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Moulaei K, Moulaei R, Bahaadinbeigy K. Barriers and facilitators of using health information technologies by women: a scoping review. BMC Med Inform Decis Mak 2023; 23:176. [PMID: 37670281 PMCID: PMC10478440 DOI: 10.1186/s12911-023-02280-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/31/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND AND AIM Health information technologies play a vital role in addressing diverse health needs among women, offering a wide array of services tailored to their specific requirements. Despite the potential benefits, the widespread utilization of these technologies by women faces numerous barriers and challenges. These barriers can cause women to either reduce their usage of health technologies or refrain from using them altogether. Therefore, this review was done with the aim of identifying and classifying barriers and facilitators. METHODS Some databases, including PubMed, Web of Sciences, and Scopus were searched using related keywords. Then, according to the inclusion and exclusion criteria, the articles were evaluated and selected. Finally, the barriers and facilitators were identified and classified. RESULTS Out of 14,399 articles, finally 35 articles were included in the review. In general, 375 barriers (232 items) and facilitators (143 items) were extracted from the studies. After merging similar items, 121 barriers (51 items) and facilitators (70 items) identified were organized into five main themes (management, technological, legal and regulatory, personal, and data and information management). The most important barriers were "privacy, confidentiality, and security concerns" (n = 24), "deficiencies and limitations of infrastructure, software, hardware, and network" (n = 19), "sociocultural challenges" (n = 15), and "poor economic status" (n = 15). Moreover, the most important facilitators were "increasing awareness, skills and continuous education of women" (n = 17, in personal theme), "providing training services" (n = 14, in management theme), "simple, usable, and user-friendly design of technologies" (n = 14, in technological theme), and "providing financial or non-financial incentives (motivation) for women" (n = 14, in personal theme). CONCLUSION This review showed that in order to use technologies, women face many barriers, either specific to women (such as gender inequality) or general (such as lack of technical skills). To overcome these barriers, policymakers, managers of organizations and medical centers, and designers of health systems can consider the facilitators identified in this review.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Reza Moulaei
- School of medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Kim SH, Kang SY, Sunwoo S, Choi WS, Kim C, Park YK, Jung S, Kim YS. Experience With and Awareness of Telemedicine Among Korean Outpatients During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1595-1603. [PMID: 35333644 DOI: 10.1089/tmj.2021.0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Owing to the coronavirus disease 19 pandemic, the demand for telemedicine has increased. However, the awareness of and experience with telemedicine among the Korean population have not been investigated. Therefore, we examined Korean outpatients' experience with and awareness of telemedicine. Methods: From December 2020 to March 2021, we conducted a survey exploring the awareness of and experience with telemedicine of outpatients who were consecutively enrolled by family physicians from four hospitals. The participants completed questionnaires on sociodemographic characteristics and knowledge, experience, satisfaction, preference, and future considerations concerning telemedicine. We evaluated factors associated with satisfaction with telemedicine experiences using multivariate logistic regression analysis. Results: Among the 563 study participants, 364 participants had experience with telemedicine. More than 95% of the telemedicine visits were performed by telephone consultation, and the most common disease type for telemedicine visits was chronic diseases (67.5%). Overall, 82.4% of the participants were satisfied with telemedicine. More than 90% of the participants were satisfied with telemedicine in terms of saving time and money relative to hospital visits, no risk of infection, and convenience. According to the multivariate logistic regression analysis, adults aged ≥65 years (odds ratio [OR] 3.53, 95% confidence interval [CI] 1.44-8.68), residents of a metropolitan city (OR 6.8, 95% CI 1.41-32.55), and those with knowledge of telemedicine (OR 2.96, 95% CI 1.21-7.26) were more likely to be satisfied with their telemedicine experience, compared with their counterparts. For chronic diseases, participants with telemedicine experience were significantly more likely to prefer telemedicine for revisits, compared with those with no telemedicine experience. Nonetheless, most respondents recognized that telemedicine requires improvement. Conclusions: Most Korean outpatients showed high satisfaction with telemedicine. Telemedicine may be considered in various medical situations in the future. Therefore, building a practical system for telemedicine and changes in the medical environment are required.
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Affiliation(s)
- Seung Hee Kim
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Seo Young Kang
- International Healthcare Center, Asan Medical Center, Seoul, Republic of Korea
| | - Sung Sunwoo
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Whan-Seok Choi
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Churlmin Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Kyu Park
- Department of Family Medicine, Bundang Jesaeng General Hospital, Seongnam, Republic of Korea
| | - Seungpil Jung
- Department of Family Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Young Sik Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ahmad F, Wang J, Wong B, Fung WLA. Interactive mental health assessments for Chinese Canadians: A pilot randomized controlled trial in nurse practitioner-led primary care clinic. Asia Pac Psychiatry 2022; 14:e12400. [PMID: 32608131 DOI: 10.1111/appy.12400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Mental health conditions like depression and anxiety are on the rise, but access to care remains a challenge. Immigrants and racialized communities including Chinese Canadians experience high level of access barriers including communication with clinicians. With the aim to facilitate mental health communications, we tested an Interactive Computer-assisted Client Assessment Survey (iCCAS) in Cantonese/Mandarin and English at a nurse practitioner-led primary care clinic in Toronto. The iCCAS offers a touch-screen, pre-consultation survey with questions on depression, anxiety, post-traumatic stress, alcohol abuse, and social context. The program generates point-of-care reports for the clinician and patient. METHODS A pilot randomized controlled trial examined the intervention impact on mental health discussion and symptom detection, compared with the usual care, followed by clinicians' qualitative interviews. RESULTS Fifty self-identified Chinese adult patients participated (iCCAS = 26, Usual Care = 24), response rate 79.4%. Participant mean age was 44.8 years and 92% were immigrants. There was an increase of 19% and 15% in the mental health discussion and detection of symptoms in the iCCAS group compared with the usual care. More participants in the iCCAS group were referred to a social worker or psychiatrist. Patients found the use of iCCAS easy and clinicians identified its benefits for themselves (eg, early identification and comfort) and patients (eg, self-awareness and anonymity) and proposed practice-integration. DISCUSSION The studied tool holds promise for enhancing clinician-patient mental health communications in primary care settings for overseas Chinese. Implications are discussed for in-person and virtual healthcare which could also inform responses to mental health crisis related to COVID-19.
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Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management, York University, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada
| | - Jamie Wang
- Office of Research and Innovations, North York General Hospital, Toronto, Ontario, Canada
| | - Bonnie Wong
- Hong Fook Mental Health Association, Toronto, Ontario, Canada.,HF Connecting Health Nurse Practitioner-Led Clinic, Toronto, Ontario, Canada
| | - Wai Lun Alan Fung
- HF Connecting Health Nurse Practitioner-Led Clinic, Toronto, Ontario, Canada.,Tyndale University, Toronto, Ontario, Canada.,North York General Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada.,Faculty Member, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Ahmad F, Lou W, Shakya Y, Ginsburg L, Ng PT, Rashid M, Dinca-Panaitescu S, Ledwos C, McKenzie K. Preconsult interactive computer-assisted client assessment survey for common mental disorders in a community health centre: a randomized controlled trial. CMAJ Open 2017; 5:E190-E197. [PMID: 28401134 PMCID: PMC5378520 DOI: 10.9778/cmajo.20160118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Access disparities for mental health care exist for vulnerable ethnocultural and immigrant groups. Community health centres that serve these groups could be supported further by interactive, computer-based, self-assessments. METHODS An interactive computer-assisted client assessment survey (iCCAS) tool was developed for preconsult assessment of common mental disorders (using the Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder 7-item [GAD-7] scale, Primary Care Post-traumatic Stress Disorder [PTSD-PC] screen and CAGE [concern/cut-down, anger, guilt and eye-opener] questionnaire), with point-of-care reports. The pilot randomized controlled trial recruited adult patients, fluent in English or Spanish, who were seeing a physician or nurse practitioner at the partnering community health centre in Toronto. Randomization into iCCAS or usual care was computer generated, and allocation was concealed in sequentially numbered, opaque envelopes that were opened after consent. The objectives were to examine the interventions' efficacy in improving mental health discussion (primary) and symptom detection (secondary). Data were collected by exit survey and chart review. RESULTS Of the 1248 patients assessed, 190 were eligible for participation. Of these, 148 were randomly assigned (response rate 78%). The iCCAS (n = 75) and usual care (n = 72) groups were similar in sociodemographics; 98% were immigrants, and 68% were women. Mental health discussion occurred for 58.7% of patients in the iCCAS group and 40.3% in the usual care group (p ≤ 0.05). The effect remained significant while controlling for potential covariates (language, sex, education, employment) in generalized linear mixed model (GLMM; adjusted odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1-4.5). Mental health symptom detection occurred for 38.7% of patients in the iCCAS group and 27.8% in the usual care group (p > 0.05). The effect was not significant beyond potential covariates in GLMM (adjusted OR 1.9; 95% CI 0.9-4.1). INTERPRETATION The studied intervention holds potential for community health centres to improve mental health discussion. Further research with larger samples should examine the impact on detection and enhance generalizability. Trial registration: ClinicalTrials.gov, no: NCT02023957, registered on Dec. 12, 2013.
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Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Wendy Lou
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Yogendra Shakya
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Liane Ginsburg
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Peggy T Ng
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Meb Rashid
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Serban Dinca-Panaitescu
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Cliff Ledwos
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
| | - Kwame McKenzie
- School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont
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Ahmad F, Shakya Y, Ginsburg L, Lou W, Ng PT, Rashid M, Ferrari M, Ledwos C, McKenzie K. Burden of common mental disorders in a community health centre sample. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:e758-e766. [PMID: 27965352 PMCID: PMC5154667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine the rates of common mental disorders (CMDs) such as depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol use in an urban community health care centre (CHC) serving vulnerable immigrant and ethnoracial communities in order to improve knowledge on the rates of CMDs specific to these groups accessing primary care settings. DESIGN English or Spanish, self-administered, tablet-based survey known as the Interactive Computer-Assisted Client Assessment Survey (iCCAS). SETTING Access Alliance Multicultural Health and Community Services CHC in Toronto, Ont. PARTICIPANTS Adult patients waiting to see a clinician. MAIN OUTCOME MEASURES The iCCAS screened for depression (using the PHQ-9 [Patient Health Questionnaire]), anxiety (using the GAD-7 [Generalized Anxiety Disorder 7-item scale]), PTSD (using the PC-PTSD [Primary Care PTSD Screen]), and alcohol dependency (using the CAGE questionnaire); those with an existing diagnosis and active treatment for one of these conditions were not asked to complete that condition-specific screening scale. An exit survey measured demographic characteristics and relevant indicators. RESULTS A response rate of 78.6% was achieved. The iCCAS survey was completed by 75 patients (26 men and 49 women) with a mean age of 36.5 years. Almost all were first-generation immigrants: 32.0% originated from Latin America, 28.0% from South Asia, and 17.3% from Africa or the Middle East. Major depression was found among 44.0% of participants (11 with diagnosis and treatment, 22 with a score of 10 or greater on the PHQ-9). Generalized anxiety disorder was present in 26.7% of participants (7 with diagnosis and treatment, 13 with a score of 10 or greater on the GAD-7 scale). Posttraumatic stress disorder was detected in 37.3% of participants (7 with diagnosis and treatment, 21 with a score of 3 or greater on the PC-PTSD tool). Alcohol dependency was found among 10.7% of participants (1 with diagnosis and treatment, 7 with a score of 2 or greater on the CAGE questionnaire). CONCLUSION The high rates of probable depression, generalized anxiety, and PTSD that were found in the studied population suggest a need for systematic assessment of CMDs in CHCs, as well as training and resources to increase readiness to handle identified cases.
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Affiliation(s)
- Farah Ahmad
- Associate Professor in the School of Health Policy and Management at York University in Toronto, Ont, and Research Scientist at the North York General Hospital.
| | - Yogendra Shakya
- Senior Research Scientist at Access Alliance Multicultural Health and Community Services and Assistant Professor in the Dalla Lana School of Public Health at the University of Toronto
| | - Liane Ginsburg
- Associate Professor in the School of Health Policy and Management at York University
| | - Wendy Lou
- Professor and Head of the Biostatistics Division of the Dalla Lana School of Public Health at the University of Toronto
| | - Peggy T Ng
- Professor in the School of Administrative Studies at York University
| | - Meb Rashid
- Director of Cross Roads Clinic at Women's College Hospital and Assistant Professor at the Department of Family and Community Medicine at the University of Toronto
| | - Manuela Ferrari
- Postdoctoral fellow in the School of Health Policy and Management at York University
| | - Cliff Ledwos
- Director of Primary Health Care and Special Initiatives at Access Alliance Multicultural Health and Community Services
| | - Kwame McKenzie
- Psychiatrist and Medical Director of Underserved Populations at the Centre for Addiction and Mental Health in Toronto, Ont, and Chief Executive Officer of The Wellesley Institute
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Ferrari M, Ahmad F, Shakya Y, Ledwos C, McKenzie K. Computer-assisted client assessment survey for mental health: patient and health provider perspectives. BMC Health Serv Res 2016; 16:516. [PMID: 27663508 PMCID: PMC5035495 DOI: 10.1186/s12913-016-1756-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The worldwide rise in common mental disorders (CMDs) is posing challenges in the provision of and access to care, particularly for immigrant, refugee and racialized groups from low-income backgrounds. eHealth tools, such as the Interactive Computer-Assisted Client Assessment Survey (iCCAS) may reduce some barriers to access. iCCAS is a tablet-based, touch-screen self-assessment completed by clients while waiting to see their family physician (FP) or nurse practitioner (NP). In an academic-community initiative, iCCAS was made available in English and Spanish at a Community Health Centre in Toronto through a mixed-method trial. METHODS This paper reports the perspectives of clients in the iCCAS group (n = 74) collected through an exit survey, and the perspectives of 9 providers (four FP and five NP) gathered through qualitative interviews. Client acceptance of the tool was assessed for cognitive and technical dimensions of their experience. They rated twelve items for perceived Benefits and Barriers and four questions for the technical quality. RESULTS Most clients reported that the iCCAS completion time was acceptable (94.5 %), the touch-screen was easy to use (97.3 %), and the instructions (93.2 %) and questions (94.6 %) were clear. Clients endorsed the tool's Benefits, but were unsure about Barriers to information privacy and provider interaction (mean 4.1, 2.6 and 2.8, respectively on a five-point scale). Qualitative analysis of the provider interviews identified five themes: challenges in Assessing Mental Health Services, such as case complexity, time, language and stigma; the Tool's Benefits, including non-intrusive prompting of clients to discuss mental health, and facilitation of providers' assessment and care plans; the Tool's Integration into everyday practice; Challenges for Use (e.g. time); and Promoting Integration Effectively, centered on the timing of screening, setting readiness, language diversity, and technological advances. CONCLUSIONS Participant clients and providers perceived iCCAS as an easy and useful tool for mental health assessments at the Community Health Centre and similar settings. The findings are anticipated to inform further work in this area. TRIAL REGISTRATION ClinicalTrials.gov; NCT02023957 ; Registered retrospectively 12 Dec. 2013.
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Affiliation(s)
- Manuela Ferrari
- School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, Rm 414, Toronto, ON M3J1P3 Canada
| | - Farah Ahmad
- School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, Rm 414, Toronto, ON M3J1P3 Canada
| | - Yogendra Shakya
- Access Alliance Multicultural Health and Community Services, 340 College Street, Suite 500, Toronto, ON M5T3A9 Canada
| | - Cliff Ledwos
- Access Alliance Multicultural Health and Community Services, 340 College Street, Suite 500, Toronto, ON M5T3A9 Canada
| | - Kwame McKenzie
- Wellesley Institute, Centre for Addiction & Mental Health, 33 Russell Street, Toronto, ON M5S2S1 Canada
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O'Doherty L, Hegarty K, Ramsay J, Davidson LL, Feder G, Taft A. Screening women for intimate partner violence in healthcare settings. Cochrane Database Syst Rev 2015; 2015:CD007007. [PMID: 26200817 PMCID: PMC6599831 DOI: 10.1002/14651858.cd007007.pub3] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) damages individuals, their children, communities, and the wider economic and social fabric of society. Some governments and professional organisations recommend screening all women for IPV rather than asking only women with symptoms (case-finding). Here, we examine the evidence for whether screening benefits women and has no deleterious effects. OBJECTIVES To assess the effectiveness of screening for IPV conducted within healthcare settings on identification, referral, re-exposure to violence, and health outcomes for women, and to determine if screening causes any harm. SEARCH METHODS On 17 February 2015, we searched CENTRAL, Ovid MEDLINE, Embase, CINAHL, six other databases, and two trial registers. We also searched the reference lists of included articles and the websites of relevant organisations. SELECTION CRITERIA Randomised or quasi-randomised controlled trials assessing the effectiveness of IPV screening where healthcare professionals either directly screened women face-to-face or were informed of the results of screening questionnaires, as compared with usual care (which could include screening that did not involve a healthcare professional). DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias in the trials and undertook data extraction. For binary outcomes, we calculated a standardised estimation of the odds ratio (OR). For continuous data, either a mean difference (MD) or standardised mean difference (SMD) was calculated. All are presented with a 95% confidence interval (CI). MAIN RESULTS We included 13 trials that recruited 14,959 women from diverse healthcare settings (antenatal clinics, women's health clinics, emergency departments, primary care) predominantly located in high-income countries and urban settings. The majority of studies minimised selection bias; performance bias was the greatest threat to validity. The overall quality of the body of evidence was low to moderate, mainly due to heterogeneity, risk of bias, and imprecision.We excluded five of 13 studies from the primary analysis as they either did not report identification data, or the way in which they did was not consistent with clinical identification by healthcare providers. In the remaining eight studies (n = 10,074), screening increased clinical identification of victims/survivors (OR 2.95, 95% CI 1.79 to 4.87, moderate quality evidence).Subgroup analyses suggested increases in identification in antenatal care (OR 4.53, 95% CI 1.82 to 11.27, two studies, n = 663, moderate quality evidence); maternal health services (OR 2.36, 95% CI 1.14 to 4.87, one study, n = 829, moderate quality evidence); and emergency departments (OR 2.72, 95% CI 1.03 to 7.19, three studies, n = 2608, moderate quality evidence); but not in hospital-based primary care (OR 1.53, 95% CI 0.79 to 2.94, one study, n = 293, moderate quality evidence).Only two studies (n = 1298) measured referrals to domestic violence support services following clinical identification. We detected no evidence of an effect on referrals (OR 2.24, 95% CI 0.64 to 7.86, low quality evidence).Four of 13 studies (n = 2765) investigated prevalence (excluded from main analysis as rates were not clinically recorded); detection of IPV did not differ between face-to-face screening and computer/written-based assessment (OR 1.12, 95% CI 0.53 to 2.36, moderate quality evidence).Only two studies measured women's experience of violence (three to 18 months after screening) and found no evidence that screening decreased IPV.Only one study reported on women's health with no differences observable at 18 months.Although no study reported adverse effects from screening interventions, harm outcomes were only measured immediately afterwards and only one study reported outcomes at three months.There was insufficient evidence on which to judge whether screening increases uptake of specialist services, and no studies included an economic evaluation. AUTHORS' CONCLUSIONS The evidence shows that screening increases the identification of women experiencing IPV in healthcare settings. Overall, however, rates were low relative to best estimates of prevalence of IPV in women seeking healthcare. Pregnant women in antenatal settings may be more likely to disclose IPV when screened, however, rigorous research is needed to confirm this. There was no evidence of an effect for other outcomes (referral, re-exposure to violence, health measures, lack of harm arising from screening). Thus, while screening increases identification, there is insufficient evidence to justify screening in healthcare settings. Furthermore, there remains a need for studies comparing universal screening to case-finding (with or without advocacy or therapeutic interventions) for women's long-term wellbeing in order to inform IPV identification policies in healthcare settings.
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Affiliation(s)
- Lorna O'Doherty
- Coventry UniversityCentre for Research in Psychology, Behaviour and AchievementPriory StreetCoventryUKCV1 5FB
- The University of MelbourneDepartment of General Practice200 Berkeley StreetCarltonMelbourneVictoriaAustralia3053
| | - Kelsey Hegarty
- The University of MelbourneDepartment of General Practice200 Berkeley StreetCarltonMelbourneVictoriaAustralia3053
| | - Jean Ramsay
- Queen Mary University of LondonCentre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry58 Turner StreetWhitechapelLondonUKE1 2AB
| | - Leslie L Davidson
- Columbia UniversityDepartment of Epidemiology, Mailman School of Public HealthRoom 1613, 722 W 168 StNew YorkNYUSA10032
| | - Gene Feder
- University of BristolCentre for Academic Primary Care, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Angela Taft
- La Trobe UniversityMother and Child Health Research215 Franklin StreetMelbourneVictoriaAustralia3000
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Blander E, Saewyc EM. Adolescent reactions to icon-driven response modes in a tablet-based health screening tool. Comput Inform Nurs 2015; 33:181-8. [PMID: 25851558 PMCID: PMC5756075 DOI: 10.1097/cin.0000000000000145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increasingly popular touch-screen electronic tablets offer clinics a new medium for collecting adolescent health screening data in the waiting area before visits, but there has been limited evaluation of interactive response modes. This study investigated the clarity, comprehensibility, and utility of icon-driven and gestural response functions employed in one such screening tool, TickiT. We conducted cognitive processing interviews with 30 adolescents from Vancouver (aged 14-20 years, 60% female, 30% English as a second language) as they completed the TickiT survey. Participants used seven different interactive functions to respond to questions across 30 slides, while being prompted to articulate their thoughts and reactions. The audio-recorded, transcribed interviews were analyzed for evidence of comprehension, nuances in response choices, and youth interest in the modes. Participants were quite receptive to the icon response modes. Across demographics and cultural backgrounds, they indicated question prompts were clear, response choices appropriate, and response modes intuitive. Most said they found the format engaging and would be more inclined to fill out such a screening tool than a paper-and-pencil form in a clinical setting. Given the positive responses and ready understanding of these modes among youth, clinicians may want to consider interactive icon-driven approaches for screening.
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Affiliation(s)
- Eitan Blander
- Author Affiliation: Stigma and Resilience Among Vulnerable Youth Centre School of Nursing, University of British Columbia, Vancouver, Canada
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Access to chronic disease care in general practice: the acceptability of implementing systematic waiting-room screening using computer-based patient-reported risk status. Br J Gen Pract 2014; 63:e620-6. [PMID: 23998842 DOI: 10.3399/bjgp13x671605] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Routine screening and advice regarding risky lifestyle behaviours is appropriate in the primary care setting, but often not implemented. Routine electronic collection of patients' self-reported data may streamline the collection of such information. AIM To explore the perceptions of GPs and their attending patients regarding the acceptability of waiting-room touchscreen computers for the collection of health behaviour information. Uptake, ease of operation, and the perceived likelihood of future implementation were studied. DESIGN AND SETTING Cross-sectional health-risk survey. General practices in metropolitan areas in Australia. METHOD Practices were randomly selected by postcode. Consecutive patients who were eligible to take part in the study were approached in the waiting room and invited to do so. Participants completed the touchscreen health survey. A subsample of patients and GPs completed additional items regarding acceptability. RESULTS Twelve general practices participated in the study, with 4058 patients (86%) and 51 of 68 (75%) GPs consenting to complete the health-risk survey, 596 patients and 30 GPs were selected to complete the acceptability survey. A majority of the 30 GPs indicated that the operation of the survey was not disruptive to practice and more than 90% of patients responded positively to all items regarding its operation. More than three-quarters of the patient sample were willing to consider allowing their responses to be kept on file and complete such surveys in the future. CONCLUSION As waiting-room-based collection of this information appears to be both feasible and acceptable, practitioners should consider collecting and incorporating routine patient-reported health behaviours for inclusion in the medical record.
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Whitehouse SR, Lam PY, Balka E, McLellan S, Deevska M, Penn D, Issenman R, Paone M. Co-Creation With TickiT: Designing and Evaluating a Clinical eHealth Platform for Youth. JMIR Res Protoc 2013; 2:e42. [PMID: 24140595 PMCID: PMC3806391 DOI: 10.2196/resprot.2865] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/12/2013] [Accepted: 09/15/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND All youth are susceptible to mental health issues and engaging in risky behavior, and for youth with chronic health conditions, the consequences can be more significant than in their healthy peers. Standardized paper-based questionnaires are recommended by the American Academy of Pediatrics in community practice to screen for health risks. In hospitals, psychosocial screening is traditionally undertaken using the Home Education, Eating, Activities, Drugs, Depression, Sex, Safety (HEEADDSS) interview. However, time constraints and patient/provider discomfort reduce implementation. We report findings from an eHealth initiative undertaken to improve uptake of psychosocial screening among youth. OBJECTIVE Youth are sophisticated "technology natives." Our objective was to leverage youth's comfort with technology, creating a youth-friendly interactive mobile eHealth psychosocial screening tool, TickiT. Patients enter data into the mobile application prior to a clinician visit. Response data is recorded in a report, which generates alerts for clinicians, shifting the clinical focus from collecting information to focused management. Design goals included improving the patient experience, improving efficiency through electronic patient based data entry, and supporting the collection of aggregated data for research. METHODS This paper describes the iterative design and evaluation processes undertaken to develop TickiT including co-creation processes, and a pilot study utilizing mixed qualitative and quantitative methods. A collaborative industry/academic partnership engaged stakeholders (youth, health care providers, and administrators) in the co-creation development process. An independent descriptive study conducted in 2 Canadian pediatric teaching hospitals evaluated the feasibility of the platform in both inpatient and ambulatory clinical settings, evaluating both providers and patient responses to the platform. RESULTS The independent pilot feasibility study included 80 adolescents, 12-18 years, and 38 medical staff-residents, inpatient and outpatient pediatricians, and surgeons. Youth uptake was 99% (79/80), and survey completion 99% (78/79; 90 questions). Youth found it easy to understand (92%, 72/78), easy to use (92%, 72/78), and efficient (80%, 63/79 with completion rate < 10 minutes). Residents were most positive about the application and surgeons were least positive. All inpatient providers obtained new patient information. CONCLUSIONS Co-creative design methodology with stakeholders was effective for informing design and development processes to leverage effective eHealth opportunities. Continuing stakeholder engagement has further fostered platform development. The platform has the potential to meet IHI Triple Aim goals. Clinical adaptation requires planning, training, and support for health care providers to adjust their practices.
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Affiliation(s)
- Sandy R Whitehouse
- BC Children's Hospital, Division of Adolescent Medicine, University of British Columbia, Vancouver, BC, Canada.
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Smith PH, Homish GG, Barrick C, Grier NL. Using touch-screen technology to assess smoking in a low-income primary care clinic: a pilot study. Subst Use Misuse 2011; 46:1750-4. [PMID: 21974691 DOI: 10.3109/10826084.2011.618999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This pilot study examined the use of a touch-screen tablet personal computer to assess smoking and alcohol use among low-income primary care patients (N = 100) and tested cross-method consistency with a paper assessment. Data were collected in 2009. A touch-screen survey assessed smoking, alcohol use, partner smoking, and acceptability. A separate paper survey assessed smoking, partner smoking, and acceptability. The touch-screen assessment was highly acceptable and reliable. Implications and limitations are noted. Future research should explore the use of touch-screen technology for clinical endeavors requiring a quick assessment of substance use. There was no outside funding for this study.
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Affiliation(s)
- Philip H Smith
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, New York 14214, USA.
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12
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Ahmad F, Skinner HA, Stewart DE, Levinson W. Perspectives of family physicians on computer-assisted health-risk assessments. J Med Internet Res 2010; 12:e12. [PMID: 20457555 PMCID: PMC2885781 DOI: 10.2196/jmir.1260] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 01/22/2010] [Accepted: 02/01/2010] [Indexed: 12/03/2022] Open
Abstract
Background The firsthand experience of physicians using computer-assisted health-risk assessment is salient for designing practical eHealth solutions. Objective The aim of this study was to enhance understanding about computer-assisted health-risk assessments from physicians’ perspectives after completion of a trial at a Canadian, urban, multi-doctor, hospital-affiliated family practice clinic. Methods A qualitative approach of face-to-face, in-depth, semi-structured interviews was used. All interviews were audio recorded and field notes taken. Analytic induction and constant comparative techniques were used for coding and analyses. Interpretation was facilitated by peer audit and insights gained from the social exchange theoretical perspective. Results Ten physicians (seven female and three male) participated in the interviews. Three overarching themes emerged in relation to computer-assisted health-risk assessments: (1) perceived benefits, (2) perceived concerns or challenges, and (3) feasibility. Physicians unanimously acknowledged the potential of computer-assisted health-risk assessments to open dialogue on psychosocial health risks. They also appreciated the general facilitative roles of the tool, such as improving time-efficiency by asking questions on health risks prior to the consultation and triggering patients’ self-reflections on the risks. However, in the context of ongoing physician-patient relationships, physicians expressed concerns about the impact of the computer-assisted health-risk assessment tool on visit time, patient readiness to talk about psychosocial issues when the purpose of the visit was different, and the suitability of such risk assessment for all visits to detect new risk information. In terms of feasibility, physicians displayed general acceptance of the risk assessment tool but considered it most feasible for periodic health exams and follow-up visits based on their perceived concerns or challenges and the resources needed to implement such programs. These included clinic level (staff training, space, confidentiality) and organizational level (time, commitment and finances) support. Conclusions Participants perceived computer-assisted health-risk assessment as a useful tool in family practice, particularly for identifying psychosocial issues. Physicians displayed a general acceptance of the computer tool and indicated its greater feasibility for periodic health exams and follow-up visits than all visits. Future physician training on psychosocial issues should address physicians’ concerns by emphasizing the varying forms of “clinical success” for the management of chronic psychosocial issues. Future research is needed to examine the best ways to implement this program in diverse clinical settings and patient populations. Trial Registration ClinicalTrials.gov NCT00385034; http://clinicaltrials.gov/ct2/show/NCT00385034 (Archived by WebCite at http://www.webcitation.org/5pV8AGRgt)
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Affiliation(s)
- Farah Ahmad
- Social and Behavioral Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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13
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Monitoring symptoms at home: what methods would cancer patients be comfortable using? Qual Life Res 2010; 19:965-8. [PMID: 20446045 DOI: 10.1007/s11136-010-9662-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to determine which methods of remote symptom assessment cancer outpatients would be comfortable using, including those involving information technology, and whether this varied with age and gender. METHODS A questionnaire survey of 477 outpatients attending the Edinburgh Cancer Centre in Edinburgh, UK. RESULTS Most patients reported that they would not feel comfortable using methods involving technology such as a secure website, email, mobile phone text message, or a computer voice on the telephone but that they would be more comfortable using more traditional methods such as a paper questionnaire, speaking to a nurse on the telephone, or giving information in person. CONCLUSIONS The uptake of new, potentially cost-effective technology-based methods of monitoring patients' symptoms at home might be limited by patients' initial discomfort with the idea of using them. It will be important to develop methods of addressing this potential barrier (such as detailed explanation and supervised practice) if these methods are to be successfully implemented.
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Bonevski B, Campbell E, Sanson-Fisher RW. The validity and reliability of an interactive computer tobacco and alcohol use survey in general practice. Addict Behav 2010; 35:492-8. [PMID: 20092954 DOI: 10.1016/j.addbeh.2009.12.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 11/18/2009] [Accepted: 12/21/2009] [Indexed: 01/05/2023]
Abstract
BACKGROUND Uncertainty regarding the accuracy of the computer as a data collection or patient screening tool persists. Previous research evaluating the validity of computer health surveys have tended to compare those responses to that of paper survey or clinical interview (as the gold standard). This approach is limited as it assumes that the paper version of the self-report survey is valid and an appropriate gold standard. OBJECTIVES First, to compare the accuracy of computer and paper methods of assessing self-reported smoking and alcohol use in general practice with biochemical measures as gold standard. Second, to compare the test re-test reliability of computer administration, paper administration and mixed methods of assessing self-reported smoking status and alcohol use in general practice. METHODS A randomised cross-over design was used. Consenting patients were randomly assigned to one of four groups; Group 1. C-C : completing a computer survey at the time of that consultation (Time 1) and a computer survey 4-7 days later (Time 2); Group 2. C-P: completing a computer survey at Time 1 and a paper survey at Time 2; Group 3. P-C: completing a paper survey at Time 1 and a computer survey at Time 2; and Group 4. P-P: completing a paper survey at Time 1 and 2. At Time 1 all participants also completed biochemical measures to validate self-reported smoking status (expired air carbon monoxide breath test) and alcohol consumption (ethyl alcohol urine assay). RESULTS Of the 618 who were eligible, 575 (93%) consented to completing the Time 1 surveys. Of these, 71% (N=411) completed Time 2 surveys. Compared to CO, the computer smoking self-report survey demonstrated 91% sensitivity, 94% specificity, 75% positive predictive value (PPV) and 98% negative predictive value (NPV). The equivalent paper survey demonstrated 86% sensitivity, 95% specificity, 80% PPV, and 96% NPV. Compared to urine assay, the computer alcohol use self-report survey demonstrated 92% sensitivity, 50% specificity, 10% PPV and 99% NPV. The equivalent paper survey demonstrated 75% sensitivity, 57% specificity, 6% PPV, and 98% NPV. Level of agreement of smoking self-reports at Time 1 and Time 2 revealed kappa coefficients ranging from 0.95 to 0.98 in each group and hazardous alcohol use self-reports at Time 1 and Time 2 revealed kappa coefficients ranging from 0.90 to 0.96 in each group. CONCLUSION The collection of self-reported health risk information is equally accurate and reliable using computer interface in the general practice setting as traditional paper survey. Computer survey appears highly reliable and accurate for the measurement of smoking status. Further research is needed to confirm the adequacy of the quantity/frequency measure in detecting those who drink alcohol. Interactive computer administered health surveys offer a number of advantages to researchers and clinicians and further research is warranted.
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Affiliation(s)
- B Bonevski
- Centre for Health Research and Psycho-oncology, Cancer Council NSW and The University of Newcastle, Callaghan, NSW 2308, Australia
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Ahmad F, Hogg-Johnson S, Stewart DE, Skinner HA, Glazier RH, Levinson W. Computer-assisted screening for intimate partner violence and control: a randomized trial. Ann Intern Med 2009; 151:93-102. [PMID: 19487706 DOI: 10.7326/0003-4819-151-2-200907210-00124] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intimate partner violence and control (IPVC) is prevalent and can be a serious health risk to women. OBJECTIVE To assess whether computer-assisted screening can improve detection of women at risk for IPVC in a family practice setting. DESIGN Randomized trial. Randomization was computer-generated. Allocation was concealed by using opaque envelopes that recruiters opened after patient consent. Patients and providers, but not outcome assessors, were blinded to the study intervention. SETTING An urban, academic, hospital-affiliated family practice clinic in Toronto, Ontario, Canada. PARTICIPANTS Adult women in a current or recent relationship. INTERVENTION Computer-based multirisk assessment report attached to the medical chart. The report was generated from information provided by participants before the physician visit (n = 144). Control participants received standard medical care (n = 149). MEASUREMENTS Initiation of discussion about risk for IPVC (discussion opportunity) and detection of women at risk based on review of audiotaped medical visits. RESULTS The overall prevalence of any type of violence or control was 22% (95% CI, 17% to 27%). In adjusted analyses based on complete cases (n = 282), the intervention increased opportunities to discuss IPVC (adjusted relative risk, 1.4 [CI, 1.1 to 1.9]) and increased detection of IPVC (adjusted relative risk, 2.0 [CI, 0.9 to 4.1]). Participants recognized the benefits of computer screening but had some concerns about privacy and interference with physician interactions. LIMITATION The study was done at 1 clinic, and no measures of women's use of services or health outcomes were used. CONCLUSION Computer screening effectively detected IPVC in a busy family medicine practice, and it was acceptable to patients. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research and Ontario Women's Health Council.
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Affiliation(s)
- Farah Ahmad
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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