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Tarver WL, Justice Z, Jonnalagadda P, Rahurkar S, Obeng-Gyasi S, Krok-Schoen JL, Petrecca A, Paskett ED. A scoping review of the evidence on survivorship care plans among minority, rural, and low-income populations. J Cancer Surviv 2024:10.1007/s11764-024-01609-z. [PMID: 38907799 DOI: 10.1007/s11764-024-01609-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 04/19/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE Despite recent advances in cancer control and the number of cancer survivors increasing substantially over the past years, some cancer survivors continue to experience disparities due to barriers to recommended survivorship care. The use of survivorship care plans (SCPs) may be a way to help care for these individuals and their respective issues after they complete their primary treatment. The purpose of this scoping review is to understand the evidence on SCPs among minority, rural, and low-income populations: groups that experience disproportionately poorer cancer health outcomes. METHODS Computer-based searches were conducted in four academic databases. We included peer-reviewed studies published in the English language and conducted in the USA. We systematically extracted information from each paper meeting our inclusion criteria. RESULTS Our search identified 45 articles. The 4 major themes identified were (1) disparities in the receipt of SCPs where populations experience unmet needs; (2) benefits of SCPs, including improved care coordination and self-management of cancer; (3) needs and preferences for survivorship care; and (4) barriers and facilitators to using SCPs. CONCLUSIONS Despite the potential benefits, underserved cancer survivors experience disparities in the receipt of SCPs and continue to have unmet needs in their survivorship care. Survivorship care may benefit from a risk-stratified approach where SCPs are prioritized to survivors belonging to high-risk groups. IMPLICATIONS FOR CANCER SURVIVORS SCPs are a tool to deliver quality care for cancer survivors. While evidence is mixed on SCPs' benefits among the general population, SCPs show promise for underserved populations when it comes to proximal outcomes that contribute to disparities.
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Affiliation(s)
- Willi L Tarver
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | | | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- Division of Health Sciences, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Abigail Petrecca
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Electra D Paskett
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Groom LL, Schoenthaler AM, Mann DM, Brody AA. Construction of the Digital Health Equity-Focused Implementation Research Conceptual Model - Bridging the Divide Between Equity-focused Digital Health and Implementation Research. PLOS DIGITAL HEALTH 2024; 3:e0000509. [PMID: 38776354 PMCID: PMC11111026 DOI: 10.1371/journal.pdig.0000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 04/10/2024] [Indexed: 05/24/2024]
Abstract
Digital health implementations and investments continue to expand. As the reliance on digital health increases, it is imperative to implement technologies with inclusive and accessible approaches. A conceptual model can be used to guide equity-focused digital health implementations to improve suitability and uptake in diverse populations. The objective of this study is expand an implementation model with recommendations on the equitable implementation of new digital health technologies. The Digital Health Equity-Focused Implementation Research (DH-EquIR) conceptual model was developed based on a rigorous review of digital health implementation and health equity literature. The Equity-Focused Implementation Research for Health Programs (EquIR) model was used as a starting point and merged with digital equity and digital health implementation models. Existing theoretical frameworks and models were appraised as well as individual equity-sensitive implementation studies. Patient and program-related concepts related to digital equity, digital health implementation, and assessment of social/digital determinants of health were included. Sixty-two articles were analyzed to inform the adaption of the EquIR model for digital health. These articles included digital health equity models and frameworks, digital health implementation models and frameworks, research articles, guidelines, and concept analyses. Concepts were organized into EquIR conceptual groupings, including population health status, planning the program, designing the program, implementing the program, and equity-focused implementation outcomes. The adapted DH-EquIR conceptual model diagram was created as well as detailed tables displaying related equity concepts, evidence gaps in source articles, and analysis of existing equity-related models and tools. The DH-EquIR model serves to guide digital health developers and implementation specialists to promote the inclusion of health-equity planning in every phase of implementation. In addition, it can assist researchers and product developers to avoid repeating the mistakes that have led to inequities in the implementation of digital health across populations.
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Affiliation(s)
- Lisa L. Groom
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
- Medical Center Information Technology Department of Health Informatics, New York University Langone Health, New York, New York, United States of America
| | - Antoinette M. Schoenthaler
- Institute for Excellence in Health Equity, New York University Langone Health, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Devin M. Mann
- Medical Center Information Technology Department of Health Informatics, New York University Langone Health, New York, New York, United States of America
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Abraham A. Brody
- Rory Meyers College of Nursing, New York University, New York, New York, United States of America
- Division of Geriatric Medicine and Palliative Care, New York University Grossman School of Medicine, New York, New York, United States of America
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Hutton HE, Aggarwal S, Gillani A, Chander G. A Digital Counselor-Delivered Intervention for Substance Use Among People With HIV: Development and Usability Study. JMIR Form Res 2023; 7:e40260. [PMID: 37639294 PMCID: PMC10495853 DOI: 10.2196/40260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 03/25/2023] [Accepted: 06/22/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Substance use disorders are prevalent and undertreated among people with HIV. Computer-delivered interventions (CDIs) show promise in expanding reach, delivering evidence-based care, and offering anonymity. Use in HIV clinic settings may overcome access barriers. Incorporating digital counselors may increase CDI engagement, and thereby improve health outcomes. OBJECTIVE We aim to develop and pilot a digital counselor-delivered brief intervention for people with HIV who use drugs, called "C-Raven," which is theory grounded and uses evidence-based practices for behavior change. METHODS Intervention mapping was used to develop the CDI including a review of the behavior change research in substance use, HIV, and digital counselors. We conducted in-depth interviews applying the situated-information, motivation, and behavior skills model and culturally adapting the content for local use with people with HIV. With a user interaction designer, we created various digital counselors and CDI interfaces. Finally, a mixed methods approach using in-depth interviews and quantitative assessments was used to assess the usability, acceptability, and cultural relevance of the intervention content and the digital counselor. RESULTS Participants found CDI easy to use, useful, relevant, and motivating. A consistent suggestion was to provide more information about the negative impacts of drug use and the interaction of drug use with HIV. Participants also reported that they learned new information about drug use and its health effects. The CDI was delivered by a "Raven," digital counselor, programmed to interact in a motivational interviewing style. The Raven was perceived to be nonjudgmental, understanding, and emotionally responsive. The appearance and images in the intervention were perceived as relevant and acceptable. Participants noted that they could be more truthful with a digital counselor, however, it was not unanimously endorsed as a replacement for a human counselor. The C-Raven Satisfaction Scale showed that all participants rated their satisfaction at either a 4 (n=2) or a 5 (n=8) on a 5-point Likert scale and all endorsed using the C-Raven program again. CONCLUSIONS CDIs show promise in extending access to care and improving health outcomes but their development necessarily requires integration from multiple disciplines including behavioral medicine and computer science. We developed a cross-platform compatible CDI led by a digital counselor that interacts in a motivational interviewing style and (1) uses evidence-based behavioral change methods, (2) is culturally adapted to people with HIV who use drugs, (3) has an engaging and interactive user interface, and (4) presents personalized content based on participants' ongoing responses to a series of menu-driven conversations. To advance the continued development of this and other CDIs, we recommend expanded testing, standardized measures to evaluate user experience, integration with clinician-delivered substance use treatment, and if effective, implementation into HIV clinical care.
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Affiliation(s)
- Heidi E Hutton
- Department of Psychiatry & Behaviorial Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Saavitri Aggarwal
- Department of Psychiatry & Behaviorial Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Afroza Gillani
- College of Dentistry, New York University, New York, NY, United States
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, United States
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Mai F, Ko DG, Shan Z, Zhang D. The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study. J Med Internet Res 2023; 25:e44981. [PMID: 37384810 PMCID: PMC10414031 DOI: 10.2196/44981] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. OBJECTIVE We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19-induced digital acceleration? Does the effect differ across racial lines? METHODS We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). RESULTS Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=-.158; P<.001; RE, β=-.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=-.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=-.004; P<.001; RE, β=-.004; P<.001; FE, β=-.003; P=.001). CONCLUSIONS Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world.
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Affiliation(s)
- Feng Mai
- School of Business, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Dong-Gil Ko
- Department of Operations, Business Analytics, and Information Systems, University of Cincinnati, Cincinnati, OH, United States
| | - Zhe Shan
- Department of Information Systems and Analytics, Miami University, Oxford, OH, United States
| | - Dawei Zhang
- Department of Decision and Technology Analytics, Lehigh University, Bethlehem, PA, United States
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Penn N, Laron M. Use and barriers to the use of telehealth services in the Arab population in Israel: a cross sectional survey. Isr J Health Policy Res 2023; 12:21. [PMID: 37221598 DOI: 10.1186/s13584-023-00569-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/30/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Studies conducted in Israel and in other countries show that minority populations typically underuse telehealth services notwithstanding the advantages inherent in the use of these services. The goal of this study was to examine telehealth use patterns and the barriers to the use of telehealth services in the Arab population in Israel, which is a culturally and ethnically varied minority population with a unique language and culture. METHODS A telephone survey was conducted among a representative sample of the adult Arab population in Israel from October 29 to November 4, 2020. Of the randomly sampled 1,192 adult Israeli Arabs 501 participants responded to the entire questionnaire, representing a response rate of 42%. RESULTS The study found that the majority of the adult Arab population in Israel faced no technology or Internet accessibility barriers. Thus, the majority of adult Israeli Arabs (87%) use the Internet on a daily basis and have smartphones (96%) and an Internet connection (93%). However, although they have high technology and Internet accessibility, their use of telehealth services is mostly a telephone appointment with a doctor (66%). At the same time, significantly lower use rates were found with regard to advanced telehealth services delivered through the Internet, e.g., consultation with a health care provider by email or chat (34%) or video chat (8%) and ordering of medications (14%). It was found that Arab Christians are more likely to use digital services than Arab Muslims, even when background characteristics are statistically controlled. Lack of awareness was found to be the major barrier to the use of telehealth services, specifically advanced services such as ordering of medications (23%) and video medical consultation (15%). A high rate of women cited the unmet need for the discreet provision of telehealth services as a barrier to their use of the services. It was also found that the majority of the adult Arab population had no objection in principle to the use of email or chat (75%) or video chat (51%) for consultation with a health care provider. It was further found that facilitating factors promoting the use of telehealth services include previous acquaintance with the health care provider, a stable internet infrastructure, the provision of the services in the Arabis language, guidance in the use of the service, a recommendation by a health care provider, and the participation of a family member in the online medical consultation. CONCLUSIONS The study findings highlight the need for the provision of accessible and customized telehealth services for minority populations. Whether delivered over the phone or through the Internet, the services have to be culturally (for Muslims and Christians) and linguistically (Arabic) adapted, guidance in the use of the services should be provided, and service marketing should be tailored to the target minority population. Specific solutions should be developed for the discreet provision of telehealth services for women, maintaining their privacy in online consultation with a health care provider, while the option of having a family member participate in the online medical consultation should be clearly indicated. In addition, awareness of telehealth services should be enhanced through promotional activities culturally adapted to the Arab society, for instance, through recommendation by the family doctor.
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Affiliation(s)
- Nadav Penn
- Health Policy Team, The Myers-JDC-Brookdale Institute, JDC Hill, POB 3886, 9103702, Jerusalem, Israel
| | - Michal Laron
- Health Policy Team, The Myers-JDC-Brookdale Institute, JDC Hill, POB 3886, 9103702, Jerusalem, Israel.
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Shahid S, Hogeveen S, Sky P, Chandra S, Budhwani S, de Silva R, Bhatia RS, Seto E, Shaw J. Health equity related challenges and experiences during the rapid implementation of virtual care during COVID-19: a multiple case study. Int J Equity Health 2023; 22:44. [PMID: 36906566 PMCID: PMC10007658 DOI: 10.1186/s12939-023-01849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/18/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Virtual care quickly became of crucial importance to health systems around the world during the COVID-19 pandemic. Despite the potential of virtual care to enhance access for some communities, the scale and pace at which services were virtualized did not leave many organizations with sufficient time and resources to ensure optimal and equitable delivery of care for everyone. The objective of this paper is to outline the experiences of health care organizations rapidly implementing virtual care during the first wave of the COVID-19 pandemic and examine whether and how health equity was considered. METHODS We used an exploratory, multiple case study approach involving four health and social service organizations providing virtual care services to structurally marginalized communities in the province of Ontario, Canada. We conducted semi-structured qualitative interviews with providers, managers, and patients to understand the challenges experienced by organizations and the strategies put in place to support health equity during the rapid virtualization of care. Thirty-eight interviews were thematically analyzed using rapid analytic techniques. RESULTS Organizations experienced challenges related to infrastructure availability, digital health literacy, culturally appropriate approaches, capacity for health equity, and virtual care suitability. Strategies to support health equity included the provision of blended models of care, creation of volunteer and staff support teams, participation in community engagement and outreach, and securement of infrastructure for clients. We put our findings into the context of an existing framework conceptualizing access to health care and expand on what this means for equitable access to virtual care for structurally marginalized communities. CONCLUSION This paper highlights the need to pay greater attention to the role of health equity in virtual care delivery and situate that conversation around existing inequitable structures in the health care system that are perpetuated when delivering care virtually. An equitable and sustainable approach to virtual care delivery will require applying an intersectionality lens on the strategies and solutions needed to address existing inequities in the system.
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Affiliation(s)
- Simone Shahid
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.
| | - Sophie Hogeveen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Philina Sky
- Waasegiizhig Nanaandawe'iyewigamig, PO Box 320, Keewatin, ON, P0X 1C0, Canada
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Suman Budhwani
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - Ryan de Silva
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada
| | - R Sacha Bhatia
- Peter Munk Cardiac Centre, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 55 College St, Toronto, ON, M5T 3M6, Canada.,Centre for Digital Therapeutics, Techna Institute, University Health Network, 90 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - James Shaw
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B3, Canada.,Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, M5G 1V7, Canada
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Narayan S, Mok H, Ho K, Kealy D. "I don't think they're as culturally sensitive": a mixed-method study exploring e-mental health use among culturally diverse populations. J Ment Health 2023; 32:241-247. [PMID: 35770901 DOI: 10.1080/09638237.2022.2091762] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Culturally diverse populations (CDPs), such as visible minorities, face challenges, such as lack of culturally tailored resources, when accessing mental health services. These barriers may be addressed by e-mental health (eMH) technologies. However, little attention has been devoted to understanding the cultural responsiveness of these services among CDPs. AIMS This study explores CDPs experience of eMH for anxiety and depressive disorders in an urban area and gauge its cultural responsiveness. METHODS In this mixed methods study, participants (N = 136) completed a survey regarding their eMH use, mental health status, and socio-demographic characteristics. Subsequently, participants (N = 14) shared their experiences through semi-structured focus groups. RESULTS The majority of participants (68%) indicated that the eMH resources used were not culturally tailored. However, most participants (65%) agreed that the resource was available in their preferred language. Focus group discussions revealed key experiences around limited language diversity, cultural representation and cultural competency, and culturally linked stigma. eMH recommendations suggested by participants focused on including culturally tailored content, graphics and phrases, and lived experiences of CDPs. CONCLUSIONS The findings showcase the need for more culturally responsive eMH beyond language translation, while providing healthcare professionals with a greater and nuanced understanding of treatment needs in cultural groups.
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Affiliation(s)
- Shawna Narayan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Hiram Mok
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kendall Ho
- University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kealy
- University of British Columbia, Vancouver, British Columbia, Canada
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Vaughan RM, Moore JA, Moreno JS, Dyer KJ, Oluyomi AO, Lopez KN. Remote Care Adoption in Underserved Congenital Heart Disease Patients During the COVID-19 Era. Pediatr Cardiol 2023; 44:404-412. [PMID: 36562781 PMCID: PMC9786515 DOI: 10.1007/s00246-022-03042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/01/2022] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic restricted in-person appointments and prompted an increase in remote healthcare delivery. Our goal was to assess access to remote care for complex pediatric cardiology patients. We performed a retrospective chart review of Texas Children's Hospital (TCH) pediatric cardiology outpatient appointments from March 2020 to December 2020 for established congenital heart disease (CHD) patients 1 to 17 yo. Primary outcome variables were remote care use of telemedicine and patient portal activation. Primary predictor variables were age, sex, insurance, race/ethnicity, language, and location. Descriptive statistics were used to analyze patient demographics. Multivariate logistic regression determined associations with remote care use (p < 0.05). We identified 5,410 established patients with clinic appointments during the identified timeframe. Adopters of telemedicine included 13% of patients (n = 691). Of the prior non patient portal users, 4.5% activated their accounts. On multivariate analysis, older age (10-17 yo) was associated with increased telemedicine (OR 2.04, 95%CI 1.71, 2.43) and patient portal use (OR 1.70, 95%CI 1.33, 2.17). Public insurance (OR 1.66, 95%CI 1.25, 2.20) and Spanish speaking were associated with increased patient portal adoption. Race/ethnicity was not significantly associated with telemedicine use or patient portal adoption. Telehealth adoption among older children may be indicative of their ability to aid in the use of these technologies. Higher participation in patient portal activation among publicly insured and Spanish speaking patients is encouraging and demonstrates ability to navigate some degree of remote patient care. Adoption of remote patient care may assist in reducing access to care disparities.
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Affiliation(s)
- Ruth M. Vaughan
- Department of Pediatrics, Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street Legacy Tower MC E1920, Houston, TX 77030 USA ,Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Judson A. Moore
- Department of Pediatrics, Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street Legacy Tower MC E1920, Houston, TX 77030 USA ,Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA ,Department of Pediatrics, Section of Cardiology, Primary Children’s Hospital, Salt Lake City, UT USA
| | - Jasmine S. Moreno
- Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Karla J. Dyer
- Department of Pediatrics, Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street Legacy Tower MC E1920, Houston, TX 77030 USA ,Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Abiodun O. Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX USA ,Gulf Coast Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, USA
| | - Keila N. Lopez
- Department of Pediatrics, Section of Cardiology, Texas Children’s Hospital, Baylor College of Medicine, 6651 Main Street Legacy Tower MC E1920, Houston, TX 77030 USA ,Lillie Frank Abercrombie Section of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
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Greenberg KL, Poupko T, Sorotzkin D, Keidar O, Zwas DR. Development and usage of a health recommendation web tool (HeaRT) designed to inform women of personalized preventive health recommendations. Internet Interv 2022; 31:100599. [PMID: 36618777 PMCID: PMC9813537 DOI: 10.1016/j.invent.2022.100599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 11/15/2022] [Accepted: 12/23/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Implementation of guidelines for evidence-based screening and disease prevention remains a core challenge in health care. The lack of access to accurate and personalized health recommendations may contribute to sub-optimal performance of medical screening, and ultimately increased risk for communicable and non-communicable disease. Many women do not monitor their cardiovascular disease (CVD) risk or receive regular medical screenings. A health recommendation tool (HeaRT) that provides women with profiled, individually tailored information about recommended tests and screening was designed to improve women's engagement in preventive health. This study characterized utilization of the tool in a real world setting. OBJECTIVE To describe the development and usage patterns of HeaRT, a novel health web-tool that provides personalized health recommendations for women. METHODS Extracted web-tool data including user input (age, BMI, smoking status and family history of CVD) and time spent in the results screen were analysed. Engagement was assessed by time spent in each results category, number of clicks and whether the user emailed/printed the recommendations. Usage patterns were analysed using multivariate analyses, logistic regression and cluster analyses. RESULTS HeaRT was used 13,749 times in the years between its launch and data extraction three years later. Web-tool analysis found that 68.6 % of users accessed results and approximately 15 % printed or emailed the list of recommendations. Further analysis found that almost all the users entered the nutrition category (78 %), followed by the risk-factor category (69.5 %) and Physical activity category (61.9 %). Three usage patterns were identified by cluster analysis, including a nutrition/physical activity cluster, a risk-factor cluster and an all-categories cluster. Cluster affiliation analysis found BMI and smoking status were not predictors of cluster affiliation, whereas users over the age of 65 were more likely to solely enter the risk-factor tab (P < .001) and users with family history of CVD were more likely to either enter only the risk-factor tab or to enter all tabs (P < .01). CONCLUSIONS HeaRT users looked at health recommendations on a variety of health topics, and 15 % printed or emailed the recommendations. A tailored health recommendation web-tool may empower women to seek preventive-care and health maintenance, and help them interact with health care providers from a position of shared responsibility. This tool and similar programs may enable health care consumers to actively participate in directing their own health maintenance by providing consumers with personalized health recommendations. Additionally, user characteristics may inform future web-tool designers on target population profile and usage patterns.
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Affiliation(s)
- Keren L. Greenberg
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel,Corresponding author at: The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel.
| | - Tamar Poupko
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel
| | - Devorah Sorotzkin
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel
| | - Osnat Keidar
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel,The Braun School of Public Health and Community Medicine, Hebrew University and Hadassah University Medical Center, P.O.B 12272, Jerusalem, Israel
| | - Donna R. Zwas
- The Linda Joy Pollin Cardiovascular Wellness Center for Women, Hadassah University Medical Center, P.O.B 12000, Jerusalem, Israel
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10
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Valdez RS, Lyon SE, Wellbeloved-Stone C, Collins M, Rogers CC, Cantin-Garside KD, Gonclaves Fortes D, Kim C, Desai SS, Keim-Malpass J, Kushalnagar R. Engaging the disability community in informatics research: rationales and practical steps. J Am Med Inform Assoc 2022; 29:1989-1995. [PMID: 35972753 PMCID: PMC9552212 DOI: 10.1093/jamia/ocac136] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
As the informatics community grows in its ability to address health disparities, there is an opportunity to expand our impact by focusing on the disability community as a health disparity population. Although informaticians have primarily catered design efforts to one disability at a time, digital health technologies can be enhanced by approaching disability from a more holistic framework, simultaneously accounting for multiple forms of disability and the ways disability intersects with other forms of identity. The urgency of moving toward this more holistic approach is grounded in ethical, legal, and design-related rationales. Shaped by our research and advocacy with the disability community, we offer a set of guidelines for effective engagement. We argue that such engagement is critical to creating digital health technologies which more fully meet the needs of all disabled individuals.
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, Virginia, USA
- Blue Trunk Foundation, Charlottesville, Virginia, USA
| | - Sophie E Lyon
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | | | - Mary Collins
- Medline Industries, LP, Northfield, Illinois, USA
| | - Courtney C Rogers
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, Virginia, USA
| | - Kristine D Cantin-Garside
- Global Commercial Data Science Digital Health, Global Commercial Strategy Organization, Janssen Pharmaceuticals, Raritan, New Jersey, USA
| | | | | | - Shaalini S Desai
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | | | - Raja Kushalnagar
- Department of Science, Technology, Accessibility, Mathematics, and Public Health, Gallaudet University, Washington, District of Columbia, USA
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11
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Bonnell TJ, Revere D, Baseman J, Hills R, Karras BT. Equity and Accessibility of Washington State’s COVID-19 Digital Exposure Notification Tool (WA Notify): Survey and Listening Sessions Among Community Leaders. JMIR Form Res 2022; 6:e38193. [PMID: 35787520 PMCID: PMC9359117 DOI: 10.2196/38193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background
In November 2020, WA Notify, Washington State’s COVID-19 digital exposure notification tool, was launched statewide to mitigate ongoing COVID-19 transmission. WA Notify uses the Bluetooth proximity–triggered, Google/Apple Exposure Notification Express framework to distribute notifications to users who have added or activated this tool on their smartphones. This smartphone-based tool relies on sufficient population-level activation to be effective; however, little is known about its adoption among communities disproportionately impacted by the COVID-19 pandemic or what barriers might limit its adoption and use among diverse populations.
Objective
We sought to (1) conduct a formative exploration of equity-related issues that may influence the access, adoption, and use of WA Notify, as perceived by community leaders of populations disproportionately impacted by the COVID-19 pandemic; and (2) generate recommendations for promoting the equitable access to and impact of this novel intervention for these communities.
Methods
We used a 2-step data collection process to gather the perspectives of community leaders across Washington regarding the launch and implementation of WA Notify in their communities. A web-based, brief, and informational survey measured the perceptions of the community-level familiarity and effectiveness of WA Notify at slowing the spread of COVID-19 and identified potential barriers and concerns to accessing and adopting WA Notify (n=17). Semistructured listening sessions were conducted to expand upon survey findings and explore the community-level awareness, barriers, facilitators, and concerns related to activating WA Notify in greater depth (n=13).
Results
Our findings overlap considerably with those from previous mobile health equity studies. Digital literacy, trust, information accessibility, and misinformation were highlighted as key determinants of the adoption and use of WA Notify. Although WA Notify does not track users or share data, community leaders expressed concerns about security, data sharing, and personal privacy, which were cited as outweighing the potential benefits to adoption. Both the survey and informational sessions indicated low community-level awareness of WA Notify. Community leaders recommended the following approaches to improve engagement: tailoring informational materials for low-literacy levels, providing technology navigation, describing more clearly that WA Notify can help the community, and using trusted messengers who are already engaged with the communities to communicate about WA Notify.
Conclusions
As digital public health tools, such as WA Notify, emerge to address public health problems, understanding the key determinants of adoption and incorporating equity-focused recommendations into the development, implementation, and communication efforts around these tools will be instrumental to their adoption, use, and retention.
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Affiliation(s)
- Tyler Jarvis Bonnell
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Debra Revere
- Department of Health Systems & Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Janet Baseman
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Rebecca Hills
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
| | - Bryant Thomas Karras
- Office of Innovation & Technology, State of Washington Department of Health, Tumwater, WA, United States
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12
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Balci S, Spanhel K, Sander LB, Baumeister H. Culturally adapting internet- and mobile-based health promotion interventions might not be worth the effort: a systematic review and meta-analysis. NPJ Digit Med 2022; 5:34. [PMID: 35322172 PMCID: PMC8943001 DOI: 10.1038/s41746-022-00569-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Health promotion interventions offer great potential in advocating a healthy lifestyle and the prevention of diseases. Some barriers to communicating health promotion to people of certain cultural groups might be overcome via the internet- and mobile-based interventions (IMI). This systematic review and meta-analysis aims to explore the effectiveness of culturally adapted IMI for health promotion interventions among culturally diverse populations. We systematically searched on Cochrane Central Register of Controlled Trials (CENTRAL), EbscoHost/MEDLINE, Ovid/Embase, EbscoHost/PsychINFO, and Web of Science databases in October 2020. Out of 9438 records, 13 randomized controlled trials (RCT) investigating culturally adapted health promotion IMI addressing healthy eating, physical activity, alcohol consumption, sexual health behavior, and smoking cessation included. From the included studies 10,747 participants were eligible. Culturally adapted IMI proved to be non-superior over active control conditions in short- (g = 0.10, [95% CI −0.19 to 0.40]) and long-term (g = 0.20, [95% CI −0.11 to 0.51]) in promoting health behavior. However, culturally adapted IMI for physical activity (k = 3, N = 296) compared to active controls yielded a beneficial effect in long-term (g = 0.48, [95%CI 0.25 to 0.71]). Adapting health promotion IMI to the cultural context of different cultural populations seems not yet to be recommendable given the substantial adaption efforts necessary and the mostly non-significant findings. However, these findings need to be seen as preliminary given the limited number of included trials with varying methodological rigor and the partly substantial between-trial heterogeneity pointing in the direction of potentially useful culturally adapted IMI which now need to be disentangled from the less promising approaches. PROSPERO registration number: 42020152939
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Affiliation(s)
- Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, D-89081, Ulm, Germany.
| | - Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany
| | - Lasse Bosse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, D-89081, Ulm, Germany
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13
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Budhwani S, Fujioka J, Thomas-Jacques T, De Vera K, Challa P, De Silva R, Fuller K, Shahid S, Hogeveen S, Chandra S, Bhatia RS, Seto E, Shaw J. Challenges and strategies for promoting health equity in virtual care: findings and policy directions from a scoping review of reviews. J Am Med Inform Assoc 2022; 29:990-999. [PMID: 35187571 PMCID: PMC9006706 DOI: 10.1093/jamia/ocac022] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We sought to understand and synthesize review-level evidence on the challenges associated with accessibility of virtual care among underserved population groups and to identify strategies that can improve access to, uptake of, and engagement with virtual care for these populations. MATERIALS AND METHODS A scoping review of reviews was conducted (protocol available at doi: 10.2196/22847). A total of 14 028 records were retrieved from MEDLINE, EMBASE, CINAHL, Scopus, and Epistemonikos databases. Data were abstracted, and challenges and strategies were identified and summarized for each underserved population group and across population groups. RESULTS A total of 37 reviews were included. Commonly occurring challenges and strategies were grouped into 6 key thematic areas based on similarities across communities: (1) the person's orientation toward health-related needs, (2) the person's orientation toward health-related technology, (3) the person's digital literacy, (4) technology design, (5) health system structure and organization, and (6) social and structural determinants of access to technology-enabled care. We suggest 4 important directions for policy development: (1) investment in digital health literacy education and training, (2) inclusive digital health technology design, (3) incentivizing inclusive digital health care, and (4) investment in affordable and accessible infrastructure. DISCUSSION AND CONCLUSION Challenges associated with accessibility of virtual care among underserved population groups can occur at the individual, technological, health system, and social/structural determinant levels. Although the policy approaches suggested by our review are likely to be difficult to achieve in a given policy context, they are essential to a more equitable future for virtual care.
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Affiliation(s)
- Suman Budhwani
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Jamie Fujioka
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Tyla Thomas-Jacques
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kristina De Vera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Priyanka Challa
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ryan De Silva
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Kaitlin Fuller
- University of Toronto Libraries, University of Toronto, Toronto, Ontario, Canada
| | - Simone Shahid
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Sophie Hogeveen
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Shivani Chandra
- Women’s College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Ontario Health, Toronto, Ontario, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Centre for Global eHealth Innovation, University Health Network, Techna Institute, Toronto, Ontario, Canada
| | - James Shaw
- Corresponding Author: James Shaw, PhD, Women’s College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, ON M5S 1B3, Canada;
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14
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Kini S, Duluk D, Weinstein J. Modeling the impact of digital readiness in recruiting and sustaining underrepresented groups: Data from the All of Us research program. Front Digit Health 2022; 4:1082098. [PMID: 37124163 PMCID: PMC10133694 DOI: 10.3389/fdgth.2022.1082098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/13/2022] [Indexed: 05/02/2023] Open
Abstract
The All of Us Research Program (All of Us or Program) is an ongoing longitudinal data collection operated by the National Institutes of Health (NIH). The Program aims to improve healthcare for all through the development of a biomedical research resource reflective of the diversity of the United States that includes Underrepresented in Biomedical Research (UBR) groups. Federally Qualified Health Centers (FQHCs) are a key recruitment stream of UBR participants, which are community based and provide primary care and preventive services in medically underserved areas. Over 90% of FQHC patients enrolled in All of Us to date are UBR. The COVID-19 pandemic caused a pause in All of Us activities. Re-starting the activities was a challenge, especially due to the digital divide faced by FQHC participants, and that most Program activities are primarily completed via web-based portal from a computer or a mobile device. This paper investigates the extent to which digital readiness impacted recruitment and sustainment of a pre-pandemic sample of 2,791 FQHC participants to the Program. Digital readiness was defined by access to home-based or other internet-accessing devices, and participants' comfort level using such devices. Results from multivariable logistic regression models showed that lower age, more education, female gender identity, and higher income were associated with higher digital readiness (p ≤ 0.01). Race, rurality, and sexual orientation status were not significant factors associated with digital readiness. Older participants had higher odds of completing Program activities, even though less digitally ready than their younger peers, as they often completed the activities during their in-person clinical visits. A subsequent weighted model demonstrated that FQHC participants who were digitally ready had 27% higher odds of completing Program activities than those not digitally ready. The data highlight the need for improved connectivity and sustainment between longitudinal data collection, research programs, and UBR participants, particularly among those facing the digital divide. Quantifying digital challenges provide operational insights for longitudinal data collection (All of Us, or others), and broadly, other aspects of digital medicine such as telehealth or patient portals by recognizing digital readiness of participants and patients, and the level of support required for success.
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Affiliation(s)
- Soumya Kini
- Principal Health Systems Engineer atThe MITRE Corporation, Mclean, VA, United States
- Correspondence: Soumya Kini
| | - Dave Duluk
- Lead Data Scientist atThe MITRE Corporation, Mclean, VA, United States
| | - Joshua Weinstein
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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15
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Williamson A, Barbarin A, Campbell B, Campbell T, Franzen S, Reischl TM, Zimmerman M, Veinot TC. Uptake of and Engagement With an Online Sexual Health Intervention (HOPE eIntervention) Among African American Young Adults: Mixed Methods Study. J Med Internet Res 2021; 23:e22203. [PMID: 34269689 PMCID: PMC8325088 DOI: 10.2196/22203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 04/16/2021] [Accepted: 05/16/2021] [Indexed: 01/30/2023] Open
Abstract
Background Regarding health technologies, African American young adults have low rates of uptake, ongoing usage, and engagement, which may widen sexual health inequalities. Objective We aimed to examine rates of uptake and ongoing usage, and factors influencing uptake, ongoing usage, and engagement for a consumer health informatics (CHI) intervention for HIV/sexually transmitted infection (STI) prevention among African American young adults, using the diffusion of innovation theory, trust-centered design framework, and O’Brien and Toms’ model of engagement. Methods This community-based participatory mixed methods study included surveys at four time points (n=315; 280 African American participants) among young adults aged 18 to 24 years involved in a blended offline/online HIV/STI prevention intervention (HIV Outreach, Prevention, and Education [HOPE] eIntervention), which was described as a “HOPE party.” Qualitative interviews were conducted with a subset of participants (n=19) after initial surveys and website server logs indicated low uptake and ongoing usage. A generalized linear mixed-effects model identified predictors of eIntervention uptake, server logs were summarized to describe use over time, and interview transcripts were coded and thematically analyzed to identify factors affecting uptake and engagement. Results Participants’ initial self-reported eIntervention uptake was low, but increased significantly over time, although uptake never reached expectations. The most frequent activity was visiting the website. Demographic factors and HOPE party social network characteristics were not significantly correlated with uptake, although participant education and party network gender homophily approached significance. According to interviews, one factor driving uptake was the desire to share HIV/STI prevention information with others. Survey and interview results showed that technology access, perceived time, and institutional and technological trust were necessary conditions for uptake. Interviews revealed that factors undermining uptake were insufficient promotion and awareness building, and the platform of the intervention, with social media being less appealing due to previous negative experiences concerning discussion of sexuality on social media. During the interaction with the eIntervention, interview data showed that factors driving initial engagement were audience-targeted website esthetics and appealing visuals. Ongoing usage was impeded by insufficiently frequent updates. Similarly, lack of novelty drove disengagement, although a social media contest for sharing intervention content resulted in some re-engagement. Conclusions To encourage uptake, CHI interventions for African American young adults can better leverage users’ desires to share information about HIV/STI prevention with others. Ensuring implementation through trusted organizations is also important, though vigorous promotion is needed. Visual appeal and targeted content foster engagement at first, but ongoing usage may require continual content changes. A thorough analysis of CHI intervention use can inform the development of future interventions to promote uptake and engagement. To guide future analyses, we present an expanded uptake and engagement model for CHI interventions targeting African American young adults based on our empirical results.
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Affiliation(s)
- Alicia Williamson
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | | | - Terrance Campbell
- YOUR Center, Flint, MI, United States.,TigerLIFE, University of Memphis, Memphis, TN, United States
| | - Susan Franzen
- Prevention Research Center of Michigan, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Thomas M Reischl
- Prevention Research Center of Michigan, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Marc Zimmerman
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany Christine Veinot
- School of Information, University of Michigan, Ann Arbor, MI, United States.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States
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16
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Kothari A, Foisey L, Donelle L, Bauer M. How do Canadian public health agencies respond to the COVID-19 emergency using social media: a protocol for a case study using content and sentiment analysis. BMJ Open 2021; 11:e041818. [PMID: 33888527 PMCID: PMC8068947 DOI: 10.1136/bmjopen-2020-041818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Keeping Canadians safe requires a robust public health (PH) system. This is especially true when there is a PH emergency, like the COVID-19 pandemic. Social media, like Twitter and Facebook, is an important information channel because most people use the internet for their health information. The PH sector can use social media during emergency events for (1) PH messaging, (2) monitoring misinformation, and (3) responding to questions and concerns raised by the public. In this study, we ask: what is the Canadian PH risk communication response to the COVID-19 pandemic in the context of social media? METHODS AND ANALYSIS We will conduct a case study using content and sentiment analysis to examine how provinces and provincial PH leaders, and the Public Health Agency of Canada and national public heath leaders, engage with the public using social media during the first wave of the pandemic (1 January-3 September 2020). We will focus specifically on Twitter and Facebook. We will compare findings to a gold standard during the emergency with respect to message content. ETHICS AND DISSEMINATION Western University's research ethics boards confirmed that this study does not require research ethics board review as we are using social media data in the public domain. Using our study findings, we will work with PH stakeholders to collaboratively develop Canadian social media emergency response guideline recommendations for PH and other health system organisations. Findings will also be disseminated through peer-reviewed journal articles and conference presentations.
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Affiliation(s)
- Anita Kothari
- School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Lyndsay Foisey
- Health Information Science Graduate Program, Western University, London, Ontario, Canada
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Michael Bauer
- Department of Computer Sciences, Faculty of Science, Western University, London, Ontario, Canada
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17
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Liu D, Yamashita T, Burston B, Keene JR. The Use of Online Health-Management Tools and Health Care Utilization Among Older Americans. THE GERONTOLOGIST 2021; 60:1224-1232. [PMID: 32525983 DOI: 10.1093/geront/gnaa068] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The digital divide, or differences in access to technology, can have far-reaching consequences. This study identified disparities in access to online health-related technology. It then investigated associations between online health-related technology use and health care utilization among older adults in the United States. RESEARCH DESIGN AND METHODS The study used a cross-sectional data set of 1,497 adults aged 51 and older from the 2014 Health and Retirement Study (HRS)'s supplemental module (Health Behaviors) and the RAND version of the HRS fat file. RESULTS Older age, being a racial/ethnic minority, married, uninsured, and having lower educational attainment, lower income, and reporting poorer health were each associated with lower levels of use of online health-management tools. The use of online health-management tools was associated with a 34% greater mean number of doctor visits (incidence rate ratio = 1.34, SE = 0.10, p < .05) than nonuse. However, such use was not associated with the number or type of hospitalizations. Indeed, only health care needs as measured by self-rated health status (odds ratio [OR] = 0.58, SE = 0.18, p < .05) and the number of chronic conditions were associated with hospitalizations (OR = 1.68, SE = 0.07, p < .05). DISCUSSION AND IMPLICATIONS While more research is needed to clarify the purposes (e.g., prevention vs. treatment) and outcomes of health care service utilization as a function of technology use, it may be wise to proactively tackle the digital divide as one upstream strategy for improving various health and health care outcomes among older adults.
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Affiliation(s)
- Darren Liu
- Department of Public Health, Des Moines University, Iowa
| | - Takashi Yamashita
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore
| | - Betty Burston
- Department of Health Care Administration and Policy, University of Nevada Las Vegas
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18
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Kim HS, Kim HJ, Juon HS. Racial/Ethnic Disparities in Patient-Provider Communication and the Role of E-Health Use. JOURNAL OF HEALTH COMMUNICATION 2021; 26:194-203. [PMID: 33899688 DOI: 10.1080/10810730.2021.1919248] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Although the health care industry has strived to address racial/ethnic disparities in health communication, several gaps remain. Previous findings suggest that communication technology might help narrow the gaps; however, they do not provide a comprehensive picture of how or why. To answer these questions, we examined the potential role of communication technology in mitigating the racial/ethnic disparities in patient-provider communication. Data analysis of the 2018 Health Information National Trends Survey (N= 3,504) revealed that the levels of perceived quality of communication with health care providers were lower among Asians and Hispanics than non-Hispanic Whites while no difference emerged between Blacks and non-Hispanic Whites. Although the adoption of communication technology was relatively high across minority groups, its use appeared to play different roles in different racial/ethnic populations. The Internet and patient portals showed no particular associations with patient-provider communication except for Black Internet users, who reported poorer experiences with patient-provider communication than non-users. Among Asians and Hispanics, social media and mobile communication appeared to play different roles in impacting communication experiences with health care providers. The findings suggest that communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities.
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Affiliation(s)
- Hyang-Sook Kim
- Department of Mass Communication, Towson University, Towson, Maryland, USA
| | - Hee Jun Kim
- College of Nursing, Ajou University, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Hee-Soon Juon
- Department of Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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19
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Lattie EG, Bass M, Garcia SF, Phillips SM, Moreno PI, Flores AM, Smith JD, Scholtens D, Barnard C, Penedo FJ, Cella D, Yanez B. Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation. JMIR Form Res 2020; 4:e18412. [PMID: 32955450 PMCID: PMC7536600 DOI: 10.2196/18412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 01/22/2023] Open
Abstract
Background Unmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms offer the possibility to supplement existing care and optimize symptom management. Objective This paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system. Methods A web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability. Results Ten cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements. Conclusions Cancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform.
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Affiliation(s)
- Emily G Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Michael Bass
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Patricia I Moreno
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
| | - Ann Marie Flores
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - J D Smith
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States.,Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, United States
| | - Denise Scholtens
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Cynthia Barnard
- Department of Medicine, Northwestern University, Chicago, IL, United States
| | - Frank J Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, United States
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States.,Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, United States
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Patel D, Sarlati S, Martin-Tuite P, Feler J, Chehab L, Texada M, Marquez R, Orellana FJ, Henderson TL, Nwabuo A, Plevin R, Dicker RA, Juillard C, Sammann A. Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study. JMIR Mhealth Uhealth 2020; 8:e15866. [PMID: 32831179 PMCID: PMC7477672 DOI: 10.2196/15866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/31/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023] Open
Abstract
Background Violence is a public health problem. Hospital-based violence intervention programs such as the San Francisco Wraparound Project (WAP) have been shown to reduce future violent injury. The WAP model employs culturally competent case managers who recruit and enroll violently injured patients as clients. Client acceptance of the WAP intervention is variable, and program success depends on streamlined, timely communication and access to resources. High rates of smartphone usage in populations who are at risk for violent reinjury create an opportunity to design a tailored information and communications technology (ICT) tool to support hospital-based violence intervention programs. Objective Current evidence shows that ICT tools developed in the health care space may not be successful in engaging vulnerable populations. The goal of this study was to use human-centered design methodology to identify the unique communication needs of the clients and case managers at WAP to design a mobile ICT. Methods We conducted 15 semi-structured interviews with users: clients, their friends and families, case managers, and other stakeholders in violence intervention and prevention. We used a human-centered design and general inductive approach to thematic analysis to identify themes in the qualitative data, which were extrapolated to insight statements and then reframed into design opportunities. Wireframes of potential mobile ICT app screens were developed to depict these opportunities. Results Thematic analysis revealed four main insights that were characterized by the opposing needs of our users. (1) A successful relationship is both professional and personal. Clients need this around the clock, but case managers can only support this while on the clock. (2) Communications need to feel personal, but they do not always need to be personalized. (3) Healing is a journey of skill development and lifestyle changes that must be acknowledged, monitored, and rewarded. (4) Social networks need to provide peer support for healing rather than peer pressure to propagate violence. These insights resulted in the following associated design opportunities: (1) Maximize personal connection while controlling access, (2) allow case managers to personalize automated client interactions, (3) hold clients accountable to progress and reward achievements, and (4) build a connected, yet confidential community. Conclusions Human-centered design enabled us to identify unique insights and design opportunities that may inform the design of a novel and tailored mobile ICT tool for the WAP community.
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Affiliation(s)
- Devika Patel
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Siavash Sarlati
- Department of Emergency Medicine, University of California, San Francisco, CA, United States
| | - Patrick Martin-Tuite
- University of California, San Francisco School of Medicine, San Francisco, CA, United States
| | - Joshua Feler
- Yale University School of Medicine, New Haven, CT, United States
| | - Lara Chehab
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Michael Texada
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Ruben Marquez
- Department of Surgery, University of California, San Francisco, CA, United States
| | - F Julia Orellana
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Terrell L Henderson
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Adaobi Nwabuo
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Rebecca Plevin
- Department of Surgery, University of California, San Francisco, CA, United States
| | - Rochelle Ami Dicker
- Division of Surgical Critical Care, Department of Surgery, University of California, Los Angeles, CA, United States
| | - Catherine Juillard
- Division of Surgical Critical Care, Department of Surgery, University of California, Los Angeles, CA, United States
| | - Amanda Sammann
- Department of Surgery, University of California, San Francisco, CA, United States
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Bakken S, Marden S, Arteaga SS, Grossman L, Keselman A, Le PT, Creber RM, Powell-Wiley TM, Schnall R, Tabor D, Das R, Farhat T. Behavioral Interventions Using Consumer Information Technology as Tools to Advance Health Equity. Am J Public Health 2020; 109:S79-S85. [PMID: 30699018 DOI: 10.2105/ajph.2018.304646] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The digital divide related to consumer information technologies (CITs) has diminished, thus increasing the potential to use CITs to overcome barriers of access to health interventions as well as to deliver interventions situated in the context of daily lives. However, the evidence base regarding the use and impact of CIT-enabled interventions in health disparity populations lags behind that for the general population. Literature and case examples are summarized to demonstrate the use of mHealth, telehealth, and social media as behavioral intervention platforms in health disparity populations, identify challenges to achieving their use, describe strategies for overcoming the challenges, and recommend future directions. The evidence base is emerging. However, challenges in design, implementation, and evaluation must be addressed for the promise to be fulfilled. Future directions include (1) improved design methods, (2) enhanced research reporting, (3) advancement of multilevel interventions, (4) rigorous evaluation, (5) efforts to address privacy concerns, and (6) inclusive design and implementation decisions.
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Affiliation(s)
- Suzanne Bakken
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Sue Marden
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - S Sonia Arteaga
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Lisa Grossman
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Alla Keselman
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Phuong-Tu Le
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Ruth Masterson Creber
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Tiffany M Powell-Wiley
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Rebecca Schnall
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Derrick Tabor
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Rina Das
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Tilda Farhat
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
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Taghavifard MT, Hanafizadeh P, Bamdad-Soofi J, Yoosefvand A. Model of Acceptance of E-Health Services. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2020. [DOI: 10.29252/jech.7.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Alolod GP, Gardiner H, Agu C, Turner JL, Kelly PJ, Siminoff LA, Gordon EJ, Norden R, Daly TA, Benitez A, Hernandez I, Guinansaca N, Winther LR, Bergeron CD, Montalvo A, Gonzalez T. A Culturally Targeted eLearning Module on Organ Donation (Promotoras de Donación): Design and Development. J Med Internet Res 2020; 22:e15793. [PMID: 31929102 PMCID: PMC6996759 DOI: 10.2196/15793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 01/20/2023] Open
Abstract
Background As an overrepresented population on the transplant waitlist, stagnated rates of organ donation registration among Latinxs must be redressed. Promotoras (community health workers), who are effective at advocating and spearheading health promotion efforts in the Latinx community, show promise in their ability to educate about organ donation and donor registration. Objective This study aimed (1) to develop an interactive, evidence-based program to educate promotoras about organ donation, the need for organ donors in the Latinx American community, and ways to register as deceased organ donors and (2) to train promotoras to lead discussions about organ donation and to promote the act of donor registration. Methods In partnership with 4 promotoras organizations, the culturally targeted Promotoras de Donación eLearning module was developed based on input from 12 focus groups conducted with Latina women (n=61) and promotoras (n=37). Formative work, existing literature, the Vested Interest Theory, and the Organ Donation Model guided curriculum development. In partnership with the Gift of Life Institute and regional promotoras, the curriculum was designed, filmed, and developed in a visually appealing module interface. The module was beta-tested with promotoras before launch. Results Promotoras de Donación, available in Spanish with English subtitling, lasts just over an hour. The module comprised 6 sections including various activities and videos, with the curriculum divided into a skills-based communication component and a didactic educational component. Pre- and posttests assessed the module’s direct effects on promotoras’ organ donation knowledge and attitudes as well as confidence promoting the act of donor registration. Conclusions This novel, theoretically and empirically based intervention leveraged the existing network of promotoras to promote the act of donor registration. Future research should assess whether the module helps increase rates of donor registration within Latinx communities and reduce disparities in access to transplantation. Trial Registration ClinicalTrials.gov NCT04007419; https://www.clinicaltrials.gov/ct2/show/NCT04007419
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Affiliation(s)
- Gerard P Alolod
- College of Public Health, Temple University, Philadelphia, PA, United States
| | - Heather Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Chidera Agu
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Jennie L Turner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Patrick J Kelly
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Laura A Siminoff
- College of Public Health, Temple University, Philadelphia, PA, United States
| | - Elisa J Gordon
- Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Robert Norden
- Gift of Life Institute, Philadelphia, PA, United States
| | | | | | | | | | | | | | | | - Tony Gonzalez
- Esperanza Health Center, Philadelphia, PA, United States
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eHealth and mHealth Interventions for Ethnic Minority and Historically Underserved Populations in Developed Countries: an Umbrella Review. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s42413-019-00055-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractHealth disparities among historically disadvantaged populations can undermine the effectiveness of eHealth and mHealth interventions and limit their acceptability among diverse community members. The twin aims of this umbrella review of systematic reviews (SRs) are to summarise the evidence on the characteristics and effectiveness of eHealth and mHealth interventions among underserved populations in developed counties and provide recommendations to community organizers, policy makers and researchers. Comprehensive searches were conducted in bibliographic databases, Google Scholar and references lists for SRs published in English between 2000 and 2019. SRs were selected following a protocol registered with PROSPERO. Two independent reviewers were involved in the selection appraisal process, quality assessment and data extraction process. Six SRs met the inclusion criteria for this umbrella review. The six SRs concerned interventions delivered by computer programmes, cell-phones or other electronic devices. The studies in the SRs reported improvements to physiological well-being, health knowledge and self-management, as well as improvements in psychosocial outcomes. This umbrella review concludes with recommendations for community organizers, policy makers and researches for the formation of guidelines, inclusion of target community members in the development of eHealth interventions and directions for future research.
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Isler J, Sawadogo NH, Harling G, Bärnighausen T, Adam M, Kagoné M, Sié A, Greuel M, McMahon SA. Iterative Adaptation of a Mobile Nutrition Video-Based Intervention Across Countries Using Human-Centered Design: Qualitative Study. JMIR Mhealth Uhealth 2019; 7:e13604. [PMID: 31710302 PMCID: PMC6878105 DOI: 10.2196/13604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/29/2019] [Accepted: 07/27/2019] [Indexed: 11/16/2022] Open
Abstract
Background Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. Objective The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. Methods Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. Results We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. Conclusions Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions.
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Affiliation(s)
- Jasmin Isler
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | | | - Guy Harling
- Institute for Global Health, University College London, London, United Kingdom.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States.,Harvard Center for Population & Development Studies, Harvard University, Cambridge, MA, United States.,Africa Health Research Institute, KwaZulu-Natal, South Africa.,MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, United States.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Maya Adam
- Stanford Center for Health Education, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Ali Sié
- Nouna Health Research Center, Nouna, Nouna, Burkina Faso
| | - Merlin Greuel
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Patten CA, Fu S, Vickerman K, Bock MJ, Nelson D, Zhu SH, Balls-Berry JE, Torres AJ, Brockman TA, Hughes CA, Klein AE, Valdez-Soto M, Keller PA. Support person interventions to increase use of quitline services among racially diverse low-income smokers: A pilot study. Addict Behav Rep 2019; 9:100171. [PMID: 31193750 PMCID: PMC6542743 DOI: 10.1016/j.abrep.2019.100171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Social support from nonsmokers may have a role in prompting smokers to use evidence-based cessation treatment. Prior studies found that an intervention for nonsmoking support persons (SPs) was effective for promoting smokers' use of free, state quitline services. This pilot study adapted and assessed feasibility of this intervention for a racially diverse, low-income population. METHODS Single group, non-randomized design enrolling SP-smoker dyads with low income status enrolled in one of three study "waves" of 10 pairs each. Participants were recruited using flyers and in-person outreach methods. The SP intervention included a 1-session coaching call and written materials; study waves 2 and 3 also included text messaging and a monetary incentive for smokers who used quitline services. Using content analysis, the intervention was iteratively adapted based on SP feedback. Baseline measures assessed socio-demographics, dyad and tobacco use characteristics. Follow-up assessments were conducted among SPs at 1-month follow-up and among smokers at 3-months follow-up. Feasibility indicators were recruitment, retention, and SP intervention acceptability and adherence. Secondary outcomes were smokers' use of any quitline service verified by quitline staff and 7-day, point prevalence, biochemically verified smoking abstinence at 3 months. RESULTS Recruitment of 30 dyads was feasible; in-person recruitment methods were the most successful. SPs who completed follow-up assessments found the intervention acceptable, suggesting only minor content modifications, and they perceived the quitline information as novel. But the study had some feasibility challenges (e.g., SP coaching call completion: 60% and SP study retention: 53%). At 3 months, 2 smokers (7%) had used any quitline service and 13% were biochemically confirmed smoking abstinent. CONCLUSIONS This pilot study demonstrated feasibility of recruiting SP-smoker dyads from diverse, low-income communities. While the intervention was well received, its delivery was not feasible in this population. Results suggest that further consumer adaptation of the intervention is needed among both SPs and smokers.
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Affiliation(s)
- Christi A. Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Steven Fu
- Veterans Affairs HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Mail code: 152, Bldg 9, One Veterans Drive, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, United States
| | - Katrina Vickerman
- Optum Center for Wellbeing Research, Optum Health, 999 Third Ave, Seattle, WA 98104, United States
| | - Martha J. Bock
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - David Nelson
- Veterans Affairs HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Mail code: 152, Bldg 9, One Veterans Drive, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, United States
| | - Shu-Hong Zhu
- University of California San Diego, 9500 Gilman Drive #0905, La Jolla, CA 92093, United States
| | - Joyce E. Balls-Berry
- Center for Clinical and Translational Science Community Engagement Program, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Alula Jimenez Torres
- Optum Center for Wellbeing Research, Optum Health, 999 Third Ave, Seattle, WA 98104, United States
| | - Tabetha A. Brockman
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
- Center for Clinical and Translational Science Community Engagement Program, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Christine A. Hughes
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Abigail E. Klein
- Veterans Affairs HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Mail code: 152, Bldg 9, One Veterans Drive, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, One Veterans Drive, Minneapolis, MN 55417, United States
| | - Miguel Valdez-Soto
- Center for Clinical and Translational Science Community Engagement Program, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States
| | - Paula A. Keller
- ClearWay Minnesota℠, 8011 34th Ave S, Suite 400, Minneapolis, MN 55425, United States
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Mitchell UA, Chebli PG, Ruggiero L, Muramatsu N. The Digital Divide in Health-Related Technology Use: The Significance of Race/Ethnicity. THE GERONTOLOGIST 2019; 59:6-14. [PMID: 30452660 DOI: 10.1093/geront/gny138] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Indexed: 01/31/2023] Open
Abstract
Background and Objectives Technology can enhance the health and quality of life of diverse populations and may play an important role in reducing health disparities. Although a "digital divide" between the young and the old has been noted, it is unclear whether the use of technology for managing health differs by race/ethnicity among older adults. This study uses nationally representative data from community-dwelling older Americans to characterize racial/ethnic differences in health-related technology use. Design and Methods Data came from 1,336 white, black, and Hispanic adults aged 54 and older who completed the 2014 technology module of the Health and Retirement Study. Racial/ethnic differences in overall health-related technology use were assessed using Poisson regression. Then, F-tests were used to assess differences in the use of phone calls, text messages, E-mails, social media, health management sites, health-related mobile applications, web searches, and brain games for health purposes. Results Compared to whites, older blacks and Hispanics were less likely to use technology for health-related purposes after accounting for demographic characteristics, education, and health conditions. They were also less likely to make or receive phone calls, use health management sites, search the web for health information, and use brain games for their health. Discussion and Implications Older racial and ethnic minorities are less likely than whites to use certain technologies when managing their health. These findings highlight the importance of understanding the patterns of health-related technology use across racially and ethnically diverse populations to appropriately tailor interventions aimed at improving minority health and eliminating health disparities.
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Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Perla G Chebli
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Laurie Ruggiero
- Behavioral Health and Nutrition Department, College of Health Sciences, University of Delaware, Newark
| | - Naoko Muramatsu
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
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Tarver WL, Haggstrom DA. The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States: Systematic Review. J Med Internet Res 2019; 21:e10256. [PMID: 31012855 PMCID: PMC6658273 DOI: 10.2196/10256] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/31/2018] [Accepted: 09/14/2018] [Indexed: 12/11/2022] Open
Abstract
Background In the United States, more than 1.6 million new cases of cancer are estimated to be diagnosed each year. However, the burden of cancer among the US population is not shared equally, with racial and ethnic minorities and lower-income populations having a higher cancer burden compared with their counterparts. For example, African Americans have the highest mortality rates and shortest survival rates for most cancers compared with other racial or ethnic groups in the United States. A wide range of technologies (eg, internet-based [electronic health, eHealth] technologies, mobile [mobile health, mHealth] apps, and telemedicine) available to patients are designed to improve their access to care and empower them to participate actively in their care, providing a means to reduce health care disparities; however, little is known of their use among underserved populations. Objective The aim of this study was to systematically review the current evidence on the use of cancer-specific patient-centered technologies among various underserved populations. Methods Computer-based search was conducted in the following academic databases: (1) PubMed (cancer subset), (2) MEDLINE, (3) PsycINFO, and (4) CINAHL. We included studies that were peer-reviewed, published in the English language, and conducted in the United States. Each study was individually assessed for relevance, with any disagreements being reconciled by consensus. We used a 3-step inclusion process in which we examined study titles, abstracts, and full-text papers for assessment of inclusion criteria. We systematically extracted information from each paper meeting our inclusion criteria. Results This review includes 71 papers that use patient-centered technologies that primarily targeted African Americans (n=31), rural populations (n=14), and Hispanics (n=12). A majority of studies used eHealth technologies (n=41) finding them to be leading sources of cancer-related health information and significantly improving outcomes such as screening among nonadherent individuals and increasing knowledge about cancer and cancer screening. Studies on mHealth found that participants reported overall favorable responses to receiving health information via short message service (SMS) text message; however, challenges were experienced with respect to lack of knowledge of how to text among some participants. More complex mobile technologies (eg, a tablet-based risk assessment tool) were also found favorable to use and acceptable among underserved populations; however, they also resulted in more significant barriers, for example, participants expressed concerns regarding security and unfamiliarity with the technology and preferred further instruction and assistance in its use. Conclusions There is a growing body of literature exploring patient-centered technology and its influence on care of underserved populations. In this review, we find that these technologies seem to be effective, especially when tailored, in improving patient and care-related outcomes. Despite the potential of patient-centered technologies and the receptivity of underserved populations, challenges still exist with respect to their effective use and usability.
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Affiliation(s)
- Will L Tarver
- VA Health Services Research and Development, Center for Health Information & Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Department of Health Policy & Management, Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - David A Haggstrom
- VA Health Services Research and Development, Center for Health Information & Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, United States.,Division of General Internal Medicine and Geriatrics, School of Medicine, Indiana University, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
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Ruvalcaba D, Nagao Peck H, Lyles C, Uratsu CS, Escobar PR, Grant RW. Translating/Creating a Culturally Responsive Spanish-Language Mobile App for Visit Preparation: Case Study of "Trans-Creation". JMIR Mhealth Uhealth 2019; 7:e12457. [PMID: 30950803 PMCID: PMC6482869 DOI: 10.2196/12457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/19/2018] [Accepted: 01/03/2019] [Indexed: 01/19/2023] Open
Abstract
Background Health information technology (IT) tools are increasingly used to improve patient care. However, implementation of English-only health IT tools could potentially worsen health disparities for non-English speakers. Objective We aim to describe the “trans-creation” process of developing linguistically and culturally appropriate health IT tools through a detailed case analysis of a waiting room health mobile app designed to help Spanish-speaking Latino people prepare for primary care visits. Methods We adapted the English-language Visit Planner mobile app for Spanish-speaking Latino patients. We applied culturally defined themes derived from prior published research and input by both skilled linguists and potential end users. Initial changes were iteratively reviewed and edited by a team of writers, health care educators, subject matter experts, patients, and providers. Results The trans-creation process resulted in the following key culturally mediated changes to the tool: replacing the “provider” actors with “patient” actors; changing the choice of “Stress at Home or Work” (represented by an icon of a house) to “Mi Familia” (translation: my family; icon is an outline of family members holding hands); replacing the English terms “anxiety” and “depression” with “Me siento desanimado”(translation: I am feeling down) to avoid mental health stigma; and using more concise text translation to ensure the wording fit the available on-screen space. Conclusions The trans-creation process of cultural and linguistic adaptation led to several design changes that would not have been implemented if we had simply translated the words from English to Spanish.
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Affiliation(s)
- Denise Ruvalcaba
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Hidemi Nagao Peck
- Regional Health Education, The Permanente Medical Group, Oakland, CA, United States
| | - Courtney Lyles
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, United States.,Center for Vulnerable Populations, University of California, San Francisco, CA, United States
| | - Connie S Uratsu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Patricia R Escobar
- Regional Health Education, The Permanente Medical Group, Oakland, CA, United States
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
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30
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Sherman LD, Grande SW. Building Better Clinical Relationships With Patients: An Argument for Digital Health Solutions With Black Men. Health Serv Insights 2019; 12:1178632919834315. [PMID: 30886522 PMCID: PMC6415479 DOI: 10.1177/1178632919834315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/31/2019] [Indexed: 11/17/2022] Open
Abstract
There is a rapid evolution of care delivery taking place across the globe in response to an explosion of novel health technologies. Growing in parallel to this expansion is the anticipation of mHealth technologies to drive patient-centered care into the future. Despite this hope, continuing reports of health inequities and lived experiences of substandard care fill national, state, and community health reports. The impact of these inequities is particularly pernicious on Black men and their long-term health status. As decades of robust evidence substantiates needed interventions, current progress is not seeing expected gains. In this commentary, we argue that at the heart of these inequities are issues of access, health literacy, institutional racism, and growing social distance between clinicians and Black men. To address these inequities, we suggest that digital interventions, designed to support decision-making, information exchange, and shared accountability have the best hope to overcome current inequities by promoting authentic relationships that ultimately drive better communication between Black men and their clinicians.
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Affiliation(s)
- Ledric D Sherman
- Department of Health & Kinesiology, Texas A&M University, College Station, TX, USA
| | - Stuart W Grande
- Division of Health Policy & Management, School of Public Health, The University of Minnesota, Minneapolis, MN, USA
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31
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Menon U, Ashing K, Chang MW, Christy SM, Friberg-Felsted K, Rivas VG, Gwede CK, Lu Q, Meade CD, Sly J, Wang M, Yanez B, Yeary K, Yi JC, Alcaraz KI. Application of the ConNECT Framework to Precision Health and Health Disparities. Nurs Res 2019; 68:99-109. [PMID: 30540700 PMCID: PMC6863736 DOI: 10.1097/nnr.0000000000000329] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An emphasis on precision health (PH) has stimulated precision medicine studies to focus on the interplay of biological, behavioral, and environmental factors with disease risks, treatments, prognoses, and outcomes affecting health disparities. It is imperative, as well, that improving health equity among underserved populations remains central to the efforts and aims of PH. OBJECTIVES The aim if this study was to apply the transdisciplinary ConNECT Framework: A Model for Advancing Behavioral Medicine Science and Practice to Foster Health Equity to PH by integrating a population health agenda for reducing health disparities. METHODS There are five ConNECT principles: (a) integrating context; (b) fostering a norm of inclusion; (c) ensuring equitable diffusion of innovations; (d) harnessing communication technology; and (e) prioritizing specialized training as an organizing framework to PH, including examples of how to integrate behavioral and socioecological determinants to better understand the contexts of individuals, systems, and place to design targeted treatments and interventions. RESULTS We describe proactive, actionable strategies for the systematic application of ConNECT Framework principles to address health equity via the PH initiative. Context and implications for nursing research and practice are also described. DISCUSSION The ConNECT Framework emphasizes that diversity inclusion is imperative for true population health benefit from PH, broadly in public health, behavioral medicine, medicine, and nursing, to equip health researchers and practitioners to account for contextual socioecologic data that can be aligned with biologic data for more population responsive and individually tailored interventions to prevent, diagnose, and treat diseases.
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Affiliation(s)
- Usha Menon
- Usha Menon, PhD, RN, FAAN, is Professor and Vice Dean of Research, University of South Florida College of Nursing, Tampa, Florida. Kimlin Ashing, PhD, is Founding Director, Center of Community Alliance for Research Education, and Professor, Department of Population Sciences, Beckman Research Institute, City of Hope Medical Center, Duarte, California. Mei Wei Chang, PhD, RN, is Associate Professor, The Ohio State University, College of Nursing, Columbus. Shannon M. Christy, PhD, is Assistant Member, Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. Katarina Friberg-Felsted, PhD, is Assistant Professor, College of Nursing, University of Utah Salt Lake City. Virginia Gil Rivas, PhD, is Professor, Department of Psychological Science, University of North Carolina at Charlotte. Clement K. Gwede, PhD, MPH, RN, FAAN, is Senior Member, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. Qian Lu, MD, PhD, is Associate Professor, Department of Health Disparities Research, MD Anderson Cancer Center, Houston, Texas. Cathy D. Meade, PhD, RN, FAAN, is Senior Member, Division of Population Science, H. Lee Moffitt Cancer Center, and Research Institute & Department of Oncological Sciences, University of South Florida, College of Medicine, Tampa, Florida. Jamila Sly, PhD, is Assistant Professor, Department of Oncology Sciences, Icahn School of Medicine at Mount Sinai, New York, New York. Monica Wang, ScD, MS, is Assistant Professor, Department of Community Health Sciences, Boston University School of Public Health, and Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Betina Yanez, PhD, is Assistant Professor, Department of Medical Social Sciences and Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Karen Yeary, PhD, is Associate Professor, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Jean C. Yi, PhD, is Staff Scientist, Project Director, Biobehavioral Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. Kassandra I. Alcaraz, PhD, MPH, is Strategic Director of Health Disparities Research, Behavioral Research Center, American Cancer Society, Atlanta, Georgia
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Badau D, Badau A. Identifying the Incidence of Exercise Dependence Attitudes, Levels of Body Perception, and Preferences for Use of Fitness Technology Monitoring. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122614. [PMID: 30469525 PMCID: PMC6313704 DOI: 10.3390/ijerph15122614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/15/2018] [Accepted: 11/18/2018] [Indexed: 12/19/2022]
Abstract
Background: The study was focused on identifying the relationship between the incidence of exercise dependence attitudes, the level of body perception, and preferences for use of fitness technology monitoring. Methods: We investigated 241 students from physical education and sports specializations. We used a questionnaire structured in 5 parts: personal information (age, gender, weight, height, and institutional membership), Exercise Dependence Scale-R (EDS-21), the Compulsive Exercise Test (CET), Body perception questionnaire, and Fitness Monitoring Technology. Results: Application of EDS-21 revealed 8.3% with dependence and CET with 13.4%. Body mass index (BMI) in combination with self-image body: 18 (7.4%) of subjects over-estimated themselves, 18 (7.4%) of subjects underestimated themselves, 38.6% of the subjects were satisfied with their appearance, 17% were very satisfied and none were dissatisfied. A total of 36.1% thought they had the correct weight and 8.7% thought of losing weight. The most preferred monitoring technologies were the treadmill and the smartphone's fitness applications. A total of 11.6% of the subjects always used technologies, and 17% of subjects never did so. Conclusions: In order to identify the level of incidence of exercise dependence, body perception, and preference and frequency of use of monitoring technology, it is necessary to expand the level of knowledge about health and physical activities. The approach would diminish medical incidences of addiction, improve proactive behaviors, and correct prohealth.
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Affiliation(s)
- Dana Badau
- Department of Human Movement Sciences, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540139 Targu Mures, Romania.
| | - Adela Badau
- Department of Physical Education, University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540139 Targu Mures, Romania.
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33
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Huh J, Koola J, Contreras A, Castillo AK, Ruiz M, Tedone KG, Yakuta M, Schiaffino MK. Consumer Health Informatics Adoption among Underserved Populations: Thinking beyond the Digital Divide. Yearb Med Inform 2018; 27:146-155. [PMID: 30157518 PMCID: PMC6115231 DOI: 10.1055/s-0038-1641217] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives:
Underserved populations can benefit from consumer health informatics (CHI) that promotes self-management at a lower cost. However, prior literature suggested that the digital divide and low motivation constituted barriers to CHI adoption. Despite increased Internet use, underserved populations continue to show slow CHI uptake. The aim of the paper is to revisit barriers and facilitators that may impact CHI adoption among underserved populations.
Methods:
We surveyed the past five years of literature. We searched PubMed for articles published between 2012 and 2017 that describe empirical evaluations involving CHI use by underserved populations. We abstracted and summarized data about facilitators and barriers impacting CHI adoption.
Results:
From 645 search results, after abstract and full-text screening, 13 publications met the inclusion criteria of identifying barriers to and facilitators of underserved populations' CHI adoption. Contrary to earlier literature, the studies suggested that the motivation to improve health literacy and adopt technology was high among studied populations. Beyond the digital divide, barriers included: low health and computer literacy, challenges in accepting the presented information, poor usability, and unclear content. Factors associated with increased use were: user needs for information, user-access mediated by a proxy person, and early user engagement in system design.
Conclusions:
While the digital divide remains a barrier, newer studies show that high motivation for CHI use exists. However, simply gaining access to technology is not sufficient to improve adoption unless CHI technology is tailored to address user needs. Future interventions should consider building larger empirical evidence on identifying CHI barriers and facilitators.
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Affiliation(s)
- Jina Huh
- Michigan State University, MI, USA
| | - Jejo Koola
- University of California San Diego, CA, USA
| | - Alejandro Contreras
- Institute for Behavioral and Community Health, San Diego State University, CA, USA
| | - Alanah Kp Castillo
- Institute for Behavioral and Community Health, San Diego State University, CA, USA
| | - Melissa Ruiz
- Institute for Behavioral and Community Health, San Diego State University, CA, USA
| | - Keely G Tedone
- Institute for Behavioral and Community Health, San Diego State University, CA, USA
| | - Melissa Yakuta
- Institute for Behavioral and Community Health, San Diego State University, CA, USA
| | - Melody K Schiaffino
- Institute for Behavioral and Community Health, San Diego State University, CA, USA
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Levitz N, Wood E, Kantor L. The Influence of Technology Delivery Mode on Intervention Outcomes: Analysis of a Theory-Based Sexual Health Program. J Med Internet Res 2018; 20:e10398. [PMID: 30158100 PMCID: PMC6135965 DOI: 10.2196/10398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/05/2018] [Accepted: 06/28/2018] [Indexed: 01/19/2023] Open
Abstract
Background There are few studies on the role of technology delivery mode on health intervention outcomes. Furthermore, the opportunity to examine potential mode effects on a program that is theory-based and integrates principles of communication and decision-making science to influence sexual and reproductive health outcomes is a new contribution to the literature. Objective Planned Parenthood Federation of America’s national Chat/Text program can be accessed via short message service (SMS; more commonly referred to as text messaging), Web-based desktop chatting, and mobile phone chatting. The program has been in existence since 2010 and has conducted over 1,000,000 conversations. In this study, we examined whether the mode used to access the program (SMS text, desktop chat, or mobile phone chat) affected program users’ intention to act on the action plan established in their conversation. Methods Data were examined for a 6-month period from January 2016 to June 2016. The data were collected as a part of the monitoring and evaluation of an ongoing program. We limited our sample to the program’s priority audience of 15-24 years residing within the United States, which resulted in a sample of 64,939 conversations. Available data items for analysis included user demographics, delivery mode, topic discussed, helpfulness rating (on a 4-point scale), user confidence in following through on the intentions made during the conversation (on a 4-point scale), and educator confidence in whether the user would follow through on the stated intention. Linear and multinomial robust regression analyses were conducted to examine the relationships between conversation delivery mode and confidence. Results No significant relationships between users’ confidence to carry out their intentions and gender or race were found. None of the 3 modalities (SMS text, desktop chat, or mobile phone chat) were significantly associated with user confidence. All the 3 modalities had significant associations with educator confidence and showed similar effect sizes to those of user confidence. Educator confidence was significantly associated with all the topics discussed. Conclusions The Planned Parenthood Chat/Text program was designed as a tool to improve access to sexual and reproductive health care among young people. The mode of intervention delivery was not associated with users’ confidence in their ability to carry out their stated intention, suggesting that all modes are legitimate for delivering this intervention. Furthermore, each mode worked across gender and race or ethnicity, indicating that this is a modality that can work across groups.
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Affiliation(s)
- Nicole Levitz
- Planned Parenthood Federation of America, New York, NY, United States
| | - Erica Wood
- Planned Parenthood Federation of America, New York, NY, United States
| | - Leslie Kantor
- Planned Parenthood Federation of America, New York, NY, United States.,Rutgers School of Public Health, Rutgers University, Newark, NJ, United States
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Kvasny L, Payton FC. Managing Hypervisibility in the HIV Prevention Information‐Seeking Practices of Black Female College Students. J Assoc Inf Sci Technol 2018. [DOI: 10.1002/asi.24001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Lynette Kvasny
- Pennsylvania State University, College of Information Sciences & Technology, 329C IST Building, University Park PA16802
| | - Fay Cobb Payton
- North Carolina State University, College of Management, Campus Box 7229Raleigh NC27695
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36
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Nebeker C, Murray K, Holub C, Haughton J, Arredondo EM. Acceptance of Mobile Health in Communities Underrepresented in Biomedical Research: Barriers and Ethical Considerations for Scientists. JMIR Mhealth Uhealth 2017; 5:e87. [PMID: 28659258 PMCID: PMC5508114 DOI: 10.2196/mhealth.6494] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 03/25/2017] [Accepted: 05/04/2017] [Indexed: 12/29/2022] Open
Abstract
Background The rapid expansion of direct-to-consumer wearable fitness products (eg, Flex 2, Fitbit) and research-grade sensors (eg, SenseCam, Microsoft Research; activPAL, PAL Technologies) coincides with new opportunities for biomedical and behavioral researchers. Underserved communities report among the highest rates of chronic disease and could benefit from mobile technologies designed to facilitate awareness of health behaviors. However, new and nuanced ethical issues are introduced with new technologies, which are challenging both institutional review boards (IRBs) and researchers alike. Given the potential benefits of such technologies, ethical and regulatory concerns must be carefully considered. Objective Our aim was to understand potential barriers to using wearable sensors among members of Latino, Somali and Native Hawaiian Pacific Islander (NHPI) communities. These ethnic groups report high rates of disparate health conditions and could benefit from wearable technologies that translate the connection between physical activity and desired health outcomes. Moreover, these groups are traditionally under-represented in biomedical research. Methods We independently conducted formative research with individuals from southern California, who identified as Latino, Somali, or Native Hawaiian Pacific Islander (NHPI). Data collection methods included survey (NHPI), interview (Latino), and focus group (Somali) with analysis focusing on cross-cutting themes. Results The results pointed to gaps in informed consent, challenges to data management (ie, participant privacy, data confidentiality, and data sharing conventions), social implications (ie, unwanted attention), and legal risks (ie, potential deportation).
Conclusions Results shed light on concerns that may escalate the digital divide. Recommendations include suggestions for researchers and IRBs to collaborate with a goal of developing meaningful and ethical practices that are responsive to diverse research participants who can benefit from technology-enabled research methods.
Trial Registration ClinicalTrials.gov NCT02505165; https://clinicaltrials.gov/ct2/show/NCT02505165 (Archived by WebCite at http://www.Webcitation.org/6r9ZSUgoT)
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Affiliation(s)
- Camille Nebeker
- Center for Wireless and Population Health Systems, Qualcomm Institute, University of California, San Diego, La Jolla, CA, United States.,Scripps Translational Science Institute, Scripps Health, La Jolla, CA, United States.,Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Kate Murray
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States.,School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia
| | - Christina Holub
- Department of Public Health, California State University San Marcos, San Marcos, CA, United States
| | - Jessica Haughton
- Institute of Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, United States
| | - Elva M Arredondo
- Institute of Behavioral and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, United States
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Wieland ML, Njeru JW, Hanza MM, Boehm DH, Singh D, Yawn BP, Patten CA, Clark MM, Weis JA, Osman A, Goodson M, Porraz Capetillo MD, Hared A, Hasley R, Guzman-Corrales L, Sandler R, Hernandez V, Novotny PJ, Sloan JA, Sia IG. Pilot Feasibility Study of a Digital Storytelling Intervention for Immigrant and Refugee Adults With Diabetes. DIABETES EDUCATOR 2017; 43:349-359. [PMID: 28592205 DOI: 10.1177/0145721717713317] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this pilot feasibility project was to examine the potential effectiveness of a digital storytelling intervention designed through a community-based participatory research (CBPR) approach for immigrants and refugees with type 2 diabetes mellitus (T2DM). Methods The intervention was a 12-minute culturally and linguistically tailored video consisting of an introduction, 4 stories, and a concluding educational message. A structured interview was used to assess the intervention for acceptability, interest level, and usefulness among 25 participants with T2DM (15 Latino, 10 Somali) across 5 primary care clinical sites. After watching the video, participants rated their confidence and motivation about managing T2DM as a result of the intervention. Baseline A1C and follow-up values (up to 6 months) were abstracted from medical records. Results All participants reported that the intervention got their attention, was interesting, and was useful; 96% reported that they were more confident about managing their T2DM than before they watched the video, and 92% reported that the video motivated them to change a specific behavior related to T2DM self-management. The mean baseline A1C level for the intervention participants was 9.3% (78 mmol/mol). The change from baseline to first follow-up A1C level was -0.8% (-10 mmol/mol) ( P < .05). Conclusions Implementation of a digital storytelling intervention for T2DM among immigrant populations in primary care settings is feasible and resulted in self-rated improvement in psychosocial constructs that are associated with healthy T2DM self-management behaviors, and there was some evidence of improvement in glycemic control. A large-scale efficacy trial of the intervention is warranted.
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Affiliation(s)
- Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota (Dr Wieland, Dr Njeru)
| | - Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota (Dr Wieland, Dr Njeru)
| | - Marcelo M Hanza
- Department of Development, Mayo Clinic, Rochester, Minnesota (Mr Hanza)
| | - Deborah H Boehm
- Minneapolis Medical Research Foundation, Minneapolis, Minnesota (Dr Boehm, Ms Guzman-Corrales, Dr Sandler)
| | - Davinder Singh
- Mountain Park Health Center, Phoenix, Arizona (Dr Singh, Ms Hernandez)
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, Minnesota (Dr Yawn)
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Dr Patten, Dr Clark)
| | - Matthew M Clark
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota (Dr Patten, Dr Clark)
| | - Jennifer A Weis
- Department of Research Administration, Mayo Clinic, Rochester, Minnesota (Ms Weis, Ms Goodson).,Center for Clinical and Translational Science, Mayo Clinic, Rochester, Minnesota (Ms Weis)
| | - Ahmed Osman
- Somali Community Resettlement Services, Rochester, Minnesota (Mr Osman, Mr. Hared)
| | - Miriam Goodson
- Department of Research Administration, Mayo Clinic, Rochester, Minnesota (Ms Weis, Ms Goodson)
| | | | - Abdullah Hared
- Somali Community Resettlement Services, Rochester, Minnesota (Mr Osman, Mr. Hared)
| | - Rachel Hasley
- Community Health Services, Inc, Rochester, Minnesota (Ms Hasley)
| | - Laura Guzman-Corrales
- Language Services, Mayo Clinic, Rochester, Minnesota (Ms Porraz- Capetillo).,Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota (Mr Novotny, Dr Sloan).,Minneapolis Medical Research Foundation, Minneapolis, Minnesota (Dr Boehm, Ms Guzman-Corrales, Dr Sandler)
| | - Rachel Sandler
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota (Dr Sia).,Minneapolis Medical Research Foundation, Minneapolis, Minnesota (Dr Boehm, Ms Guzman-Corrales, Dr Sandler)
| | | | - Paul J Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota (Mr Novotny, Dr Sloan)
| | - Jeff A Sloan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota (Mr Novotny, Dr Sloan)
| | - Irene G Sia
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota (Dr Sia)
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38
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Nour M, Yeung SH, Partridge S, Allman-Farinelli M. A Narrative Review of Social Media and Game-Based Nutrition Interventions Targeted at Young Adults. J Acad Nutr Diet 2017; 117:735-752.e10. [DOI: 10.1016/j.jand.2016.12.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
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39
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Latulippe K, Hamel C, Giroux D. Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies. J Med Internet Res 2017; 19:e136. [PMID: 28450271 PMCID: PMC5427250 DOI: 10.2196/jmir.6731] [Citation(s) in RCA: 202] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/09/2017] [Accepted: 03/02/2017] [Indexed: 01/08/2023] Open
Abstract
Background eHealth is developing rapidly and brings with it a promise to reduce social health inequalities (SHIs). Yet, it appears that it also has the potential to increase them. Objectives The general objective of this review was to set out how to ensure that eHealth contributes to reducing SHIs rather than exacerbating them. This review has three objectives: (1) identifying characteristics of people at risk of experiencing social inequality in health; (2) determining the possibilities of developing eHealth tools that avoid increasing SHI; and (3) modeling the process of using an eHealth tool by people vulnerable to SHI. Methods Following the EPPI approach (Evidence for Policy and Practice of Information of the Institute of Education at the University of London), two databases were searched for the terms SHIs and eHealth and their derivatives in titles and abstracts. Qualitative, quantitative, and mixed articles were included and evaluated. The software NVivo (QSR International) was employed to extract the data and allow for a metasynthesis of the data. Results Of the 73 articles retained, 10 were theoretical, 7 were from reviews, and 56 were based on empirical studies. Of the latter, 40 used a quantitative approach, 8 used a qualitative approach, 4 used mixed methods approach, and only 4 were based on participatory research-action approach. The digital divide in eHealth is a serious barrier and contributes greatly to SHI. Ethnicity and low income are the most commonly used characteristics to identify people at risk of SHI. The most promising actions for reducing SHI via eHealth are to aim for universal access to the tool of eHealth, become aware of users’ literacy level, create eHealth tools that respect the cultural attributes of future users, and encourage the participation of people at risk of SHI. Conclusions eHealth has the potential to widen the gulf between those at risk of SHI and the rest of the population. The widespread expansion of eHealth technologies calls for rigorous consideration of interventions, which are not likely to exacerbate SHI.
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Affiliation(s)
- Karine Latulippe
- Department of Studies of Teaching and Learning, Laval University, Québec, QC, Canada
| | - Christine Hamel
- Department of Studies of Teaching and Learning, Laval University, Québec, QC, Canada
| | - Dominique Giroux
- Faculté de médecine, Département de réadaptation, Laval University, Québec, QC, Canada.,Centre d'Excellence du Vieillissement de Québec, Chu de Québec, Québec, QC, Canada
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40
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Alcaraz KI, Sly J, Ashing K, Fleisher L, Gil-Rivas V, Ford S, Yi JC, Lu Q, Meade CD, Menon U, Gwede CK. The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity. J Behav Med 2017; 40:23-38. [PMID: 27509892 PMCID: PMC5296246 DOI: 10.1007/s10865-016-9780-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 08/02/2016] [Indexed: 12/23/2022]
Abstract
Health disparities persist despite ongoing efforts. Given the United States' rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT's five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice.
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Affiliation(s)
- Kassandra I Alcaraz
- Behavioral Research Center, American Cancer Society, 250 Williams Street NW, Atlanta, GA, 30303, USA.
| | - Jamilia Sly
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kimlin Ashing
- Beckman Research Institute, City of Hope Medical Center, Duarte, CA, USA
| | - Linda Fleisher
- Center for Injury Research and Prevention, Fox Chase Cancer Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Virginia Gil-Rivas
- Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Sabrina Ford
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Jean C Yi
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Qian Lu
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Cathy D Meade
- Moffitt Cancer Center, Population Science, Health Outcomes and Behavior, Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Usha Menon
- The University of Arizona College of Nursing, Tucson, AZ, USA
| | - Clement K Gwede
- Moffitt Cancer Center, Population Science, Health Outcomes and Behavior, Department of Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Bernecker SL, Banschback K, Santorelli GD, Constantino MJ. A Web-Disseminated Self-Help and Peer Support Program Could Fill Gaps in Mental Health Care: Lessons From a Consumer Survey. JMIR Ment Health 2017; 4:e5. [PMID: 28104578 PMCID: PMC5290297 DOI: 10.2196/mental.4751] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 05/20/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Self-guided mental health interventions that are disseminated via the Web have the potential to circumvent barriers to treatment and improve public mental health. However, self-guided interventions often fail to attract consumers and suffer from user nonadherence. Uptake of novel interventions could be improved by consulting consumers from the beginning of the development process in order to assess their interest and their preferences. Interventions can then be tailored using this feedback to optimize appeal. OBJECTIVE The aim of our study was to determine the level of public interest in a new mental health intervention that incorporates elements of self-help and peer counseling and that is disseminated via a Web-based training course; to identify predictors of interest in the program; and to identify consumer preferences for features of Web-based courses and peer support programs. METHODS We surveyed consumers via Amazon's Mechanical Turk to estimate interest in the self-help and peer support program. We assessed associations between demographic and clinical characteristics and interest in the program, and we obtained feedback on desired features of the program. RESULTS Overall, 63.9% (378/592) of respondents said that they would try the program; interest was lower but still substantial among those who were not willing or able to access traditional mental health services. Female gender, lower income, and openness to using psychotherapy were the most consistent predictors of interest in the program. The majority of respondents, although not all, preferred romantic partners or close friends as peer counselors and would be most likely to access the program if the training course were accessed on a stand-alone website. In general, respondents valued training in active listening skills. CONCLUSIONS In light of the apparent public interest in this program, Web-disseminated self-help and peer support interventions have enormous potential to fill gaps in mental health care. The results of this survey can be used to inform the design of such interventions.
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Affiliation(s)
- Samantha L Bernecker
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, United States
| | - Kaitlin Banschback
- Division of Education, Queens College, City University of New York, Flushing, NY, United States
| | - Gennarina D Santorelli
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, United States
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, United States
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42
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Stiles-Shields C, Ho J, Mohr DC. A review of design characteristics of cognitive behavioral therapy-informed behavioral intervention technologies for youth with depression and anxiety. Digit Health 2016; 2:2055207616675706. [PMID: 29942571 PMCID: PMC6001244 DOI: 10.1177/2055207616675706] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 09/23/2016] [Indexed: 11/19/2022] Open
Abstract
Objective Cognitive behavioral therapy (CBT) has the strongest evidence base for the prevention and treatment of depression and anxiety in youth. Behavioral intervention technologies (BITs) provide an opportunity to overcome access barriers to traditional delivery of CBT. The present review evaluates the design characteristics of CBT-informed BITs for depression and anxiety designed for and tested with youth. Methods A state-of-the-art review of three library databases (PubMed, Scopus, and Web of Science) was conducted to identify papers that evaluated the use of CBT-informed BITs for the prevention and/or treatment of depression and anxiety among youth. Narrative results of design characteristics were organized using the BIT model, which provides a framework for design and evaluation. Results 219 unique results were retrieved through the search. After review, 14 papers (4 prevention and 10 treatment) met the selection criteria. A broad diversity occurred in reporting the design and methodology of CBT delivered to youth through BITs. Psychoeducation was overwhelmingly utilized as the primary change strategy throughout the interventions, with a heavy use of content delivery elements and linear workflows. The reporting of sample characteristics was minimal and varied. Conclusions Providing psychoeducation via content delivery was the most utilized BIT change strategy in the interventions, likely limiting the use of multiple BIT elements or flexible workflows. While characterizations could be inferred from the current reports, the high level of variability in reporting is problematic. Generalizability becomes increasingly more difficult to carry out effectively without clear descriptions of the design for evaluated BITs.
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Affiliation(s)
- Colleen Stiles-Shields
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Joyce Ho
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
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43
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Tao D, Shao F, Liu S, Wang T, Qu X. Predicting Factors of Consumer Acceptance of Health Information Technologies. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1541931213601137] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Consumer-oriented health information technologies (CHITs) are emerging as promising tools to fulfill consumer requirements for healthcare. However, factors affecting user acceptance of the technologies are unclear. We conducted a systematic review to examine empirically tested predicting factors of consumer acceptance of CHITs, and to provide suggestions for future CHIT design. Thirty-one studies met our selection criteria after a screening of 1855 articles. We identified 72 different factors that were tested for association with acceptance. The factors were related to user characteristics, technology features, human– technology interaction, organizational and social factors. Forty-one of the factors (57%) were reported to have significant positive influence on user acceptance. Our study offers insights into the derivation of reliable predictors of CHIT acceptance and into future CHIT design to improve consumer acceptance of the technologies. Further efforts are warranted to examine theoretically-based, context-specific factors, and to test technology acceptance models with a comprehensive set of relevant individual, technology-related, human-technology interaction, organizational and social factors in a sociotechnical system framework.
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Affiliation(s)
- Da Tao
- Insitute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China
| | - Fenglian Shao
- Insitute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China
| | - Shuang Liu
- Marine Human Factors Engineering Lab, China Institute of Marine Technology and Economy, Beijing, China
| | - Tieyan Wang
- School of Management, Xi’an Polytechnic University, Xi’an, China
| | - Xingda Qu
- Insitute of Human Factors and Ergonomics, Shenzhen University, Shenzhen, China
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Chaet AV, Morshedi B, Wells KJ, Barnes LE, Valdez R. Spanish-Language Consumer Health Information Technology Interventions: A Systematic Review. J Med Internet Res 2016; 18:e214. [PMID: 27511437 PMCID: PMC4997005 DOI: 10.2196/jmir.5794] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/22/2016] [Accepted: 07/08/2016] [Indexed: 11/15/2022] Open
Abstract
Background As consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions. Objective Our aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics. Methods A narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author’s last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics. Results We included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the most common health domains targeted by consumer health IT interventions. More than half of the interventions were culturally tailored. The most frequently used evaluation metric was behavior/attitude change, followed by usability and knowledge retention. Conclusions This study characterizes the existing body of research exploring consumer health IT interventions for the US Spanish-speaking Latino population. In doing so, it reveals three primary needs within the field. First, while the increase in studies targeting the Latino population in the last decade is a promising advancement, future research is needed that focuses on Latino subpopulations previously overlooked. Second, preliminary steps have been taken to culturally tailor consumer health IT interventions for the US Spanish-speaking Latino population; however, focus must expand beyond intervention content. Finally, the field should work to promote long-term evaluation of technology efficacy, moving beyond intermediary measures toward measures of health outcomes.
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Affiliation(s)
- Alexis V Chaet
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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Ostherr K, Killoran P, Shegog R, Bruera E. Death in the Digital Age: A Systematic Review of Information and Communication Technologies in End-of-Life Care. J Palliat Med 2015; 19:408-20. [PMID: 26713368 PMCID: PMC4827321 DOI: 10.1089/jpm.2015.0341] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND End-of-life (EOL) communication plays a critical role in ensuring that patients receive care concordant with their wishes and experience high quality of life. As the baby boomer population ages, scalable models of end-of-life communication will be needed to ensure that patients receive appropriate care. Information and communication technologies (ICTs) may help address the needs of this generation; however, few resources exist to guide the use of ICTs in EOL care. OBJECTIVE The primary objective was to identify the ICTs being used in EOL communication. The secondary objective was to compare the effectiveness of different ICTs in EOL communication. METHODS The study was a systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched seven databases for experimental and observational studies on EOL communication between doctors and patients using ICTs, published in 1997-2013. RESULTS The review identified 38 relevant articles. Eleven types of technology were identified: video, website, telephone, videoconferencing, e-mail, telemonitoring, Internet search, compact disc, fax, PalmPilot, and short message service (SMS) text messaging. ICTs were most commonly used to provide information or education, serve as decision aids, promote advance care planning (ACP), and relieve physical symptom distress. CONCLUSIONS The use of ICTs in EOL care is a small but growing field of research. Additional research is needed to adapt older, analog technologies for use in the digital age. Many of the interventions discussed in this review do not take full advantage of the affordances of mobile, connected health ICTs. The growing evidence base for e-health applications in related fields should guide future interventions in EOL care.
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Affiliation(s)
| | - Peter Killoran
- 2 Department of Anesthesiology, University of Texas Medical School at Houston , Houston, Texas.,3 School of Biomedical Informatics, University of Texas , Houston, Texas.,4 School of Public Health, University of Texas , Houston, Texas
| | | | - Eduardo Bruera
- 5 M.D. Anderson Cancer Center, University of Texas , Houston, Texas
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46
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Thompson MJ, Valdez RS. Online Filipino-Americans' perspectives on informatics-enabled health management. HEALTH POLICY AND TECHNOLOGY 2015. [DOI: 10.1016/j.hlpt.2015.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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47
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Gowin M, Cheney M, Gwin S, Franklin Wann T. Health and Fitness App Use in College Students: A Qualitative Study. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2015.1044140] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Valdez RS, Guterbock TM, Thompson MJ, Reilly JD, Menefee HK, Bennici MS, Williams IC, Rexrode DL. Beyond traditional advertisements: leveraging Facebook's social structures for research recruitment. J Med Internet Res 2014; 16:e243. [PMID: 25348050 PMCID: PMC4259909 DOI: 10.2196/jmir.3786] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 09/24/2014] [Accepted: 10/02/2014] [Indexed: 11/20/2022] Open
Abstract
Background Obtaining access to a demographically and geographically diverse sample for health-related research can be costly and time consuming. Previous studies have reported mixed results regarding the potential of using social media-based advertisements to overcome these challenges. Objective Our aim was to develop and assess the feasibility, benefits, and challenges of recruiting for research studies related to consumer health information technology (IT) by leveraging the social structures embedded in the social networking platform, Facebook. Methods Two recruitment strategies that involved direct communication with existing Facebook groups and pages were developed and implemented in two distinct populations. The first recruitment strategy involved posting a survey link directly to consenting groups and pages and was used to recruit Filipino-Americans to a study assessing the perceptions, use of, and preferences for consumer health IT. This study took place between August and December 2013. The second recruitment strategy targeted individuals with type 2 diabetes and involved creating a study-related Facebook group and asking administrators of other groups and pages to publicize our group to their members. Group members were then directly invited to participate in an online pre-study survey. This portion of a larger study to understand existing health management practices as a foundation for consumer health IT design took place between May and June 2014. In executing both recruitment strategies, efforts were made to establish trust and transparency. Recruitment rate, cost, content of interaction, and characteristics of the sample obtained were used to assess the recruitment methods. Results The two recruitment methods yielded 87 and 79 complete responses, respectively. The first recruitment method yielded a rate of study completion proportionate to that of the rate of posts made, whereas recruitment successes of the second recruitment method seemed to follow directly from the actions of a subset of administrators. Excluding personnel time, the first recruitment method resulted in no direct costs, and the second recruitment method resulted in a total direct cost of US $118.17. Messages, posts, and comments received using both recruitment strategies reflected ten themes, including appreciation, assistance, clarification, concerns, encouragement, health information, interest, promotion, solicitations, and support. Both recruitment methods produced mixed results regarding sample representativeness with respect to characteristics such as gender, race, and ethnicity. Conclusions The results of the study demonstrate that leveraging the social structures of Facebook for health-related research was feasible for obtaining small samples appropriate for qualitative research but not for obtaining large samples needed for quantitative research. The content of interactions with members of the target population prompted ethical deliberations concerning suitable target communities and appropriate boundaries between researchers and participants. Widespread replication of this method would benefit from a broad discussion among researchers, social media users, social media companies, and experts in research ethics to address appropriate protocols for such interactions.
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States.
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Mohr DC, Schueller SM, Araya R, Gureje O, Montague E. Mental health technologies and the needs of cultural groups. Lancet Psychiatry 2014; 1:326-7. [PMID: 26360986 DOI: 10.1016/s2215-0366(14)70261-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- David C Mohr
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL 60611, USA.
| | - Stephen M Schueller
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL 60611, USA
| | - Ricardo Araya
- London School of Hygiene and Tropical Medicine, Centre for Global Mental Health, London, UK
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Enid Montague
- Department of Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL 60611, USA
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50
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Schrader G, Bidargaddi N, Harris M, Newman L, Lynn S, Peterson L, Battersby M. An eHealth Intervention for Patients in Rural Areas: Preliminary Findings From a Pilot Feasibility Study. JMIR Res Protoc 2014; 3:e27. [PMID: 24927511 PMCID: PMC4090372 DOI: 10.2196/resprot.2861] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 12/03/2013] [Accepted: 01/18/2014] [Indexed: 11/17/2022] Open
Abstract
Background eHealth facilitation of chronic disease management has potential to increase engagement and effectiveness and extend access to care in rural areas. Objective The objective of this study was to demonstrate the feasibility and acceptability of an eHealth system for the management of chronic conditions in a rural setting. Methods We developed an online management program which incorporated content from the Flinders Chronic Condition Management Program (Flinders Program) and used an existing software platform (goACT), which is accessible by patients and health care workers using either Web-enabled mobile phone or Internet, enabling communication between patients and clinicians. We analyzed the impact of this eHealth system using qualitative and simple quantitative methods. Results The eHealth system was piloted with 8 recently hospitalized patients from rural areas, average age 63 (SD 9) years, each with an average of 5 chronic conditions and high level of psychological distress with an average K10 score of 32.20 (SD 5.81). Study participants interacted with the eHealth system. The average number of logins to the eHealth system by the study participants was 26.4 (SD 23.5) over 29 weeks. The login activity was higher early in the week. Conclusions The pilot demonstrated the feasibility of implementing and delivering a chronic disease management program using a Web-based patient-clinician application. A qualitative analysis revealed burden of illness and low levels of information technology literacy as barriers to patient engagement.
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Affiliation(s)
- Geoffrey Schrader
- Mental Health Observatory Research Unit, Country Health SA Local Health Network, Adelaide, Australia
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