations. OBJECTIVES This study aimed to compare patient satisfaction with completing paper versus electronic evaluations. Secondary objectives were assessing age, education, and socioeconomic status with comfort with technology; preference for evaluation type; and timeliness of completing evaluations. STUDY DESIGN This was a single-center randomized trial comparing paper versus electronic patient evaluations of health care providers. Study participation occurred at the end of clinic visits. RESULTS Among 145 participants, 73 (50.3%) were analyzed as paper versus 72 (49.7%) as electronic. Groups were similar in age, race, education level, income, insurance type, technology comfort, and technology use. Groups were similar in finding ease (P = 0.99) and satisfaction (P = 0.76) with their randomized method. For participants randomized to paper, 34% preferred paper, 25% preferred electronic, and 41% had no preference. Electronic feedback took longer to complete (4.5 minutes vs 3.4 minutes, P < 0.001). Older participants took longer to complete the evaluation (4.5 minutes vs 3.2 minutes, P < 0.001), had less internet use (P = 0.01), and were less likely to own a computer (P = 0.03) than younger participants. There were differences by education level for comfort with technology (P = 0.007) and internet use (P = 0.016). There were no differences in ease of feedback completion or satisfaction when comparing age, education status, or income status. CONCLUSIONS Patients were satisfied with paper and electronic health care provider evaluations, regardless of age or other demographics. Evaluations were completed quickly during visits. Requesting feedback from patients via multiple modalities is feasible in a varied patient population.
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Affiliation(s)
- Samantha Lee Margulies
- From the Department of Obstetrics and Gynecology - Urogynecology and Reconstructive Surgery, University of North Carolina Chapel Hill
| | | | - Anna M Leone
- Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, Chapel Hill, NC
| | - Elizabeth J Geller
- From the Department of Obstetrics and Gynecology - Urogynecology and Reconstructive Surgery, University of North Carolina Chapel Hill
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Xiong S, Zhang T. Enhancing tourist loyalty through location-based service apps: Exploring the roles of digital literacy, perceived ease of use, perceived autonomy, virtual-content congruency, and tourist engagement. PLoS One 2024; 19:e0294244. [PMID: 38295124 PMCID: PMC10830003 DOI: 10.1371/journal.pone.0294244] [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: 06/19/2023] [Accepted: 10/27/2023] [Indexed: 02/02/2024] Open
Abstract
Advanced mobile functions and empowered smartphones have provided tourists with various location-based service apps that reshaped the business model of the tourism sector. Despite their importance to tourists, l-apps still have limitations, such as ignorance of tourist preferences and the mismatch between app introduction and tourist experience, therefore affecting tourist loyalty to destinations. Understanding tourist-oriented factors thus becomes critical for l-app designers and service providers. This study integrates the technology-acceptance model (TAM) into a unique context to examine the roles of digital literacy, perceived ease of use, perceived autonomy, virtual-content congruence, and tourist engagement on tourist loyalty. Our empirical test of a structural equation model based on a randomly recruited 319 customers found that tourists' digital literacy influences their engagement and perceived ease of use, which mediates the relationship between digital literacy and engagement; tourists' perceived autonomy influences their engagement. Moreover, we found the moderating role of information-experience congruency between digital literacy, perceived ease of use, and perceived autonomy and tourist engagement, thus contributing to the boundary conditions of the TAM model. Finally, tourist engagement contributes to tourist loyalty. The study contributes to the integration of the technology acceptance model with a tourist orientation. The findings also offer meaningful, practical implications and recommendations on l-app design to stakeholders of tourist destinations.
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Affiliation(s)
- Shaowei Xiong
- College of Art Design, The College of Post and Telecommunication of WIT, Wuhan, Hubei, China
| | - Tong Zhang
- College of Art Design, The College of Post and Telecommunication of WIT, Wuhan, Hubei, China
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Guo SHM, Lin JL, Hsing HC, Lee CC, Chuang SM. The Effect of Mobile eHealth Education to Improve Knowledge, Skills, Self-Care, and Mobile eHealth Literacies Among Patients With Diabetes: Development and Evaluation Study. J Med Internet Res 2023; 25:e42497. [PMID: 38055321 PMCID: PMC10733817 DOI: 10.2196/42497] [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: 09/06/2022] [Revised: 12/23/2022] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The promotion of mobile health (mHealth) and eHealth technologies as tools for managing chronic diseases, particularly diabetes mellitus, is on the rise. Nevertheless, individuals with diabetes frequently face a literacy gap that hinders their ability to fully leverage the benefits offered by these resources. Enhancing technology literacy to facilitate the adoption of mobile eHealth services poses a significant challenge in numerous countries. OBJECTIVE This study aims to develop an educational mobile eHealth literacy (eHL) program for patients with diabetes and to evaluate its effect on patients' outcomes. METHODS This study designed a mobile eHL education program comprising 2 modules specifically tailored for individuals with type 2 diabetes (T2D). These modules focused on guiding participants through the process of effectively navigating reliable health websites and utilizing diabetes-related apps. Using a pre- and posttest experimental design, the study featured an intervention group and a control group. Participants were recruited from 3 outpatient departments in hospitals, and assessments were conducted both before and after the intervention, along with a follow-up measure at the 3-month mark. The evaluation encompassed sociodemographic characteristics, computer and internet proficiency, mobile app usage, mobile eHL, and patient outcomes such as self-care behaviors and glycated hemoglobin (HbA1c) levels. RESULTS The analysis included a total of 132 eligible participants. Significant differences were observed in the mean scores of knowledge (P<.001) and skills (P<.001) related to computers, the web, and mobile devices at the initiation of the study and after the intervention. During the 3-month follow-up, the findings indicated a significant improvement in mobile eHL (t114=3.391, P=.001) and mHealth literacy (mHL, a subconcept of mobile eHL; t114=3.801, P<.001) within the intervention group, whereas no such improvement was observed in the control group. The chi-square values from the McNemar test underscored that individuals with uncontrolled diabetes (HbA1c≥7%) in the intervention group exhibited more improvement compared with the control group. The generalized estimating equations model unveiled a significant difference in the change of general mHL in the intervention group (β=1.91, P=.047) and self-care behavior in the control group from T0 to T2 (β=-8.21, P=.015). Despite being small, the effect sizes for mobile eHL (d=0.49) and HbA1c (d=0.33) in the intervention group were greater than those in the control group (d=0.14 and d=0.16, respectively). CONCLUSIONS The implementation of a mobile eHL education intervention demonstrates a positive influence on the familiarity of patients with T2D regarding health technology, leading to favorable glycemic outcomes. While additional studies are warranted for a more comprehensive understanding, this program emerges as a promising solution for enhancing patients' uptake of digital health technology.
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Affiliation(s)
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hung-Chun Hsing
- Department of Nursing, Hsinchu Cathay General Hospital, HsinChu, Taiwan
| | - Chun-Chuan Lee
- Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shih-Ming Chuang
- Division of Endocrinology and Metabolism, Mackay Memorial Hospital, Taipei, Taiwan
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Yang C, Prokop L, Barwise A. Strategies Used by Healthcare Systems to Communicate with Hospitalized Patients and Families with Limited English Proficiency During the COVID-19 Pandemic: A Narrative Review. J Immigr Minor Health 2023; 25:1393-1401. [PMID: 36821068 PMCID: PMC9948796 DOI: 10.1007/s10903-023-01453-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/24/2023]
Abstract
The COVID-19 pandemic disproportionately affected racial and ethnic minorities in the United States, including many with limited English proficiency (LEP). These patients face various communication barriers, including a shortage of available interpreters and the need for masks that exacerbated communication barriers. It is not known how hospitals responded to these unique challenges to providing language services for the large number of patients with LEP during COVID-19. This narrative review assessed literature and lay media to identify strategies utilized by hospitals to communicate with patients with LEP hospitalized during the COVID-19 pandemic. A search of APA PsychInfo, EBM Reviews, Embase, Ovid MEDLINE, Epub Ahead of Print, and Ebsco Megafile initially yielded 61 articles, 6 of which were ultimately included after reviewing abstracts and full texts. The identified interventions, which sought to increase accessibility of language-concordant care, increase accessibility of professional interpretation, and improve family communication and understanding, were described positively, though only one was tested for effectiveness.
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Affiliation(s)
- Catherine Yang
- Mayo Clinic Alix School of Medicine, 200 First St SW, Rochester, MN, 55905, USA.
| | - Larry Prokop
- Department of Library Services, Mayo Clinic, Rochester, MN, USA
| | - Amelia Barwise
- Bioethics Research Program, Mayo Clinic, Rochester, MN, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Khan W, Jebanesan B, Ahmed S, Trimmer C, Agic B, Safa F, Ashraf A, Tuck A, Kavic K, Wadhawan S, Abbott M, Husain O, Husain I, Akhter Hamid M, McKenzie K, Quintana Y, Naeem F. Stakeholders' views and opinions on existing guidelines on "How to Choose Mental Health Apps". Front Public Health 2023; 11:1251050. [PMID: 38074730 PMCID: PMC10703154 DOI: 10.3389/fpubh.2023.1251050] [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: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Background Mental health Applications (Mhealth Apps) can change how healthcare is delivered. However, very little is known about the efficacy of Mhealth Apps. Currently, only minimum guidance is available in Assessment and Evaluation Tools (AETs). Therefore, this project aims to understand AET developers' perspectives and end users' experiences and opinions on "how to choose a Mhealth App". Objective The primary objectives were: (1) obtaining stakeholder's opinions and experiences of development and use of AETs for Mhealth Apps, their weaknesses and strengths, and barriers in their implementation of Mhealth Apps; (2) the experiences of App users, their analyzation and, obstacles in the use of apps; and (3) to quantify themes related to choosing a Mhealth App. Methods This qualitative study, used a sampling method to recruit six stakeholders (one App developer, two AET developers, an individual with lived experience of mental health illness, and two physicians) who were interviewed using a topic guide. These were examined by researchers (CT, WK, & FN) using thematic content analysis. Additionally, an anonymous online survey of 107 individuals was conducted. Findings Our analyses revealed six main themes: (a) needs and opportunities; (b) views on Mhealth apps; (c) views & opinions on AETs; (d) implementation barriers; (e) system of evaluation and; (f) future directions. The first key concept was, all stakeholders agreed that Apps could significantly impact mental health and that end-users were unaware of mental health AETs and Apps. Secondly, due to commercial interests, end-users reliability of App evaluations requires clear conflict-free guidelines. Thirdly, AETs should be evaluated and developed through a rigorous methodology. Finally, stakeholders shared insights into future developments for AETs and Mhealth Apps. Additionally, online survey respondents chose a "health professional" as their preferred source of guidance in selecting a Mhealth app (84%) and best suited to develop guidelines (70%). Conclusion The interviews and survey highlight the need for Mhealth Apps to be regulated and the importance of health professionals' engagement in the implementation process. Similarly, without well-defined roles for App evaluations within the health care system, it is unlikely that AETs will have wider spread use and impact without risk.
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Affiliation(s)
- Wishah Khan
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | | | - Sarah Ahmed
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Chris Trimmer
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Branka Agic
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Farhana Safa
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Aamna Ashraf
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Andrew Tuck
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Kelsey Kavic
- Mental Health Commission of Canada, Ottawa, ON, Canada
| | | | | | - Omair Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ishrat Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Muhammad Akhter Hamid
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Scarborough Health Network, Scarborough, ON, Canada
| | - Kwame McKenzie
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuri Quintana
- Department of Medicine, Harvard University, Boston, MA, United States
- Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Farooq Naeem
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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13
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Liew H, Pienkowska A, Ang CS, Mahadzir MDA, Goh KFI, Lodh N, Bojic I, Lawate A, Ong QC, Venkataraman K, Car J, Ho AHY. Empowering Foot Care Literacy Among People Living With Diabetes and Their Carers With an mHealth App: Protocol for a Feasibility Study. JMIR Res Protoc 2023; 12:e52036. [PMID: 37988150 DOI: 10.2196/52036] [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: 08/21/2023] [Revised: 10/09/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) cause significant morbidity affecting 19% to 34% of people living with diabetes mellitus. DFUs not only impair quality of life but may also result in limb loss and mortality. Patient education has been advocated to raise awareness of proper foot self-care and the necessity of seeking assistance when a foot wound occurs. Modern technologies, including mobile health (mHealth) interventions such as health apps, bring the potential for more cost-effective and scalable interventions. OBJECTIVE This study aims to examine the feasibility and usability of a newly developed mHealth app called Well Feet, which is a diabetes and foot care education app for individuals at risk of developing DFU. METHODS Well Feet was developed using an evidence-based and expert panel cocreation approach to deliver educational content available in 3 languages (ie, English, Chinese, and Malay) via animation videos and a range of additional features, including adaptive learning. A nonrandomized, single-arm feasibility study using a mixed methods approach with a series of validated questionnaires and focus group discussions will be conducted. In total, 40 patients and carers will be recruited from a tertiary hospital diabetes clinic to receive a 1-month mHealth intervention. The primary outcomes are the usability of the app and a qualitative perspective on user experience. Secondary outcomes include changes in foot care knowledge, self-management behaviors, and quality of life. RESULTS Patient recruitment began in July 2023, and the intervention and data collection will be completed by the end of September 2023. This study has been approved by National Healthcare Group Domain Specific Review Board (2022/00614) on February 10, 2023. The expected results will be published in spring 2024. CONCLUSIONS Through this feasibility study, the Well Feet DFU education app will undergo a comprehensive quantitative and qualitative evaluation of its usability and acceptance for future improvement in its design. With local contextualization, cultural adaptation, and its multilingual functionality, the app addresses a critical aspect of DFU health education and self-management in a multiethnic population. Findings from this study will refine and enhance the features of the app based on user feedback and shape the procedural framework for a subsequent randomized controlled trial to assess the effectiveness of Well Feet. TRIAL REGISTRATION ClinicalTrials.gov NCT05564728; https://clinicaltrials.gov/study/NCT05564728. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52036.
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Affiliation(s)
- Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Anita Pienkowska
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chin-Siang Ang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Kelley Fann Ing Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Nandika Lodh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Iva Bojic
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ashwini Lawate
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Qi Chwen Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Josip Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andy Hau Yan Ho
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Moulaei K, Sheikhtaheri A, Fatehi F, Shanbehzadeh M, Bahaadinbeigy K. Patients' perspectives and preferences toward telemedicine versus in-person visits: a mixed-methods study on 1226 patients. BMC Med Inform Decis Mak 2023; 23:261. [PMID: 37968639 PMCID: PMC10647122 DOI: 10.1186/s12911-023-02348-4] [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: 04/07/2023] [Accepted: 10/21/2023] [Indexed: 11/17/2023] Open
Abstract
INTRODUCTION Despite the fact that telemedicine can eliminate geographical and time limitations and offer the possibility of diagnosing, treating, and preventing diseases by sharing reliable information, many individuals still prefer to visit medical centers for in-person consultations. The aim of this study was to determine the level of acceptance of telemedicine compared to in-person visits, identify the perceived advantages of telemedicine over in-person visits, and to explore the reasons why patients choose either of these two types of visits. METHODS We developed a questionnaire using the rational method. The questionnaire consisted of multiple-choice questions and one open-ended question. A total of 2059 patients were invited to participate in the study. Chi-square tests and descriptive statistics were employed for data analysis. To analyze the data from the open-ended question, we conducted qualitative content analysis using MAXQDA 18. RESULTS Out of the 1226 participants who completed the questionnaire, 865 (71%) preferred in-person visits, while 361 (29%) preferred telemedicine. Factors such as education level, specific health conditions, and prior experience with telemedicine influenced the preference for telemedicine. The participants provided a total of 183 different reasons for choosing either telemedicine (108 reasons) or in-person visits (75 reasons). Avoiding infectious diseases, saving cost, and eliminating and overcoming geographical distance barriers were three primary telemedicine benefits. The primary reasons for selecting an in-person visit were: more accurate diagnosis of the disease, more accurate and better examination of the patient by the physician, and more accurate and better treatment of the disease. CONCLUSION The results demonstrate that despite the numerous benefits offered by telemedicine, the majority of patients still exhibit a preference for in-person visits. In order to promote broader acceptance of telemedicine, it becomes crucial for telemedicine services to address patient preferences and concerns effectively. Employing effective change management strategies can aid in overcoming resistance and facilitating the widespread adoption of telemedicine within the population.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Fatehi
- School of Business, The University of Queensland, Brisbane, Australia
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Kambiz Bahaadinbeigy
- Department of Health Information Management and Technology, Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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15
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McCarthy M, Jevotovsky D, Mann D, Veerubhotla A, Muise E, Whiteson J, Rizzo JR. Implementing Remote Patient Monitoring of Physical Activity in Clinical Practice. Rehabil Nurs 2023; 48:209-215. [PMID: 37723623 PMCID: PMC10840984 DOI: 10.1097/rnj.0000000000000435] [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: 09/20/2023]
Abstract
PURPOSE Remote patient monitoring (RPM) is a tool for patients to share data collected outside of office visits. RPM uses technology and the digital transmission of data to inform clinician decision-making in patient care. Using RPM to track routine physical activity is feasible to operationalize, given contemporary consumer-grade devices that can sync to the electronic health record. Objective monitoring through RPM can be more reliable than patient self-reporting for physical activity. DESIGN AND METHODS This article reports on four pilot studies that highlight the utility and practicality of RPM for physical activity monitoring in outpatient clinical care. Settings include endocrinology, cardiology, neurology, and pulmonology settings. RESULTS The four pilot use cases discussed demonstrate how RPM is utilized to monitor physical activity, a shift that has broad implications for prediction, prevention, diagnosis, and management of chronic disease and rehabilitation progress. CLINICAL RELEVANCE If RPM for physical activity is to be expanded, it will be important to consider that certain populations may face challenges when accessing digital health services. CONCLUSION RPM technology provides an opportunity for clinicians to obtain objective feedback for monitoring progress of patients in rehabilitation settings. Nurses working in rehabilitation settings may need to provide additional patient education and support to improve uptake.
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Affiliation(s)
- Margaret McCarthy
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | | | - Devin Mann
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Akhila Veerubhotla
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Jonathan Whiteson
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - John Ross Rizzo
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY, USA
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16
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Dowse R, Okeyo S, Sikhondze S, Khumalo N. Pharmaceutical indication pictograms for low literacy viewers: Health literacy and comprehension. Health SA 2023; 28:2192. [PMID: 37927939 PMCID: PMC10623492 DOI: 10.4102/hsag.v28i0.2192] [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: 10/03/2022] [Accepted: 07/19/2023] [Indexed: 11/07/2023] Open
Abstract
Background Poor comprehension of pharmaceutical pictograms used on medicine labels or leaflets can compromise understanding of medicine-taking information, potentially causing negative health outcomes. Aim The aim was to assess association of health literacy (HL) with comprehension of pictograms displaying indication and side effect information in a lower literacy, limited English proficiency (LEP) population. Setting Community centre, Makhanda, South Africa. Methods This was a quantitative cross-sectional study using simple random probability sampling. Ninety isiXhosa-speaking adults with a maximum of 12 years schooling, attending primary healthcare clinics were interviewed using structured interviews. Health literacy was assessed using the Health Literacy Test for Limited Literacy populations. Comprehension of 10 locally developed pictograms was evaluated. Results The mean pictogram comprehension score was 7.9/10, with 8/10 pictograms complying with the International Organization for Standardization criterion of 66.7% correct comprehension. Only 15.6% of participants had adequate HL. A significant association of HL with pictogram comprehension was established (p = 0.002). Pictogram misinterpretation was higher in those with lower HL; adequate HL was associated with superior comprehension. Pictogram comprehension was negatively associated with age (p < 0.006), and positively associated with education (p < 0.001) and English proficiency (p < 0.001). Conclusion Higher HL was associated with better pictogram comprehension. Low HL, LEP and low education levels are regarded as potential indicators for possible pictogram misinterpretation. Contribution This study observed the potential for misinterpretation of medication pictograms. Health professionals should be aware that low HL, limited schooling and limited English proficiency could signal difficulty in fully comprehending pictogram content.
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Affiliation(s)
- Ros Dowse
- Department of Pharmacy, Faculty of Pharmacy, Rhodes University, Makhanda, South Africa
| | - Sam Okeyo
- Department of Pharmacy, Faculty of Pharmacy, Rhodes University, Makhanda, South Africa
| | - Simise Sikhondze
- Department of Pharmacy, Faculty of Pharmacy, Rhodes University, Makhanda, South Africa
| | - Nosihle Khumalo
- Department of Pharmacy, Faculty of Pharmacy, Rhodes University, Makhanda, South Africa
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17
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Michel HK, Gorham TJ, Lee JA, Liu SB, Wright M, Maltz RM, Dotson JL. Impact of Telemedicine on Delivery of Pediatric Inflammatory Bowel Disease Care. J Pediatr Gastroenterol Nutr 2023; 77:519-526. [PMID: 37501225 DOI: 10.1097/mpg.0000000000003903] [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] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Outpatient inflammatory bowel disease (IBD) care shifted from office visits (OVs) to a model with integrated telemedicine during the 2020 COVID-19 pandemic. We describe the impact of this shift on delivery of pediatric IBD care. METHODS We collected electronic medical record data from office and telemedicine visits for pediatric patients with IBD at a single center from April 2019 to December 2020. We compared visit volume, duration, and test ordering between 2019 and 2020, and between OV and telemedicine, and assessed for differences in telemedicine adoption by sociodemographic factors. RESULTS Visit volume was maintained between 2019 and 2020. Median overall appointment time was shorter for telemedicine versus OV [46 (interquartile range, IQR 35-72) vs 62 (IQR 51-80) minutes; P < 0.001] with no significant difference in time spent with provider [28 (IQR 21-41) vs OV 30 (IQR 24-39) minutes; P = 0.08]. Accounting for drive time, telemedicine visits were 2.6 times shorter than office visits in 2020 ( P < 0.001). In univariate analyses, there was no difference in telemedicine utilization by race or gender. Variables significantly associated with telemedicine were older age, English as primary language, being non-Hispanic, commercial insurance, living in an area of very high opportunity, and having a longer drive time to the office ( P < 0.05 for all comparisons). In multivariate analyses, visits among patients with commercial insurance were significantly more likely to be conducted via telemedicine ( P = 0.02). Among those with a telemedicine visit, multivariate analyses demonstrated multiracial patients were significantly more likely to have video visits (vs audio-only; P = 0.02), while patients with public insurance, no or missing insurance, and whose primary language was Arabic were significantly less likely to have video visits ( P < 0.05 for all comparisons). CONCLUSIONS Integrated telemedicine allowed for continued delivery of pediatric IBD care and significantly decreased appointment time. While telemedicine may improve access for those who live further from the office, concerns remain about the introduction of disparities.
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Affiliation(s)
- Hilary K Michel
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
| | - Tyler J Gorham
- Information Technology Research & Innovation, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer A Lee
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
- the Department of Biomedical Informatics, the Ohio State University, Columbus, OH
| | - Swan Bee Liu
- Information Technology Research & Innovation, Nationwide Children's Hospital, Columbus, OH
| | - Molly Wright
- the Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Ross M Maltz
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
| | - Jennifer L Dotson
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, OH
- the Department of Pediatrics, The Ohio State Wexner Medical Center, Columbus, OH
- the Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
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18
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Arias López MDP, Ong BA, Borrat Frigola X, Fernández AL, Hicklent RS, Obeles AJT, Rocimo AM, Celi LA. Digital literacy as a new determinant of health: A scoping review. PLOS DIGITAL HEALTH 2023; 2:e0000279. [PMID: 37824584 PMCID: PMC10569540 DOI: 10.1371/journal.pdig.0000279] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/19/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Harnessing new digital technologies can improve access to health care but can also widen the health divide for those with poor digital literacy. This scoping review aims to assess the current situation of low digital health literacy in terms of its definition, reach, impact on health and interventions for its mitigation. METHODS A comprehensive literature search strategy was composed by a qualified medical librarian. Literature databases [Medline (Ovid), Embase (Ovid), Scopus, and Google Scholar] were queried using appropriate natural language and controlled vocabulary terms along with hand-searching and citation chaining. We focused on recent and highly cited references published in English. Reviews were excluded. This scoping review was conducted following the methodological framework of Arksey and O'Malley. RESULTS A total of 268 articles were identified (263 from the initial search and 5 more added from the references of the original papers), 53 of which were finally selected for full text analysis. Digital health literacy is the most frequently used descriptor to refer to the ability to find and use health information with the goal of addressing or solving a health problem using technology. The most utilized tool to assess digital health literacy is the eHealth literacy scale (eHEALS), a self-reported measurement tool that evaluates six core dimensions and is available in various languages. Individuals with higher digital health literacy scores have better self-management and participation in their own medical decisions, mental and psychological state and quality of life. Effective interventions addressing poor digital health literacy included education/training and social support. CONCLUSIONS Although there is interest in the study and impact of poor digital health literacy, there is still a long way to go to improve measurement tools and find effective interventions to reduce the digital health divide.
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Affiliation(s)
- Maria del Pilar Arias López
- Intermediate Care Unit. Hospital de Niños Ricardo Gutierrez Buenos Aires, Argentina
- Argentine Society of Intensive Care. Management, Quality and Data Committee Buenos Aires, Argentina
| | - Bradley A. Ong
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Xavier Borrat Frigola
- Department of Anesthesiology and Intensive Care. Hospital Clínic de Barcelona, Barcelona, Spain
- Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Boston, Massachusetts United States of America
| | - Ariel L. Fernández
- Argentine Society of Intensive Care. Management, Quality and Data Committee Buenos Aires, Argentina
| | - Rachel S. Hicklent
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, Texas United States of America
| | | | - Aubrey M. Rocimo
- College of Medicine, University of the Philippines Manila Manila, Philippines
| | - Leo A. Celi
- Laboratory for Computational Physiology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Boston, Massachusetts United States of America
- Division of Pulmonary, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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Shaikh CF, Woldesenbet S, Munir MM, Moazzam Z, Endo Y, Alaimo L, Azap L, Yang J, Katayama E, Lima HA, Dawood Z, Pawlik TM. Utilization of Telemedicine among Medicare beneficiaries undergoing Hepatopancreatic Surgery during the COVID-19 Pandemic. J Gastrointest Surg 2023; 27:1611-1620. [PMID: 37254021 PMCID: PMC10228881 DOI: 10.1007/s11605-023-05711-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Telemedicine may serve as an important avenue to address disparities in access to cancer care. We sought to define factors associated with telemedicine use among Medicare beneficiaries who underwent hepatopancreatic (HP) surgery, as well as characterize trends in telemedicine usage relative to community vulnerability based on the enactment of the Medicare telemedicine coverage waiver. METHODS Patients who underwent HP surgery between 2013-2020 were identified from the Medicare Standard Analytic Files (SAF). Telemedicine utilization was assessed pre- versus post- implementation of the Medicare telemedicine coverage waiver; the county-level social vulnerability index (SVI) was obtained from the Center for Disease Control. Interrupted time series analysis with negative binomial and multivariable logistic regression methods were used to assess changes in telemedicine utilization after the implementation of the Medicare telemedicine coverage waiver relative to SVI. RESULTS Pre-waiver telemedicine visits were scarce among 16,690 patients (0.2%, n = 28), while post-waiver telemedicine adoption was substantial among 3,301 patients (45.8%, n = 1,388). Post-waiver, the median patient age was 70 years (IQR, 66-74) with the majority of patients being age 65-69 (n = 994, 32.8%); 1,599 (52.8%) were female. Most patients self-identified as White (n = 2641, 87.1%), while a minority of patients self-identified as Black (n = 190, 6.3%), Asian (n = 18, 0.6%), Hispanic (n = 35, 1.2%), or Other/unknown (n = 147, 4.9%). On multivariable regression analysis, patients who lived in highly vulnerable counties (referent Low SVI; moderate SVI: OR 1.09, 95% CI 0.86-1.39, p = 0.449; high SVI: OR 0.72, 95% CI 0.55-0.94, p = 0.001) and individuals with advancing age (referent 18-64; 65-69, OR 0.68, 95%CI 0.54-0.86; 70-74, OR 0.56, 95%CI 0.44-0.71; 75-79, OR 0.57, 95%CI 0.44-0.75; 80-84, OR 0.43, 95%CI 0.30-0.61; 85 + , OR 0.25, 95%CI 0.13-0.49) had lower odds of utilizing telemedicine. In contrast, Black patients (referent White; OR 2.26, 95% CI 1.65-3.10) and patients with a higher CCI score > 2 (referent ≤ 2; OR 1.49, 95% CI 1.28-1.71) were more likely to use telemedicine (all p < 0.001). CONCLUSIONS Medicare beneficiaries residing in counties with extreme vulnerability, as well as elderly individuals, were markedly less likely to use telemedicine services related to HP surgical episodes of care. The lower utilization of telemedicine in areas of high social vulnerability was attributable to concomitant lower rates of internet access in these areas.
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Affiliation(s)
- Chanza Fahim Shaikh
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Lovette Azap
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Jason Yang
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Erryk Katayama
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Henrique A Lima
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Zaiba Dawood
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12th Ave., Suite 670, Columbus, OH, USA.
- Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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20
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DeCamp LR, Williams L, Palmer C, Gorman C, Olson C, Thompson DA. Mixed methods evaluation of pediatric telehealth equity for patients/families who communicate in languages other than English. Mhealth 2023; 9:24. [PMID: 37492119 PMCID: PMC10364007 DOI: 10.21037/mhealth-22-43] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/15/2023] [Indexed: 07/27/2023] Open
Abstract
Background Emerging research demonstrates telehealth disparities for patients who communicate in languages other than English. A better understanding of pediatric telehealth use with families who communicate in languages other than English is needed to inform interventions to promote telehealth equity. Methods We conducted a mixed methods study of telehealth care in a children's hospital health system using electronic health record data for outpatient video telehealth encounters from April 2020 to July 2021 and qualitative interviews with clinical staff and Spanish-speaking parents of telehealth patients. Results The 16-month study period included 102,387 telehealth encounters; 5% of which were encounters in languages other than English. 83% of languages other than English encounters were with patients/families with a preferred healthcare language of Spanish. 11% of providers conducted ≥10 languages other than English telehealth encounters. This subset of providers conducted 71% of all languages other than English encounters. We conducted 25 interviews with clinical staff (n=13) and parents (n=12). Common themes identified across interviews were: (I) technology barriers affect access to and quality of telehealth; (II) clinical staff and parents are uncertain about the future role of telehealth for patients/families who communicate in languages other than English; (III) the well-known impact of language barriers on in-person healthcare access and quality for patients who communicate in languages other than English is also evident in telehealth. Conclusions Patients who communicate in languages other than English were underrepresented among telehealth encounters and encounters were concentrated among few providers. Promoting equitable telehealth care requires investment to address technology barriers, increase the readiness of providers and clinics to provide telehealth care in languages other than English, and continued attention to reducing the healthcare impact of language barriers.
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Affiliation(s)
- Lisa Ross DeCamp
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Leah Williams
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Claire Palmer
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carol Gorman
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA
| | - Christina Olson
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Darcy A. Thompson
- Children’s Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA
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21
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Naqvi IA, Cohen AS, Kim Y, Harris J, Denny MC, Strobino K, Bicher N, Leite RA, Sadowsky D, Adegboye C, Okpala N, Okpala M, Savitz SI, Marshall RS, Sharrief A. Inequities in Telemedicine Use Among Patients With Stroke and Cerebrovascular Diseases. Neurol Clin Pract 2023; 13:e200148. [PMID: 37064589 PMCID: PMC10101710 DOI: 10.1212/cpj.0000000000200148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 01/26/2023] [Indexed: 03/18/2023]
Abstract
Background and ObjectivesIn response to the COVID-19 pandemic, outpatient stroke care delivery was rapidly transformed to outpatient evaluation through video (VTM) and telephone (TPH) telemedicine (TM) visits around the world. We sought to evaluate the sociodemographic differences in outpatient TM use among stroke patients.MethodsWe conducted a retrospective chart review of outpatients evaluated at 3 tertiary stroke centers in the early period of the pandemic, 3/16/2020 through 7/31/2020. We compared the use of TM by patient characteristics including age, sex, race/ethnicity, insurance status, stroke type, patient type, and site. The association between TM use and patient characteristics was measured using the relative risk (RR) from a modified Poisson regression, and site-specific effects were controlled using a multilevel analysis.ResultsA total of 2,024 visits were included from UTHealth (n = 878), MedStar Health (n = 269), and Columbia (n = 877). The median age was 64 [IQR 52–74] years, and 53% were female. Approximately half of the patients had private insurance, 36% had Medicare, and 15% had Medicaid. Two-thirds of the visits were established patients. TM accounted for 90% of total visits, and the use of TM over office visits was primarily associated with site, not patient characteristics. TM utilization was associated with Asian and other/unknown race. Among TM users, older age, Black race, Hispanic ethnicity, and Medicaid insurance were associated with lower VTM use. Black (aRR 0.88, 95% CI 0.86–0.91,p< 0.001) and Hispanic patients (aRR 0.92, 95% CI 0.87–0.98,p= 0.005) had approximately 10% lower VTM use, while Asian patients (aRR 0.98, 95% CI 0.89–1.07,p= 0.59) had similar VTM use compared with White patients. Patients with Medicaid were less likely to use VTM compared with those with private insurance (aRR 0.86, 95% CI 0.81–0.91,p< 0.001).DiscussionIn our diverse cohort across 3 centers, we found differences in TM visit type by race and insurance early during the COVID-19 pandemic. These findings suggest disparities in VTM access across different stroke populations. As VTM remains an integral part of outpatient neurology practice, steps to ensure equitable access are essential.
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Affiliation(s)
- Imama A Naqvi
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Audrey S Cohen
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Youngran Kim
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Jennifer Harris
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Mary Carter Denny
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Kevin Strobino
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Nathan Bicher
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Ryan A Leite
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Dylan Sadowsky
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Comfort Adegboye
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Nnedinma Okpala
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Munachi Okpala
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Sean I Savitz
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Randolph S Marshall
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
| | - Anjail Sharrief
- Department of Neurology (IAN, KS, RSM), Division of Stroke and Cerebrovascular Diseases, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY; Department of Neurology (ASC, YK, NO, MO, SIS, AS) and Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, TX; Department of Neurology (JH), Division of Stroke and Cerebrovascular Disease, Cedar-Sinai Medical Center, Los Angeles, CA; Department of Neurology (MCD, NB, RAL, DS), Georgetown University Medical Center and MedStar Georgetown University Hospital, Washington, DC; Howard University (CA), Washington, DC
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22
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Hsueh L, Huang J, Millman AK, Gopalan A, Parikh RK, Teran S, Reed ME. Cross-Sectional Association of Patient Language and Patient-Provider Language Concordance with Video Telemedicine Use Among Patients with Limited English Proficiency. J Gen Intern Med 2023; 38:633-640. [PMID: 36357732 PMCID: PMC9649000 DOI: 10.1007/s11606-022-07887-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Telemedicine's dramatic increase during the COVID-19 pandemic elevates the importance of addressing patient-care gaps in telemedicine, especially for patients with limited English proficiency. OBJECTIVE To examine the associations of patient language and patient-provider language concordance with telemedicine visit type (video versus telephone visit). DESIGN Cross-sectional automated data study of patient-scheduled primary care telemedicine appointments from March 16, 2020, to October 31, 2020. SETTING Northern California integrated healthcare delivery system. PARTICIPANTS All 22,427 completed primary care telemedicine visits scheduled by 13,764 patients with limited English proficiency via the patient portal. MEASUREMENTS Cross-sectional association of electronic health record-documented patient language (Spanish as referent) and patient-provider language concordance with patients' choice of a video (versus telephone) visit, accounting for patient sociodemographics, technology access, and technology familiarity factors. RESULTS Of all patient-scheduled visits, 34.5% (n = 7747) were video visits. The top three patient languages were Spanish (42.4%), Cantonese (16.9%), and Mandarin (10.3%). Adjusting for sociodemographic and technology access and familiarity factors and compared to patients speaking Spanish, video visit use was higher among patients speaking Cantonese (OR = 1.34, 95% CI: 1.18-1.52), Mandarin (OR = 1.33, 95% CI: 1.16-1.52), or Vietnamese (OR = 1.27, 95% CI: 1.09-1.47), but lower among patients speaking Punjabi (OR = 0.75, 95% CI: 0.75, 0.62-0.91). Language concordance was associated with lower video visit use (OR = 0.86, 95% CI: 0.80-0.93) and moderated associations of speaking Spanish, Cantonese, and Korean with video visit use. In addition, for all language groups, those with prior video visit use were more likely to re-use video visits compared to those with no prior use (p < .05 for all languages except Hindi with p = 0.06). CONCLUSIONS Among linguistically diverse patients with limited English proficiency, video telemedicine use differed by specific language. Disaggregating patient subpopulation data is necessary for identifying those at greatest risk of being negatively impacted by the digital divide.
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Affiliation(s)
- Loretta Hsueh
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
- University of Illinois at Chicago Department of Psychology, Chicago, USA.
| | - Jie Huang
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Andrea K Millman
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | - Anjali Gopalan
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
| | | | | | - Mary E Reed
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA
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23
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Beatty AL, Beckie TM, Dodson J, Goldstein CM, Hughes JW, Kraus WE, Martin SS, Olson TP, Pack QR, Stolp H, Thomas RJ, Wu WC, Franklin BA. A New Era in Cardiac Rehabilitation Delivery: Research Gaps, Questions, Strategies, and Priorities. Circulation 2023; 147:254-266. [PMID: 36649394 PMCID: PMC9988237 DOI: 10.1161/circulationaha.122.061046] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac rehabilitation (CR) is a guideline-recommended, multidisciplinary program of exercise training, risk factor management, and psychosocial counseling for people with cardiovascular disease (CVD) that is beneficial but underused and with substantial disparities in referral, access, and participation. The emergence of new virtual and remote delivery models has the potential to improve access to and participation in CR and ultimately improve outcomes for people with CVD. Although data suggest that new delivery models for CR have safety and efficacy similar to traditional in-person CR, questions remain regarding which participants are most likely to benefit from these models, how and where such programs should be delivered, and their effect on outcomes in diverse populations. In this review, we describe important gaps in evidence, identify relevant research questions, and propose strategies for addressing them. We highlight 4 research priorities: (1) including diverse populations in all CR research; (2) leveraging implementation methodologies to enhance equitable delivery of CR; (3) clarifying which populations are most likely to benefit from virtual and remote CR; and (4) comparing traditional in-person CR with virtual and remote CR in diverse populations using multicenter studies of important clinical, psychosocial, and cost-effectiveness outcomes that are relevant to patients, caregivers, providers, health systems, and payors. By framing these important questions, we hope to advance toward a goal of delivering high-quality CR to as many people as possible to improve outcomes in those with CVD.
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Affiliation(s)
- Alexis L Beatty
- Department of Epidemiology and Biostatistics (A.L.B.), University of California, San Francisco.,Department of Medicine, Division of Cardiology (A.L.B.), University of California, San Francisco
| | - Theresa M Beckie
- College of Nursing (T.M.B.), University of South Florida, Tampa.,College of Medicine, Division of Cardiovascular Sciences (T.M.B.), University of South Florida, Tampa
| | - John Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine (J.D.), New York University School of Medicine, New York.,Department of Population Health (J.D.), New York University School of Medicine, New York
| | - Carly M Goldstein
- The Weight Control and Diabetes Research Center, the Miriam Hospital, Providence, RI (C.M.G.).,Department of Psychiatry and Human Behavior, The Warren Alpert Medical School (C.M.G.), Brown University, Providence, RI
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, OH (J.W.H.)
| | - William E Kraus
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC (W.E.K.)
| | - Seth S Martin
- Department of Medicine, Division of Cardiology, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (S.S.M.)
| | - Thomas P Olson
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Quinn R Pack
- Department of Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield (Q.R.P.)
| | - Haley Stolp
- ASRT, Inc, Atlanta, GA (H.S.).,Centers for Disease Control and Prevention, Atlanta, GA (H.S.)
| | - Randal J Thomas
- Department of Cardiovascular Medicine, Division of Preventive Cardiology, Mayo Clinic, Rochester, MN (T.P.O., R.J.T.)
| | - Wen-Chih Wu
- Lifespan Cardiovascular Institute (W.-C.W.), Brown University, Providence, RI.,Division of Cardiology, Providence VA Medical Center, RI (W.-C.W.)
| | - Barry A Franklin
- William Beaumont Hospital, Royal Oak, MI (B.A.F.).,Oakland University William Beaumont School of Medicine, Rochester, MI (B.A.F.)
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24
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Bhawra J, Buchan MC, Green B, Skinner K, Katapally TR. A guiding framework for needs assessment evaluations to embed digital platforms in partnership with Indigenous communities. PLoS One 2022; 17:e0279282. [PMID: 36548382 PMCID: PMC10045546 DOI: 10.1371/journal.pone.0279282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION In community-based research projects, needs assessments are one of the first steps to identify community priorities. Access-related issues often pose significant barriers to participation in research and evaluation for rural and remote communities, particularly Indigenous communities, which also have a complex relationship with academia due to a history of exploitation. To bridge this gap, work with Indigenous communities requires consistent and meaningful engagement. The prominence of digital devices (i.e., smartphones) offers an unparalleled opportunity for ethical and equitable engagement between researchers and communities across jurisdictions, particularly in remote communities. METHODS This paper presents a framework to guide needs assessments which embed digital platforms in partnership with Indigenous communities. Guided by this framework, a qualitative needs assessment was conducted with a subarctic Métis community in Saskatchewan, Canada. This project is governed by an Advisory Council comprised of Knowledge Keepers, Elders, and youth in the community. An environmental scan of relevant programs, three key informant interviews, and two focus groups (n = 4 in each) were conducted to systematically identify community priorities. RESULTS Through discussions with the community, four priorities were identified: (1) the Coronavirus pandemic, (2) climate change impacts on the environment, (3) mental health and wellbeing, and (4) food security and sovereignty. Given the timing of the needs assessment, the community identified the Coronavirus pandemic as a key priority requiring digital initiatives. CONCLUSION Recommendations for community-based needs assessments to conceptualize and implement digital infrastructure are put forward, with an emphasis on self-governance and data sovereignty.
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Affiliation(s)
- Jasmin Bhawra
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, ON, Canada
| | - M. Claire Buchan
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Brenda Green
- Île-à-la-Crosse School Division, The Northern Village of Île-à-la-Crosse, Île-à-la-Crosse, SK, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Tarun Reddy Katapally
- DEPtH Lab, Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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25
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Grafft N, Aftosmes-Tobio A, Gago C, Lansburg K, Beckerman-Hsu J, Trefry B, Kumanyika S, Davison K. Adaptation and implementation outcomes of a parenting program for low-income, ethnically diverse families delivered virtually versus in-person. Transl Behav Med 2022; 12:1065-1075. [PMID: 36318233 PMCID: PMC9677462 DOI: 10.1093/tbm/ibac077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Driven by the COVID-19 pandemic, many in-person health behavior interventions were compelled to quickly pivot to a virtual format with little time or capacity to reflect on or examine possible equity-related implications of a format that required digital access and remote learning skills. Using a parenting program for low-income families as a case study, this paper (a) outlines the process of adapting the program from an in-person to a virtual format and (b) examines the equity-related implications of this adaptation. Parents Connect for Healthy Living (PConnect) is a 10-session empowerment-focused parenting intervention designed to promote family health for Head Start families. In 2020, PConnect was adapted over a 6-month period from an in-person to a virtual format due to the advent of the COVID-19 pandemic. Three core elements were retained in the adaptation; session content, provision of coaching support for facilitators, and the co-facilitation model. Key modifications include session length, group composition, and language of program delivery. Head Start and PConnect records provided data to compare reach, acceptability, and appropriateness of virtual and in-person PConnect. Seventy-eight parents enrolled in the in-person program and 58 in the virtual program. Participant demographics and satisfaction were similar across formats, and demographics similar to the general Head Start population. Participation was higher in the virtual format. Parents participated in the virtual program primarily via smart phones (68%). This case study supports the acceptability and appropriateness of virtual parenting programs in ethnically diverse, low-resource settings.
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Affiliation(s)
- Natalie Grafft
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | | | - Cristina Gago
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kindra Lansburg
- Action for Boston Community Development (ABCD), Boston, MA, USA
| | | | - Brooke Trefry
- School of Social Work, Boston College, Chestnut Hill, MA, USA
| | | | - Kirsten Davison
- School of Social Work, Boston College, Chestnut Hill, MA, USA
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Fitzpatrick C, Richardson D, Sherriff N, Whetham J. Pilot evaluation of PrEP EmERGE - A novel digital health innovation designed to support sexual health clinics and HIV-PrEP users. HIV Med 2022; 24:502-506. [PMID: 36134691 DOI: 10.1111/hiv.13406] [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: 05/03/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to evaluate the usability and acceptability of a co-designed mobile health (mHealth) application (PrEP-EmERGE) within a digital health pathway to support HIV pre-exposure prophylaxis (PrEP). METHODS This was a cross-sectional study to evaluate the usability and acceptability of the PrEP-EmERGE app. Data were collected via an online survey sent to all PrEP EmERGE users in September 2021. Usability was assessed with a validated usability tool, the System Usability Scale (SUS). Acceptability was assessed using modified patient-reported experience measures (PREMs). Quantitative data were analysed using descriptive and/or inferential statistics and qualitative data (free text responses) using thematic analysis. RESULTS In total, 81/133 (61%) active PrEP EmERGE users completed the online survey, which was available directly from their PrEP EmERGE app: 78/81 (96%) identified as cis-male, 74/81 (91%) reported their ethnicity as 'white', 69/81 (85%) reported daily PrEP use, 7/81 (9%) reported using an event-based dosing schedule, and 5/81 (6%) were switching between dosing schedules. Overall, the median SUS score was 78/100 (interquartile range: 70-92). There were no differences in median SUS scores by PrEP dosing schedules (p = 0.78) or months of experience of using the app (p = 0.31). Overall, 73/81 (90%) would recommend the PrEP EmERGE app to a friend and 78/81 (96%) rated their satisfaction of the app as excellent, good or satisfactory. The free text responses generated three key themes: accessibility (for results and information); autonomy [taking responsibility for their (sexual) health] and functionality (including technical recommendations for app development and the digital health pathway). CONCLUSIONS Innovative, co-designed digital health pathways, such as PrEP EmERGE can help sexual health services to manage increasing numbers of people accessing PrEP - ensuring that they retain access for those who need to be seen face-to-face. We report high levels of acceptability and usability during the first 4 months of this novel pathway.
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Affiliation(s)
- Colin Fitzpatrick
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
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Balakrishnan AS, Nguyen HG, Shinohara K, Carroll PR, Odisho AY. Patient engagement in a mobile health intervention to improve preparedness for prostate biopsy. Urol Oncol 2022; 40:407.e1-407.e7. [DOI: 10.1016/j.urolonc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 05/28/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
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Williams KDA, Wijaya C, Stamatis CA, Abbott G, Lattie EG. Insights Into Needs and Preferences for Mental Health Support on Social Media and Through Mobile Apps Among Black Male University Students: Exploratory Qualitative Study. JMIR Form Res 2022; 6:e38716. [PMID: 36044261 PMCID: PMC9475414 DOI: 10.2196/38716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Black college-aged men are less likely than their peers to use formal, therapeutic in-person services for mental health concerns. As the use of mobile technologies and social media platforms is steadily increasing, it is important to conduct work that examines the future utility of digital tools and technologies to improve access to and uptake of mental health services for Black men and Black men in college. OBJECTIVE The aim of this study was to identify and understand college-attending Black men's needs and preferences for using digital health technologies and social media for stress and mental health symptom management. METHODS Interviews were conducted with Black male students (N=11) from 2 racially diverse universities in the Midwestern United States. Participants were asked questions related to their current mental health needs and interest in using social media platforms and mobile-based apps for their mental health concerns. A thematic analysis was conducted. RESULTS Four themes emerged from the data: current stress relief strategies, technology-based support needs and preferences (subthemes: mobile-based support and social media-based support), resource information dissemination considerations (subthemes: information-learning expectations and preferences and information-sharing preferences and behaviors), and technology-based mental health support design considerations (subtheme: relatability and representation). Participants were interested in using social media and digital technologies for their mental health concerns and needs, for example, phone notifications and visual-based mental health advertisements that promote awareness. Relatability in the context of representation was emphasized as a key factor for participants interested in using digital mental health tools. Examples of methods for increasing relatability included having tools disseminated by minority-serving organizations and including components explicitly portraying Black men engaging in mental health support strategies. The men also discussed wanting to receive recommendations for stress relief that have been proven successful, particularly for Black men. CONCLUSIONS The findings from this study provide insights into design and dissemination considerations for future work geared toward developing mental health messaging and digital interventions for young Black men.
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Affiliation(s)
- Kofoworola D A Williams
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Clarisa Wijaya
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Caitlin A Stamatis
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Gabriel Abbott
- Weinberg College of Arts & Sciences, Northwestern University, Chicago, IL, United States
| | - Emily G Lattie
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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29
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Liu AW, Odisho AY, Brown Rd W, Gonzales R, Neinstein AB, Judson T. Patient Experience and Feedback after Use of an EHR-integrated COVID-19 Symptom Checker. JMIR Hum Factors 2022; 9:e40064. [PMID: 35960593 PMCID: PMC9472505 DOI: 10.2196/40064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/20/2022] [Accepted: 08/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Symptom checkers have been widely used during the COVID-19 pandemic to alleviate strain on health systems and offer patients a 24/7 self-service triage option. Although studies suggest that users may positively perceive online symptom checkers, no studies have quantified user feedback after use of an electronic health record (EHR)-integrated COVID-19 symptom checker with self-scheduling functionality. OBJECTIVE We aimed to understand user experience, user satisfaction, and user-reported alternatives to use of a COVID-19 symptom checker with self-triage and self-scheduling functionality. METHODS We launched a patient-portal based self-triage and self-scheduling tool in March 2020 for patients with COVID-19 symptoms, exposures, or questions. We made an optional, anonymous Qualtrics survey available to patients immediately after they completed the symptom checker. RESULTS Between December 16th, 2021 and March 28th, 2022, there were 395 unique responses to the survey. Overall, respondents reported high satisfaction across all demographics, with a median rating of 8 out of 10, and 47.6% of respondents giving a rating of 9 or 10 out of 10. User satisfaction scores were not associated with any demographic factors. The most common user-reported alternatives had the online tool not been available were calling the COVID-19 telephone hotline and sending a patient-portal message to their physician for advice. The ability to schedule a test online was the most important symptom checker feature for respondents. The most common categories of user feedback were regarding other COVID-19 services (e.g. telephone hotline), policies or procedures, or requesting additional features or functionality. CONCLUSIONS This analysis suggests that COVID-19 symptom checkers with self-triage and self-scheduling functionality may have high overall user satisfaction, regardless of user demographics. By allowing users to self-triage and self-schedule tests and visits, tools like this may prevent unnecessary calls and messages to clinicians. Individual feedback suggested that the user experience for this type of tool is highly dependent on the organization's operational workflows for COVID-19 testing and care. The study provides insight for the implementation and improvement of COVID-19 symptom checkers to ensure high user satisfaction. .
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Affiliation(s)
- Andrew Wayne Liu
- Center for Digital Health Innovation, University of California, San Francisco, 1700 Owens St, Suite 541, San Francisco, US
| | - Anobel Youhana Odisho
- Center for Digital Health Innovation, University of California, San Francisco, 1700 Owens St, Suite 541, San Francisco, US.,Department of Urology, University of California, San Francisco, San Francisco, US
| | - William Brown Rd
- Center for Digital Health Innovation, University of California, San Francisco, 1700 Owens St, Suite 541, San Francisco, US.,Department of Medicine, University of California, San Francisco, 521 Parnassus Avenue, Suite U127, Box 0131, San Francisco, US.,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, US
| | - Ralph Gonzales
- Department of Medicine, University of California, San Francisco, 521 Parnassus Avenue, Suite U127, Box 0131, San Francisco, US.,Clinical Innovation Center, University of California, San Francisco, San Francisco, US
| | - Aaron B Neinstein
- Center for Digital Health Innovation, University of California, San Francisco, 1700 Owens St, Suite 541, San Francisco, US.,Department of Medicine, University of California, San Francisco, 521 Parnassus Avenue, Suite U127, Box 0131, San Francisco, US
| | - Timothy Judson
- Center for Digital Health Innovation, University of California, San Francisco, 1700 Owens St, Suite 541, San Francisco, US.,Department of Medicine, University of California, San Francisco, 521 Parnassus Avenue, Suite U127, Box 0131, San Francisco, US.,Office of Population Health, University of California, San Francisco, San Francisco, US
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30
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Helleman J, Johnson B, Holdom C, Hobson E, Murray D, Steyn FJ, Ngo ST, Henders A, Lokeshappa MB, Visser-Meily JMA, van den Berg LH, Hardiman O, Beelen A, McDermott C, van Eijk RPA. Patient perspectives on digital healthcare technology in care and clinical trials for motor neuron disease: an international survey. J Neurol 2022; 269:6003-6013. [PMID: 35849154 PMCID: PMC9294855 DOI: 10.1007/s00415-022-11273-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
Introduction To capture the patient’s attitude toward remote monitoring of motor neuron disease (MND) in care and clinical trials, and their concerns and preferences regarding the use of digital technology. Methods We performed an international multi-centre survey study in three MND clinics in The Netherlands, the United Kingdom, and Australia. The survey was co-developed by investigators and patients with MND, and sent to patients by e-mail or postal-mail. The main topics included: patients’ attitude towards remote care, participating in decentralized clinical trials, and preferences for and concerns with digital technology use. Results In total, 332 patients with MND participated. A majority of patients indicated they would be happy to self-monitor their health from home (69%), be remotely monitored by a multidisciplinary care team (75%), and would be willing to participate in clinical trials from home (65%). Patients considered respiratory function and muscle strength most valuable for home-monitoring. The majority of patients considered the use of at least three devices/apps (75%) once a week (61%) to be acceptable for home-monitoring. Fifteen percent of patients indicated they would not wish to perform home-measurements; reporting concerns about the burden and distress of home-monitoring, privacy and data security. Conclusion Most patients with MND exhibited a positive attitude toward the use of digital technology in both care and clinical trial settings. A subgroup of patients reported concerns with home-monitoring, which should be addressed in order to improve widespread adoption of remote digital technology in clinical MND care. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11273-x.
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Affiliation(s)
- Jochem Helleman
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Barbara Johnson
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Cory Holdom
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia.,UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Esther Hobson
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Deirdre Murray
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,Physiotherapy Department, Beaumont Hospital, Dublin, Ireland
| | - Frederik J Steyn
- School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Brisbane, Australia.,The Royal Brisbane and Women's Hospital, Herston, Australia.,Wesley Medical Research, The Wesley Hospital, Auchenflower, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Shyuan T Ngo
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia.,The Royal Brisbane and Women's Hospital, Herston, Australia.,Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Anjali Henders
- Institute for Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Madhura B Lokeshappa
- Institute for Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Orla Hardiman
- Department of Neurology, National Neuroscience Centre, Beaumont Hospital, Dublin, Ireland.,FutureNeuro SFI Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anita Beelen
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Chris McDermott
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands. .,Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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31
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Tartarilla AB, Tennermann N, Melvin P, Ward VL, Bauer AS. Sociodemographic Missed-care Predictors for Pediatric Orthopaedic Telemedicine During COVID-19. J Pediatr Orthop 2022; 42:e688-e695. [PMID: 35667058 DOI: 10.1097/bpo.0000000000002112] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increased telehealth services may not benefit communities already lacking access to care. Race, socioeconomic status, and insurance type are known to predict missed-care opportunities (MCO) in health care. We examined differences in pediatric orthopaedic telemedicine MCOs during the COVID-19 pandemic, compared with MCOs of in-person visits in a prepandemic time frame. We hypothesized that groups with known health disparities would experience higher rates of pediatric orthopedic telemedicine MCOs. METHODS We retrospectively analyzed pediatric orthopaedic telemedicine MCOs during the COVID-19 pandemic lockdown (March-May 2020) and in-person pediatric orthopaedic visit MCOs during a nonpandemic timeframe (March-May 2019). We examined predictors of MCOs including race, ethnicity, language, insurance status, and other socioeconomic determinants of health. RESULTS There were 1448 telemedicine appointments in the pandemic cohort and 8053 in-person appointments in the prepandemic cohort. Rates of telemedicine MCOs (12.5%; n=181) were significantly lower than in-person MCOs (19.5%; n=1566; P<0.001). Telemedicine appointments with public insurance or without insurance (P<0.001) and being Black or Hispanic/Latinx (P=0.003) were associated with MCOs. There were significant differences between in-person MCOs and telemedicine MCOs among all predictors studied, except for orthopaedic subspecialty team and patient's social vulnerability index. CONCLUSIONS Patients with telemedicine appointments during the COVID-19 pandemic were less likely to experience MCOs than patients with in-person visits during the nonpandemic timeframe. However, when controlling for socioeconomic factors including race, ethnicity, and insurance type, disparities found for in-person visits persisted with the shift to telemedicine. Pediatric orthopaedists should be aware that the use of telemedicine does not necessarily improve access for our most vulnerable patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Patrice Melvin
- Office of Health Equity and Inclusion
- Center for Applied Pediatric Quality Analytics
| | - Valerie L Ward
- Office of Health Equity and Inclusion
- Department of Radiology, Boston Children's Hospital
- Harvard Medical School, Boston, MA
| | - Andrea S Bauer
- Department of Orthopaedic Surgery
- Harvard Medical School, Boston, MA
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Chelberg GR, Butten K, Mahoney R. Culturally Safe eHealth Interventions With Aboriginal and Torres Strait Islander People: Protocol for a Best Practice Framework. JMIR Res Protoc 2022; 11:e34904. [PMID: 35687420 PMCID: PMC9233256 DOI: 10.2196/34904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/26/2022] [Accepted: 05/20/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is growing global evidence on the adoption and effectiveness of eHealth (including mobile health and telehealth) by First Nation peoples including Aboriginal and Torres Strait Islander people. Although there are frameworks to guide eHealth development, implementation, and evaluation, it is unknown whether they adequately encapsulate the health, cultural, and community-related priorities of Aboriginal and Torres Strait Islander people. OBJECTIVE The aim of this research program is to prepare a best practice framework that will guide the co-design, implementation, and evaluation of culturally safe eHealth interventions within existing models of health care for Aboriginal and Torres Strait Islander people. The framework will be a synthesis of evidence that represents best practices in eHealth, as determined by Aboriginal and Torres Strait Islander people. METHODS Research activities to develop the best practice framework will occur in stepped but overlapping qualitative research phases with governance from an existing multiagency research collaboration (the Collaboration). The research protocol has been informed by key research frameworks such as the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and Developers of Health Research Reporting Guidelines. The seven phases of research will include the following: systematic literature review, scoping review, theme development, theme consultation, Delphi processes for expert reviews, and dissemination. RESULTS Members of the Collaboration conceived this research program in August 2020, and a draft was produced in June 2021 with subsequent funding obtained in July 2021. The Collaboration approved the protocol in December 2021. Results for several research phases of the best practice framework development are expected by January 2023, commencing with the systematic literature review and the scoping review. CONCLUSIONS The research program outlined in this protocol is a timely response to the growing number of eHealth interventions with Aboriginal and Torres Strait Islander people. A best practice framework is needed to guide the rigorous development and evaluation of eHealth innovations to promote genuine co-design and ensure cultural safety and clinical effectiveness for Aboriginal and Torres Strait Islander people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34904.
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Affiliation(s)
- Georgina R Chelberg
- Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia.,Centre for Online Health, The University of Queensland, Woolloongabba, Australia
| | - Kaley Butten
- Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Ray Mahoney
- Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Herston, Australia.,School of Public Health, The University of Queensland, Herston, Australia
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Galaviz KI, Shah NS, Gutierrez M, Collins LF, Lahiri CD, Moran CA, Szabo B, Sumitani J, Rhodes J, Marconi VC, Nguyen ML, Cantos VD, Armstrong WS, Colasanti JA. Patient Experiences with Telemedicine for HIV Care During the First COVID-19 Wave in Atlanta, Georgia. AIDS Res Hum Retroviruses 2022; 38:415-420. [PMID: 34693726 PMCID: PMC9206466 DOI: 10.1089/aid.2021.0109] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We explored experiences with telemedicine among persons with HIV (PWH) during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. A convenience sample of adults (>18 years) receiving care in an urban clinic in Atlanta were invited to participate. Patients completed a structured survey that assessed the usefulness, quality, satisfaction, and concerns with telemedicine services (telephone calls) received during the first wave of the COVID-19 pandemic (March-May 2020). Demographic, plasma HIV-1 RNA, and CD4+ T cell count data were obtained through medical chart abstraction. Bootstrapped t-tests and chi-square tests were used to examine differences in patient experiences by age, sex, and race. Of 406 PWH contacted, 101 completed the survey (median age 55 years, 84% men, 77% Black, 98% virally suppressed, median CD4 count 572 cells/μL). The main HIV care disruptions experienced were delays in follow-up visits (40%), difficulty getting viral load measured (35%), and difficulty accessing antiretroviral therapy (21%). Participant ratings for quality (median score 6.5/7), usefulness (median score 6.0/7), and satisfaction (median score 6.3/7) with telemedicine were high. However, 28% of patients expressed concerns about providers' ability to examine them and about the lack of laboratory tests. More women had concerns about providers' ability to examine them (92% vs. 50%, p = .005) and about the safety of their personal information (69% vs. 23%, p = .002) compared with men. No age or race differences were observed. Although PWH are generally satisfied with telephone-based telemedicine, concerns with its use were notable, particularly among women. Future HIV telemedicine models should address these.
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Affiliation(s)
- Karla I. Galaviz
- Indiana University School of Public Health, Bloomington, Indiana, USA
| | - N. Sarita Shah
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Mariana Gutierrez
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Lauren F. Collins
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Cecile D. Lahiri
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Caitlin A. Moran
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | | | | | - Jeselyn Rhodes
- Emory University, Office of Information Technology, IT Data Solutions, Atlanta, Georgia, USA
| | - Vincent C. Marconi
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Minh Ly Nguyen
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Valeria D. Cantos
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Jonathan A. Colasanti
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
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Kornfield R, Meyerhoff J, Studd H, Bhattacharjee A, Williams JJ, Reddy M, Mohr DC. Meeting Users Where They Are: User-centered Design of an Automated Text Messaging Tool to Support the Mental Health of Young Adults. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2022; 2022:329. [PMID: 35574512 PMCID: PMC9098159 DOI: 10.1145/3491102.3502046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Young adults have high rates of mental health conditions, but most do not want or cannot access formal treatment. We therefore recruited young adults with depression or anxiety symptoms to co-design a digital tool for self-managing their mental health concerns. Through study activities-consisting of an online discussion group and a series of design workshops-participants highlighted the importance of easy-to-use digital tools that allow them to exercise independence in their self-management. They described ways that an automated messaging tool might benefit them by: facilitating experimentation with diverse concepts and experiences; allowing variable depth of engagement based on preferences, availability, and mood; and collecting feedback to personalize the tool. While participants wanted to feel supported by an automated tool, they cautioned against incorporating an overtly human-like motivational tone. We discuss ways to apply these findings to improve the design and dissemination of digital mental health tools for young adults.
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Affiliation(s)
| | | | | | | | | | - Madhu Reddy
- University of California-Irvine, Irvine, CA, USA
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35
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Yan X, Stults CD, Deng S, Liang SY, Dillon E, Mudiganti S, Oscarson B, Jones JB, Frosch DL. Do Patients Continue to Use Video Visits? Factors Related to Continued Video Visit Use. Popul Health Manag 2022; 25:462-471. [PMID: 35353619 DOI: 10.1089/pop.2021.0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Many studies have assessed the factors associated with overall video visit use during the COVID-19 pandemic, but little is known about who is most likely to continue to use video visits and why. The authors combined a survey with electronic health record data to identify factors affecting the continued use of video visit. In August 2020, a stratified random sample of 20,000 active patients from a large health care system were invited to complete an email survey on health care seeking preferences during the COVID. Weighted logistic regression models were applied, adjusting for sampling frame and response bias, to identify factors associated with video visit experience, and separately for preference of continued use of video visits. Actual video visit utilization was also estimated within 12 months after the survey. Three thousand three hundred fifty-one (17.2%) patients completed the survey. Of these, 1208 (36%) reported having at least 1 video visit in the past, lowest for African American (33%) and highest for Hispanic (41%). Of these, 38% would prefer a video visit in the future. The strongest predictors of future video visit use were comfort using video interactions (odds ratio [OR] = 5.30, 95% confidence interval [95% CI]: 3.57-7.85) and satisfaction with the overall quality (OR = 3.94, 95% CI: 2.66-5.86). Interestingly, despite a significantly higher satisfaction for Hispanic (40%-55%) and African American (40%-50%) compared with Asian (29%-39%), Hispanic (OR = 0.46, 95% CI: 0.12-0.88) and African American (OR = 0.54, 95% CI: 0.16-0.90) were less likely to prefer a future video visit. Disparity exists in the use of video visit. The association between patient satisfaction and continued video visit varies by race/ethnicity, which may change the future long-term video visit use among race/ethnicity groups.
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Affiliation(s)
- Xiaowei Yan
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - Cheryl D Stults
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Sien Deng
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Su-Ying Liang
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Ellis Dillon
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA.,Palo Alto Medical Foundation Research Institute, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Satish Mudiganti
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - Brandon Oscarson
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - James B Jones
- Center for Health System Research, Sutter Health, Walnut Creek, California, USA
| | - Dominick L Frosch
- Health Science Diligence Advisors, LLC, Redwood City, California, USA
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36
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Figueroa CA, Murayama H, Amorim PC, White A, Quiterio A, Luo T, Aguilera A, Smith ADR, Lyles CR, Robinson V, von Vacano C. Applying the Digital Health Social Justice Guide. Front Digit Health 2022; 4:807886. [PMID: 35295620 PMCID: PMC8918521 DOI: 10.3389/fdgth.2022.807886] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/01/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Digital health, the use of apps, text-messaging, and online interventions, can revolutionize healthcare and make care more equitable. Currently, digital health interventions are often not designed for those who could benefit most and may have unintended consequences. In this paper, we explain how privacy vulnerabilities and power imbalances, including racism and sexism, continue to influence health app design and research. We provide guidelines for researchers to design, report and evaluate digital health studies to maximize social justice in health. Methods From September 2020 to April 2021, we held five discussion and brainstorming sessions with researchers, students, and community partners to develop the guide and the key questions. We additionally conducted an informal literature review, invited experts to review our guide, and identified examples from our own digital health study and other studies. Results We identified five overarching topics with key questions and subquestions to guide researchers in designing or evaluating a digital health research study. The overarching topics are: 1. Equitable distribution; 2. Equitable design; 3. Privacy and data return; 4. Stereotype and bias; 5. Structural racism. Conclusion We provide a guide with five key topics and questions for social justice digital health research. Encouraging researchers and practitioners to ask these questions will help to spark a transformation in digital health toward more equitable and ethical research. Future work needs to determine if the quality of studies can improve when researchers use this guide.
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Affiliation(s)
- Caroline A. Figueroa
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
- D-Lab, University of California, Berkeley, Berkeley, CA, United States
- *Correspondence: Caroline A. Figueroa
| | - Hikari Murayama
- D-Lab, University of California, Berkeley, Berkeley, CA, United States
- Energy and Resources Group, University of California, Berkeley, Berkeley, CA, United States
| | | | - Alison White
- D-Lab, University of California, Berkeley, Berkeley, CA, United States
| | - Ashley Quiterio
- D-Lab, University of California, Berkeley, Berkeley, CA, United States
| | - Tiffany Luo
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
- UCSF Center for Vulnerable Populations in the Division of General Internal Medicine San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Angela D. R. Smith
- School of Information, University of Texas at Austin, Austin, TX, United States
| | - Courtney R. Lyles
- UCSF Center for Vulnerable Populations in the Division of General Internal Medicine San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Victoria Robinson
- Ethnic Studies, University of California, Berkeley, Berkeley, CA, United States
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Crossen SS, Bruggeman BS, Haller MJ, Raymond JK. Challenges and Opportunities in Using Telehealth for Diabetes Care. Diabetes Spectr 2022; 35:33-42. [PMID: 35308158 PMCID: PMC8914589 DOI: 10.2337/dsi21-0018] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The ongoing coronavirus pandemic led to a rapid and dramatic increase in the use of telehealth for diabetes care. In the wake of this transition, we examine new opportunities and ongoing challenges for using telehealth within diabetes management, based on data and experiences from the pre-pandemic and pandemic time frames.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology, University of California, Davis, Sacramento, CA
| | | | - Michael J. Haller
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Jennifer K. Raymond
- Division of Pediatric Endocrinology, Children’s Hospital Los Angeles, Los Angeles, CA
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Huh KY, Moon SJ, Jeong SU, Kim MJ, Yang W, Jeong M, Kim MG, Lee S. Evaluation of a blockchain-based dynamic consent platform (METORY) in a decentralized and multicenter clinical trial using virtual drugs. Clin Transl Sci 2022; 15:1257-1268. [PMID: 35157788 PMCID: PMC9099134 DOI: 10.1111/cts.13246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/15/2022] Open
Abstract
Blockchain is a novel data architecture characterized by a chronological sequence of blocks in a decentralized manner. We aimed to evaluate the real-world feasibility of a blockchain-based dynamic consent platform (METORY) in a decentralized and multicenter trial. The study consisted of three visits (i.e., screening and 2 follow-up visits) with a 2-week interval. Each subject was required to report the self-measured body temperatures and take a virtual investigational drug by entering the unique drug code on the application. To simulate real-world study settings, two major (i.e., changes in the schedule of body temperature measurement) and three minor protocol amendments (i.e., nonsignificant changes without any changes in the procedures) were set. Overall study completion rates, proportion of consent, and response time to each protocol amendment and adherence were evaluated. A total of 60 subjects (30 in each center) were enrolled in two study centers. All subjects completed the study, and the overall proportion of consent to each protocol amendment was 95.7 ± 13.7% (mean ± SD), with a median response time of 0.2 h. Overall, subjects took 90.8% ± 19.2% of the total drug, whereas compliance with the schedule was 69.1% ± 27.0%. Subjects reported 96.7% ± 4.2% of the total body temperature measurements whereas the adherence to the schedule was 59.0% ± 25.0%, which remarkably decreased after major protocol amendments. In conclusion, we evaluated a blockchain-based dynamic consent platform in real clinical trial settings. The results suggested that major changes should be avoided unless subjects' proper understanding is warranted.
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Affiliation(s)
- Ki Young Huh
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Seol Ju Moon
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea
| | - Sang-Un Jeong
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea
| | - Min-Ji Kim
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea
| | - Wooseok Yang
- Clinical Trial Center, Seoul National University Hospital, Seoul, Korea
| | - Myeonggyu Jeong
- Clinical Trial Center, Seoul National University Hospital, Seoul, Korea
| | - Min-Gul Kim
- Center for Clinical Pharmacology and Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Korea.,Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.,Department of Pharmacology, School of Medicine, Jeonbuk National University, Jeonju, Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
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Kim GJ, Kim H, Fletcher J, Voelbel GT, Goverover Y, Chen P, O'Dell MW, Genova HM. The differential impact of the COVID-19 pandemic on healthcare utilization disruption for community-dwelling individuals with and without acquired brain injury. Arch Rehabil Res Clin Transl 2021; 4:100176. [PMID: 34934940 PMCID: PMC8677629 DOI: 10.1016/j.arrct.2021.100176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
All groups experienced notable disruption in health care utilization. Disruption in care for traumatic brain injury or mental health was associated with decreased health-related quality of life. Telehealth was a viable alternative to in-person visits. Telehealth is not a panacea and should be adopted using a nuanced approach.
Objective To delineate health care disruption for individuals with acquired brain injury (ABI) during the peak of the pandemic and to understand the impact of health care disruption on health-related quality of life (HRQoL). Design Cross-sectional survey. Setting General community. Participants Volunteer sample of adults with traumatic brain injury (TBI; n=33), adults with stroke (n=66), and adults without TBI or stroke (n=108) with access to the internet and personal technology (N=207). Interventions Not applicable. Main Outcome Measures Not applicable. Results Participants with TBI and stroke reported high rates of disruption in care specific to their diagnosis (53%-54.5%), while participants across all groups reported disruption for major medical care (range, 68.2%-80%), general health care (range, 60.3%-72.4%), and mental health care (range, 31.8%-83.3%). During the pandemic, participants with TBI and stroke used telehealth for care specific to their diagnosis (40.9%-42.4%), whereas all participants used telehealth for major medical care (range, 50%-86.7%), general health care (range, 31.2%-53.3%), and mental health care (range, 53.8%-72.7%). Disruption in TBI or stroke care and type of ABI explained 27.1% of the variance in HRQoL scores (F2,95=16.82, P<.001, R2=0.262), and disruption in mental health care explained 14.8% of the variance (F1,51=8.86, P=.004, R2=0.148). Conclusions Individuals with and without ABI experienced pronounced disruption in health care utilization overall. However, individuals who experienced a disruption in care specific to TBI or mental health care were most vulnerable to decreased HRQoL. Telehealth was a viable alternative to in-person visits for individuals with and without ABI, but limitations included difficulty with technology, difficulty with comprehensive examination, and decreased rapport with providers.
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Affiliation(s)
- Grace J Kim
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY.,Department of Rehabilitation Medicine, NYU Langone Health, New York, NY
| | - Hayejin Kim
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | | | - Gerald T Voelbel
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY.,Department of Rehabilitation Medicine, NYU Langone Health, New York, NY
| | - Yael Goverover
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY
| | - Peii Chen
- Kessler Foundation, West Orange and East Hanover, New Jersey.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY
| | - Helen M Genova
- Kessler Foundation, West Orange and East Hanover, New Jersey.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey
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Chatterjee A, Prinz A, Gerdes M, Martinez S. Digital Interventions on Healthy Lifestyle Management: Systematic Review. J Med Internet Res 2021; 23:e26931. [PMID: 34787575 PMCID: PMC8663673 DOI: 10.2196/26931] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/07/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle. OBJECTIVE This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns). METHODS We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles. RESULTS Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management. CONCLUSIONS This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions.
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Affiliation(s)
- Ayan Chatterjee
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Andreas Prinz
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Martin Gerdes
- Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Grimstad, Norway
| | - Santiago Martinez
- Department of Health and Nursing Science, Centre for e-Health, University of Agder, Grimstad, Norway
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Hsueh L, Huang J, Millman AK, Gopalan A, Parikh RK, Teran S, Reed ME. Disparities in Use of Video Telemedicine Among Patients With Limited English Proficiency During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2133129. [PMID: 34735015 PMCID: PMC8569485 DOI: 10.1001/jamanetworkopen.2021.33129] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cross-sectional study assesses whether having limited English proficiency was associated with lower video use compared with telephone use, especially among patients without prior video visit experience, during the COVID-19 pandemic.
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Affiliation(s)
- Loretta Hsueh
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jie Huang
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Andrea K. Millman
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Anjali Gopalan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | - Silvia Teran
- The Permanente Medical Group, Oakland, California
| | - Mary E. Reed
- Division of Research, Kaiser Permanente Northern California, Oakland
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42
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Information and Communication Technology Access and Use Among Low-Income Latino Immigrant Parents. Matern Child Health J 2021; 25:1807-1813. [PMID: 34687401 DOI: 10.1007/s10995-021-03265-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Development of mHealth interventions to address health disparities for Latino children in immigrant families requires understanding access to and use of information and communication technology. METHODS We examined access to information and communication technology and use of common applications/programs by low-income immigrant Latino parents of infants to inform development of mHealth interventions for this population. Latino immigrant parents reported technology use and access of common applications/software via survey. RESULTS Of the 157 participants, we found nearly all parents owned a smartphone and that 60% accessed the internet only via their smartphone. Around one-quarter of participants had access to unlimited data. Frequent use of text messaging was common, but frequent email use was less common. Less than 10% of participants frequently used health-oriented applications. DISCUSSION Our findings suggest that mHealth interventions that use data, email, or an application interface may not have the intended reach or effectiveness among low-income immigrant Latino parents. Consideration of these findings is important in guiding the development of future mHealth programs for the low-income Latino population. This study was registered at clinicaltrials.gov (NCT02647814).
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Haynes SC, Kompala T, Neinstein A, Rosenthal J, Crossen S. Disparities in Telemedicine Use for Subspecialty Diabetes Care During COVID-19 Shelter-In-Place Orders. J Diabetes Sci Technol 2021; 15:986-992. [PMID: 33719622 PMCID: PMC8442172 DOI: 10.1177/1932296821997851] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, telemedicine use rapidly and dramatically increased for management of diabetes mellitus. It is unknown whether access to telemedicine care has been equitable during this time. This study aimed to identify patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the pandemic. METHODS We conducted an explanatory sequential mixed-methods study using data from a single academic medical center. We used multivariate logistic regression to explore associations between telemedicine use and demographic factors for patients receiving subspecialty diabetes care between March 19 and June 30, 2020. We then surveyed a sample of patients who received in-person care to understand why these patients did not use telemedicine. RESULTS Among 1292 patients who received subspecialty diabetes care during the study period, those over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22-0.52, P < .001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31-0.91, P = .02), and patients with public insurance (OR: 0.64, 95% CI: 0.49-0.84, P = .001). Perceived quality of care and technological barriers were the most common reasons cited for choosing in-person care during the pandemic. CONCLUSIONS Our findings suggest that, amidst the COVID-19 pandemic, there have been disparities in telemedicine use by age, language, and insurance for patients with diabetes mellitus. We anticipate telemedicine will continue to be an important care modality for chronic conditions in the years ahead. Significant work must therefore be done to ensure that telemedicine services do not introduce or widen population health disparities.
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Affiliation(s)
- Sarah C. Haynes
- Department of Pediatrics, University of
California, Davis, CA, USA
- Center for Health and Technology,
University of California, Davis, CA, USA
| | - Tejaswi Kompala
- Department of Medicine, University of
California, San Francisco, CA, USA
| | - Aaron Neinstein
- Department of Medicine, University of
California, San Francisco, CA, USA
- Center for Digital Health Innovation,
University of California, San Francisco, CA, USA
| | - Jennifer Rosenthal
- Department of Pediatrics, University of
California, Davis, CA, USA
- Center for Health and Technology,
University of California, Davis, CA, USA
| | - Stephanie Crossen
- Department of Pediatrics, University of
California, Davis, CA, USA
- Center for Health and Technology,
University of California, Davis, CA, USA
- Stephanie Crossen, MD, MPH, Division of
Pediatric Endocrinology, University of California, Davis, 2516 Stockton Blvd,
Sacramento, CA 95817, USA.
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Bell A, Lonergan PE, Escobar D, Fakunle M, Chu CE, Berdy S, Palmer NR, Breyer BN, Washington SL. A Cross-Sectional Analysis of Barriers Associated With Non-Attendance at a Urology Telehealth Clinic in a Safety-Net Hospital. Urology 2021; 162:57-62. [PMID: 34461145 DOI: 10.1016/j.urology.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyze the factors associated with non-attendance at a urology telehealth clinic in a large urban safety-net hospital after institutional-mandated transition to telehealth due to COVID-19. METHODS We identified all encounters scheduled for telehealth after March 17, 2020 and in the subsequent 8 weeks. Logistic regression was used to identify factors associated with attendance. RESULTS In total there were 322 telehealth encounters, 228 (70.8%) of which were attended and 94 (29.2%) that were not attended. Racial/ethnic minorities accounted for 175 (77.0%) of attended and 73 (76.7%) of non-attended encounters. On multivariable regression, single/divorced/widowed (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.26-4.43), current substance use disorder (OR 5.33, 95% CI 2.04-13.98), and being scheduled for a new patient appointment (OR 1.81, 95% CI 1.04-3.13) were associated with higher odds of not attending a telehealth encounter. Race/ethnicity, primary language, and country of birth were not associated with odds of attendance. CONCLUSION Our findings identify several social factors (social support, substance use) associated with non-attendance at outpatient telehealth urology encounters at an urban safety-net hospital during the early stages of the COVID-19 pandemic. These barriers may have a greater impact specifically within a safety-net healthcare system and will inform equitable provision of urology telehealth programs in the future FUNDING: Goldberg-Benioff Endowed Professorship in Cancer Biology. The sponsors had no involvement with this study.
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Affiliation(s)
- Alexander Bell
- School of Medicine, University of California, San Francisco, CA
| | - Peter E Lonergan
- Department of Urology, University of California, San Francisco, CA
| | | | - Mary Fakunle
- Department of Urology, University of California, San Francisco, CA
| | - Carissa E Chu
- Department of Urology, University of California, San Francisco, CA
| | - Sara Berdy
- Department of Urology, University of California, San Francisco, CA
| | - Nynikka R Palmer
- Department of Urology, University of California, San Francisco, CA; Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA; Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA
| | - Benjamin N Breyer
- Department of Urology, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
| | - Samuel L Washington
- Department of Urology, University of California, San Francisco, CA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA.
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Miller RC, Simone BA, Lombardo JF, Taylor J, Nowak-Choi K, Ko K, Ferguson L, Donnelly A, Ali AS, Shi W, Dicker AP, Simone NL. A Pilot Trial Using Telemedicine in Radiation Oncology: The Future of Health Care Is Virtual. TELEMEDICINE REPORTS 2021; 2:171-178. [PMID: 34250522 PMCID: PMC8259074 DOI: 10.1089/tmr.2021.0007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 06/13/2023]
Abstract
Background: Social determinants of health directly affect cancer survival. Driven by advances in technology and recent demands due to COVID-19, telemedicine has the ability to improve patient access to care, lower health care costs, and increase workflow efficiency. The role of telemedicine in radiation oncology is not established. Materials and Methods: We conducted an IRB-approved pilot trial using a telehealth platform for the first post-radiation visit in patients with any cancer diagnosis. The primary endpoint was feasibility of using telehealth defined by completion of five telehealth visits per month in a single department. Secondary endpoints included the ability to assess patients appropriately, patient and physician satisfaction. Physicians were surveyed again during the pandemic to determine whether viewpoints changed. Results: Between May 27, 2016 and August 1, 2018, 37 patients were enrolled in the Telehealth in Post-operative Radiation Therapy (TelePORT) trial, with 24 evaluable patients who completed their scheduled telehealth visit. On average, 1.4 patients were accrued per month. All patients were satisfied with their care, had enough time with their physician and 85.7% believed the telehealth communication was excellent. All physicians were able to accurately assess the patient's symptoms via telehealth, whereas 82.3% felt they could accurately assess treatment-related toxicity. Physicians assessing skin toxicity from breast radiation were those who did not feel they were able to assess toxicity. Discussion and Conclusions: Both health care providers and patients have identified telemedicine as a suitable platform for radiation oncology visits. Although there are limitations, telemedicine has significant potential for increasing access of cancer care delivery in radiation oncology.
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Affiliation(s)
- Ryan C. Miller
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brittany A. Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Joseph F. Lombardo
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James Taylor
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kamila Nowak-Choi
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin Ko
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Linda Ferguson
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ann Donnelly
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ayesha S. Ali
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam P. Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicole L. Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Figueroa CA, Aguilera A, Chakraborty B, Modiri A, Aggarwal J, Deliu N, Sarkar U, Jay Williams J, Lyles CR. Adaptive learning algorithms to optimize mobile applications for behavioral health: guidelines for design decisions. J Am Med Inform Assoc 2021; 28:1225-1234. [PMID: 33657217 PMCID: PMC8200266 DOI: 10.1093/jamia/ocab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/07/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Providing behavioral health interventions via smartphones allows these interventions to be adapted to the changing behavior, preferences, and needs of individuals. This can be achieved through reinforcement learning (RL), a sub-area of machine learning. However, many challenges could affect the effectiveness of these algorithms in the real world. We provide guidelines for decision-making. MATERIALS AND METHODS Using thematic analysis, we describe challenges, considerations, and solutions for algorithm design decisions in a collaboration between health services researchers, clinicians, and data scientists. We use the design process of an RL algorithm for a mobile health study "DIAMANTE" for increasing physical activity in underserved patients with diabetes and depression. Over the 1.5-year project, we kept track of the research process using collaborative cloud Google Documents, Whatsapp messenger, and video teleconferencing. We discussed, categorized, and coded critical challenges. We grouped challenges to create thematic topic process domains. RESULTS Nine challenges emerged, which we divided into 3 major themes: 1. Choosing the model for decision-making, including appropriate contextual and reward variables; 2. Data handling/collection, such as how to deal with missing or incorrect data in real-time; 3. Weighing the algorithm performance vs effectiveness/implementation in real-world settings. CONCLUSION The creation of effective behavioral health interventions does not depend only on final algorithm performance. Many decisions in the real world are necessary to formulate the design of problem parameters to which an algorithm is applied. Researchers must document and evaulate these considerations and decisions before and during the intervention period, to increase transparency, accountability, and reproducibility. TRIAL REGISTRATION clinicaltrials.gov, NCT03490253.
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Affiliation(s)
- Caroline A Figueroa
- School of Social Welfare, University of California Berkeley, Berkeley, California, USA
| | - Adrian Aguilera
- School of Social Welfare, University of California Berkeley, Berkeley, California, USA
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Bibhas Chakraborty
- Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore, Singapore
- Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Arghavan Modiri
- Department of Computer Science, University of Toronto, Toronto, Canada
| | - Jai Aggarwal
- Department of Computer Science, University of Toronto, Toronto, Canada
| | - Nina Deliu
- Department of Computer Science, University of Toronto, Toronto, Canada
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Urmimala Sarkar
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | | | - Courtney R Lyles
- UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Onorato S, Joshi A, Schwartz AW. Lights, Camera, Action: Optimizing Virtual Video Visits to Provide High-Quality Care. J Gen Intern Med 2021; 36:1751-1754. [PMID: 33111243 PMCID: PMC7592130 DOI: 10.1007/s11606-020-06278-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/28/2020] [Indexed: 02/08/2023]
Affiliation(s)
| | | | - Andrea Wershof Schwartz
- Harvard Medical School, Boston, MA, USA
- New England Geriatrics Research Education and Clinical Center and Division of Geriatrics & Palliative Care, VA Boston Healthcare System, Boston, MA, USA
- Brigham & Women's Hospital, Boston, MA, USA
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Pathak LE, Aguilera A, Williams JJ, Lyles CR, Hernandez-Ramos R, Miramontes J, Cemballi AG, Figueroa CA. Developing Messaging Content for a Physical Activity Smartphone App Tailored to Low-Income Patients: User-Centered Design and Crowdsourcing Approach. JMIR Mhealth Uhealth 2021; 9:e21177. [PMID: 34009130 PMCID: PMC8173396 DOI: 10.2196/21177] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/21/2020] [Accepted: 04/13/2021] [Indexed: 01/17/2023] Open
Abstract
Background Text messaging interventions can be an effective and efficient way to improve health behavioral changes. However, most texting interventions are neither tested nor designed with diverse end users, which could reduce their impact, and there is limited evidence regarding the optimal design methodology of health text messages tailored to low-income, low–health literacy populations and non-English speakers. Objective This study aims to combine participant feedback, crowdsourced data, and researcher expertise to develop motivational text messages in English and Spanish that will be used in a smartphone app–based texting intervention that seeks to encourage physical activity in low-income minority patients with diabetes diagnoses and depression symptoms. Methods The design process consisted of 5 phases and was iterative in nature, given that the findings from each step informed the subsequent steps. First, we designed messages to increase physical activity based on the behavior change theory and knowledge from the available evidence. Second, using user-centered design methods, we refined these messages after a card sorting task and semistructured interviews (N=10) and evaluated their likeability during a usability testing phase of the app prototype (N=8). Third, the messages were tested by English- and Spanish-speaking participants on the Amazon Mechanical Turk (MTurk) crowdsourcing platform (N=134). Participants on MTurk were asked to categorize the messages into overarching theoretical categories based on the capability, opportunity, motivation, and behavior framework. Finally, each coauthor rated the messages for their overall quality from 1 to 5. All messages were written at a sixth-grade or lower reading level and culturally adapted and translated into neutral Spanish by bilingual research staff. Results A total of 200 messages were iteratively refined according to the feedback from target users gathered through user-centered design methods, crowdsourced results of a categorization test, and an expert review. User feedback was leveraged to discard unappealing messages and edit the thematic aspects of messages that did not resonate well with the target users. Overall, 54 messages were sorted into the correct theoretical categories at least 50% of the time in the MTurk categorization tasks and were rated 3.5 or higher by the research team members. These were included in the final text message bank, resulting in 18 messages per motivational category. Conclusions By using an iterative process of expert opinion, feedback from participants that were reflective of our target study population, crowdsourcing, and feedback from the research team, we were able to acquire valuable inputs for the design of motivational text messages developed in English and Spanish with a low literacy level to increase physical activity. We describe the design considerations and lessons learned for the text messaging development process and provide a novel, integrative framework for future developers of health text messaging interventions.
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Affiliation(s)
- Laura Elizabeth Pathak
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States.,Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | | | - Courtney Rees Lyles
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Rosa Hernandez-Ramos
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, United States
| | - Jose Miramontes
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Anupama Gunshekar Cemballi
- Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
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Steel PAD, Bodnar D, Bonito M, Torres-Lavoro J, Eid DB, Jacobowitz A, Shemesh A, Tanouye R, Rumble P, DiCello D, Sharma R, Farmer B, Pomerantz S, Zhang Y. MyEDCare: Evaluation of a Smartphone-Based Emergency Department Discharge Process. Appl Clin Inform 2021; 12:362-371. [PMID: 33910262 DOI: 10.1055/s-0041-1729165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Poor comprehension and low compliance with post-ED (emergency department) care plans increase the risk of unscheduled ED return visits and adverse outcomes. Despite the growth of personal health records to support transitions of care, technological innovation's focus on the ED discharge process has been limited. Recent literature suggests that digital communication incorporated into post-ED care can improve patient satisfaction and care quality. OBJECTIVES We evaluated the feasibility of utilizing MyEDCare, a text message and smartphone-based electronic ED discharge process at two urban EDs. METHODS MyEDCare sends text messages to patients' smartphones at the time of discharge, containing a hyperlink to a Health Insurance Portability and Accountability Act (HIPAA)-compliant website, to deliver patient-specific ED discharge instructions. Content includes information on therapeutics, new medications, outpatient care scheduling, return precautions, as well as results of laboratory and radiological diagnostic testing performed in the ED. Three text messages are sent to patients: at the time of ED discharge with the nurse assistance for initial access of content, as well as 2 and 29 days after ED discharge. MyEDCare was piloted in a 9-month pilot period in 2019 at two urban EDs in an academic medical center. We evaluated ED return visits, ED staff satisfaction, and patient satisfaction using ED Consumer Assessment of Healthcare Providers and Systems (ED-CAHPS) patient satisfaction scores. RESULTS MyEDCare enrolled 27,713 patients discharged from the two EDs, accounting for 43% of treat-and-release ED patients. Of the treat-and-release patients, 27% completed MyEDCare discharge process, accessing the online content at the time of ED discharge. Patients discharged via MyEDCare had fewer 72-hour, 9-day, and 30-day unscheduled return ED visits and reported higher satisfaction related to nursing care. CONCLUSION EDs and urgent care facilities may consider developing a HIPAA-compliant, text message, and smartphone-based discharge process, including the transmission of test results, to improve patient-centered outcomes.
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Affiliation(s)
- Peter A D Steel
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - David Bodnar
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Maryellen Bonito
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Jane Torres-Lavoro
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Dona Bou Eid
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Andrew Jacobowitz
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Amos Shemesh
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Robert Tanouye
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Patrick Rumble
- NewYork-Presbyterian Hospital, New York, New York, United States
| | - Daniel DiCello
- NewYork-Presbyterian Hospital, New York, New York, United States
| | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Brenna Farmer
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Sandra Pomerantz
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States
| | - Yiye Zhang
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, United States.,Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
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Handley MA, Landeros J, Wu C, Najmabadi A, Vargas D, Athavale P. What matters when exploring fidelity when using health IT to reduce disparities? BMC Med Inform Decis Mak 2021; 21:119. [PMID: 33827562 PMCID: PMC8028253 DOI: 10.1186/s12911-021-01476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Implementation of evidence-based interventions often involves strategies to engage diverse populations while also attempting to maintain external validity. When using health IT tools to deliver patient-centered health messages, systems-level requirements are often at odds with 'on-the ground' tailoring approaches for patient-centered care or ensuring equity among linguistically diverse populations. METHODS We conducted a fidelity and acceptability-focused evaluation of the STAR MAMA Program, a 5-month bilingual (English and Spanish) intervention for reducing diabetes risk factors among 181 post-partum women with recent gestational diabetes. The study's purpose was to explore fidelity to pre-determined 'core' (e.g. systems integration) and 'modifiable' equity components (e.g. health coaching responsiveness, and variation by language) using an adapted implementation fidelity framework. Participant-level surveys, systems-level databases of message delivery, call completion, and coaching notes were included. RESULTS 96.6% of participants are Latina and 80.9% were born outside the US. Among those receiving the STAR MAMA intervention; 55 received the calls in Spanish (61%) and 35 English (39%). 90% (n = 81) completed ≥ one week. Initially, systems errors were common, and increased triggers for health coach call-backs. Although Spanish speakers had more triggers over the intervention period, the difference was not statistically significant. Of the calls triggering a health coach follow-up, attempts were made for 85.4% (n = 152) of the English call triggers and for 80.0% (n = 279) of the Spanish call triggers (NS). Of attempted calls, health coaching calls were complete for 55.6% (n = 85) of English-language call triggers and for 56.6% of Spanish-language call triggers (NS). Some differences in acceptability were noted by language, with Spanish-speakers reporting higher satisfaction with prevention content (p = < 0.01) and English-speakers reporting health coaches were less considerate of their time (p = 0.03). CONCLUSIONS By exploring fidelity by language-specific factors, we identified important differences in some but not all equity indicators, with early systems errors quicky remedied and high overall engagement and acceptability. Practice implications include: (1) establishing criteria for languge-equity in interventions, (2) planning for systems level errors so as to reduce their impact between language groups and over time; and (3) examining the impact of engagement with language-concordant interventions on outcomes, including acceptability. Trial Registration National Clinical Trials registration number: CT02240420 Registered September 15, 2014. ClinicalTrials.gov.
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Affiliation(s)
- Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA.
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA.
| | - Jerad Landeros
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Cindie Wu
- University of California, Berkeley School of Public Health, Berkeley, USA
| | - Adriana Najmabadi
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Daniela Vargas
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Priyanka Athavale
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
- University of California, Berkeley School of Public Health, Berkeley, USA
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