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Dyal BW, Yoon SL, Powell-Roach KL, Li D, Kittelson S, Weaver M, Krieger JL, Wilkie DJ. Perceptions of Palliative Care: Demographics and Health Status Among the General Population in Florida and the United States. Am J Hosp Palliat Care 2024; 41:363-372. [PMID: 37379569 PMCID: PMC10783876 DOI: 10.1177/10499091231186819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Palliative care (PC) helps maintain quality of life for seriously ill patients, yet, many Americans lack knowledge of PC. AIM To explore the relationships between knowledge of PC of individuals living in north-central Florida and throughout the United States. DESIGN This cross-sectional survey with three sampling approaches, one was a community-engaged sample and two were panel respondent samples. Respondents and setting: Respondents of the Florida sample (n1 = 329) and the community-engaged sample (n2 = 100), were representative of the 23 Florida county general population. Respondents of the national sample (n = 1800) were adult members of a panel owned by a cloud-based survey platform. RESULTS Young adults compared with adults (OR 1.62, 95% CI 1.14-2.28, P .007), middle-adults (OR 2.47, 95% CI 1.58-3.92, P < .001) and older-adults (OR 3.75, 95% CI 2.50-5.67, P < .001) were less likely to agree that the goal of PC is to help friends and family cope with a patient's illness, and that the goal of PC is to manage pain and other physical symptoms compared with adults (OR 1.67, 95% CI 1.20-2.30, P .002) middle-adults (OR 2.58, 95% CI 1.71-3.95, P < .001) and older-adults (OR 7.19, 95% CI 4.68-11.2, P < .001). Participants with greater rural identity (OR 1.39, 95% CI 1.31-1.48, P < .001) were more likely to agree that accepting PC means giving up. CONCLUSIONS Increased knowledge of PC might be influenced through targeting educational interventions and educating the general population through social media use.
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Affiliation(s)
- Brenda W. Dyal
- Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Saunjoo L. Yoon
- Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Keesha L. Powell-Roach
- Department of Community and Population Health, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Derek Li
- University of Florida Health Science Center, University of Florida, Gainesville, FL, USA
| | - Sheri Kittelson
- Division of Palliative Care, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Michael Weaver
- Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Janice L. Krieger
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Diana J. Wilkie
- Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
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Paige SR, Krieger JL, Williams M, Salloum RG. Patient message preferences to promote clinical conversations about chronic obstructive pulmonary disease (COPD): A discrete choice experiment. PEC Innov 2023; 2:100168. [PMID: 37384164 PMCID: PMC10294043 DOI: 10.1016/j.pecinn.2023.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/21/2023] [Accepted: 05/21/2023] [Indexed: 06/30/2023]
Abstract
The purpose of this study was to identify message features that motivate patients to initiate clinical conversations about Chronic Obstructive Pulmonary Disease (COPD). A secondary aim was to determine whether preferred message features vary by socio-demographic and behavioral characteristics. A discrete choice experiment was conducted in August 2020. Participants were asked to select which messages would motivate them to speak with a clinician about COPD. This included selecting messages across 8 choice sets, or a systematic combination of messages reflecting 6 attributes (e.g., susceptibility, call-to-action, emotion-frame, efficacy, message source, organizational support). The final sample was 928, which included adults (M = 62.07; SD = 10.14 years old) who identified as non-Hispanic, white, and with at least some college experience. Message attributes ranked from most to least important were COPD susceptibility (25.53% [95% CI = 24.39, 26.66]), message source (19.32% [95% CI = 18.41-20.24]), COPD organization logo (19.13%; [95% CI = 18.26, 20.01]), call-to-action (14.12%; [95% CI = 13.40, 14.85], emotion-frame (13.24% [95% CI = 12.55-13.94]), and efficacy (8.65%; [95% CI = 8.20-9.09]). Participants preferred susceptibility messages about COPD signs/symptoms rather than risk behaviors related to smoking tobacco and environmental exposures. They also preferred messages from medical authorities (i.e., clinicians, COPD organization), a call-to-action that supports their autonomy in screening decision-making, and a message that conveys hope for living a healthy life with COPD and builds their self-efficacy to get screened. Differences in message preferences were detected according to age, gender, race, ethnicity, education level, and current vs. former smoking status. This study identified message features that motivate clinical conversations about COPD, especially those from subgroups who are disproportionately at-risk for its late-stage diagnosis.
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Affiliation(s)
- Samantha R. Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
- Health & Wellness Solutions, Johnson & Johnson Services, Inc., New Brunswick, NJ 08933, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA
| | - Maribeth Williams
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
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Vilaro MJ, Bryan E, Palani T, Cooks EJ, Mertens G, Zalake M, Lok BC, Krieger JL. Rural adults' perceptions of nutrition recommendations for cancer prevention: Contradictory and conflicting messages. Prev Oncol Epidemiol 2023; 1:2237680. [PMID: 38390218 PMCID: PMC10883477 DOI: 10.1080/28322134.2023.2237680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Despite robust evidence linking alcohol, processed meat, and red meat to colorectal cancer (CRC), public awareness of nutrition recommendations for CRC prevention is low. Marginalized populations, including those in rural areas, experience high CRC burden and may benefit from culturally tailored health information technologies. This study explored perceptions of web-based health messages iteratively in focus groups and interviews with 48 adults as part of a CRC prevention intervention. We analyzed transcripts for message perceptions and identified three main themes with subthemes: (1) Contradictory recommendations, between the intervention's nutrition risk messages and recommendations for other health conditions, from other sources, or based on cultural or personal diets; (2) reactions to nutrition risk messages, ranging from aversion (e.g., "avoid alcohol" considered "preachy") to appreciation, with suggestions for improving messages; and (3) information gaps. We discuss these themes, translational impact, and considerations for future research and communication strategies for delivering web-based cancer prevention messages.
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Affiliation(s)
| | - Emma Bryan
- STEM Translational Communication Center, University of Florida
| | - Te Palani
- STEM Translational Communication Center, University of Florida
| | - Eric J Cooks
- STEM Translational Communication Center, University of Florida
| | - Gillian Mertens
- STEM Translational Communication Center, University of Florida
- Literacy Department, SUNY Cortland
| | - Mohan Zalake
- Computer and Information Sciences and Engineering, University of Florida
| | - Benjamin C Lok
- Computer and Information Sciences and Engineering, University of Florida
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4
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Hecht ML, Jayawardene W, Henderson C, Pezalla A, Flood-Grady E, Krieger JL, Frederick A, Parker M, Ables E. Developing the Opioid Rapid Response System™ for Lay Citizen Response to the Opioid Overdose Crisis: a Randomized Controlled Trial. Prev Sci 2023; 24:1386-1397. [PMID: 37737966 DOI: 10.1007/s11121-023-01588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
Emergency responders face challenges in arriving timely to administer naloxone in opioid overdoses. Therefore, interest in having lay citizens administer naloxone nasal spray has emerged. These citizens, however, must be recruited and trained, and be in proximity to the overdose. This study aimed to develop the Opioid Rapid Response System (ORRS)tm to meet this need by developing a system to recruit and train citizen responders and evaluate outcomes in a randomized clinical trial. ORRS recruitment messages and training platform were developed iteratively and then outcomes for each were evaluated in a randomized, unblinded two-arm waitlist-controlled trial. ORRS was field tested in 5 Indiana counties, recruiting adult citizen responders (age 18 or older) who did not self-identity as a certified first responder. Participants were recruited using either personal or communal messages and then randomly assigned to online naloxone training and waitlisted-control conditions. Pre- and post-surveys were administered online to measure the exposure to recruitment messages and training effects on knowledge of opioid overdose, confidence responding, concerns about responding, and intent to respond. Of the 220 randomized participants (114 training, 106 waitlisted-control), 140 were analyzed (59 training, 81 waitlisted-control). Recruited participants more frequently identified with communal appeal than with the personal appeal (chi-square = 53.5; p < 0.0001). Between-group differences for intervention effects were significant for knowledge of overdose signs (Cohen's d = 1.17), knowledge of overdose management (d = 1.72), self-efficacy (d = 1.39), and concerns (d = 1.31), but not for intent (d = 0.17), which suffered from a ceiling effect. ORRS provides stronger support for efficacy than that reported for other training interventions and the digital modality eases rapid dissemination.Trial Registration: NCT04589676.
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Affiliation(s)
| | - Wasantha Jayawardene
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA.
| | - Cris Henderson
- Prevention Insights, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
| | | | - Elizabeth Flood-Grady
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Amy Frederick
- Prevention Insights, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
| | - Maria Parker
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
| | - Erin Ables
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, Bloomington, IN, USA
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5
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Raisa A, Roberto AJ, Love RR, Steiness HLS, Salim R, Krieger JL. Pot Song as a Novel Cancer Communication Intervention: Lessons Learned from Developing, Implementing, and Evaluating a Culturally Grounded Intervention for Breast Cancer Education in Rural Bangladesh. J Cancer Educ 2023; 38:260-273. [PMID: 34850340 PMCID: PMC9852156 DOI: 10.1007/s13187-021-02111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 06/13/2023]
Abstract
Targeted public education may offer an approach to achieving more effective treatment in countries like Bangladesh, where breast cancer is a leading cause of cancer death in women. Effective cancer education interventions address the target population's cultural and contextual needs. However, there is little published literature to guide the development of educational cancer interventions in a region where lack of resources combined with cultural stigma about cancer contribute to poor breast health outcomes for women. The goal of the current study was to design, test, and evaluate a culturally grounded intervention to promote breast problem care among women in rural Bangladesh. The current manuscript first describes the process of formative evaluation that led to the development of the intervention, including decisions about the audience, message construction, and mode of intervention delivery. Second, we describe the testing process, including process and outcome evaluation. Finally, we describe the lessons learned from the process. We conclude with recommendations related to cultural grounding for message development, questionnaire design, data collection procedures, and analysis.
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Vilaro MJ, McAlindon K, Mertens G, Ashley T, Zalake M, Cooks EJ, Krieger JL. Information Architects: Using Community-Engaged and Qualitative Methods to Design a Technology-Based Nutrition and Cancer Risk Intervention for Rural Adults. Cancer Control 2023; 30:10732748221130162. [PMID: 36919704 PMCID: PMC10017944 DOI: 10.1177/10732748221130162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Nearly half of all cancer deaths are preventable through modification or avoidance of key risk factors. As such, there is a growing urgency to identify effective, low-resource, and scalable technologies that support clinical care and patient self-management of health behaviors. PURPOSE Informed by theories of cognitive load and user-centered design approaches, we develop a culturally tailored, multicomponent digital intervention to engage rural adults between 50-73 years old with their personalized nutrition risk factors for colorectal cancer (CRC) prevention. METHOD A total of 48 adults tested a Virtual Health Assistant (VHA) prototype during focus groups in individual think-aloud interviews to facilitate iterative adaptations to a web-based CRC prevention intervention. Qualitative data was analyzed to identify user needs and preferences related to information and with a focus on avoiding cognitive overload. RESULTS The VHA serves as a conceptual pre-training for users helping them understand CRC prevention key concepts and engendering motivation to act on the promoted behavior. A website was identified as a strategy to fill information gaps and present actionable information, after the VHA interaction. Cognitive load reducing strategies were used including segmenting where information is presented in learner-controlled segments rather than continuously. CONCLUSIONS Findings indicate potential benefits of designing CRC prevention information technologies with the rural older adults. Integrating patient-centered needs before launching health information web content will be important as the rapid growth of telemedicine aims to reach traditionally marginalized and underserved populations. Theoretically informed considerations for potential adverse outcomes (eg, information overload) are discussed.
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Affiliation(s)
- Melissa J. Vilaro
- Department of Family, Youth and Community Sciences, University of Florida, Gainesville, FL, USA
- Melissa J. Vilaro, PhD, MPH, Institute of Food and Agricultural Sciences, Department of Family, Youth and Community Sciences, University of Florida, PO Box 110310, Gainesville, FL 32611-310, USA.
| | - Kathryn McAlindon
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Gillian Mertens
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Taylor Ashley
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Mohan Zalake
- Computer & Information Sciences & Engineering, University of Florida, Gainesville, FL, USA
| | - Eric J. Cooks
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
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7
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Reams RR, Odedina FT, Carpten JD, Redda K, Stern MC, Krieger JL, Aparicio J, Hensel B, Askins N, Abreu A, Adams A, Agyare E, Ali J, Allen JM, Aló R, Baezconde-Garbanati L, Brant J, Brown CP, Buxbaum SG, Cohen P, Cozen W, Ezenwa MO, Falzarano S, Fillingim RB, Flores-Rozas H, Fredenburg KM, George T, Han B, Huang Y, Hughes Halbert C, Kiros GE, Lamango NS, Lee JH, Lyon DE, Mitchell DA, Mochona B, Nieva JJ, Offringa IA, Okunieff P, Parker A, Rhie SK, Richey JM, Rogers SC, Salhia B, Schmittgen TD, Segal R, Setiawan VW, Smith U, Su LM, Suther S, Trevino J, Velazquez-Villarreal EI, Webb FJ, Wu AH, Yao Y, Wilkie DJ. Florida-California Cancer Research, Education and Engagement (CaRE 2) Health Equity Center: Structure, Innovations, and Initial Outcomes. Cancer Control 2023; 30:10732748231197878. [PMID: 37703814 PMCID: PMC10501072 DOI: 10.1177/10732748231197878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/21/2023] [Accepted: 08/03/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION The Florida-California Cancer Research, Education, and Engagement (CaRE2) Health Equity Center is a triad partnership committed to increasing institutional capacity for cancer disparity research, the diversity of the cancer workforce, and community empowerment. This article provides an overview of the structure, process innovations, and initial outcomes from the first 4 years of the CaRE2 triad partnership. METHODS CaRE2 serves diverse populations in Florida and California using a "molecule to the community and back" model. We prioritize research on the complex intersection of biological, environmental, and social determinants health, working together with scientific and health disparities communities, sharing expertise across institutions, bidirectional training, and community outreach. Partnership progress and outcomes were assessed using mixed methods and four Program Steering Committee meetings. RESULTS Research capacity was increased through development of a Living Repository of 81 cancer model systems from minority patients for novel cancer drug development. CaRE2 funded 15 scientific projects resulting in 38 publications. Workforce diversity entailed supporting 94 cancer trainees (92 URM) and 34 ESIs (32 URM) who coauthored 313 CaRE2-related publications and received 48 grants. Community empowerment was promoted via outreaching to more than 3000 individuals, training 145 community cancer advocates (including 28 Community Scientist Advocates), and publishing 10 community reports. CaRE2 members and trainees together have published 639 articles, received 61 grants, and 57 awards. CONCLUSION The CaRE2 partnership has achieved its initial aims. Infrastructure for translational cancer research was expanded at one partner institution, and cancer disparities research was expanded at the two cancer centers.
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Affiliation(s)
- R. Renee Reams
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | | | - John D. Carpten
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Kinfe Redda
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Mariana C. Stern
- Departments of Population and Public Health Sciences, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Janice L. Krieger
- Department of Advertising, University of Florida, Gainesville, FL, USA
| | - Jose Aparicio
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Brooke Hensel
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Nissa Askins
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Andre Abreu
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Angela Adams
- Department of Pharmaceutics, University of Florida, Gainesville, FL, USA
| | - Edward Agyare
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Jamel Ali
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
- Department of Chemical and Biomedical Engineering, Florida State University, Tallahassee, FL, USA
| | - John M. Allen
- Department of Pharmacotherapy & Translational Research, University of Florida, Orlando, FL, USA
| | - Richard Aló
- College of Science and Technology, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Lourdes Baezconde-Garbanati
- Departments of Population and Public Health Sciences, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason Brant
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Clyde P. Brown
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Sarah G. Buxbaum
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Pinchas Cohen
- University of Southern California Leonard Davis School of Gerontology, Los Angeles, CA, USA
| | - Wendy Cozen
- Division of Hematology/Oncology, School of Medicine, University of California, Irvine, CA, USA
| | - Miriam O. Ezenwa
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Sara Falzarano
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B. Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Hernan Flores-Rozas
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Kristianna M. Fredenburg
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas George
- Department of Medicine in the College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bo Han
- Departments of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Yong Huang
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, USA
| | - Chanita Hughes Halbert
- Departments of Population and Public Health Sciences, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Gebre-Egziabher Kiros
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Nazarius S. Lamango
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Debra E. Lyon
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Duane A. Mitchell
- Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Bereket Mochona
- Department of Chemistry, Florida Agricultural and Mechanical University, Tallahassee, FL USA
| | - Jorge J. Nieva
- Department of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ite A. Offringa
- Departments of Surgery, University of Southern California, Los Angeles, CA, USA
- Department of Biochemistry and Molecular Medicine, University of Southern California, Los Angeles, CA, USA
| | - Paul Okunieff
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Alexander Parker
- College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Suhn K. Rhie
- Department of Biochemistry and Molecular Medicine, University of Southern California, Los Angeles, CA, USA
| | - Joyce M. Richey
- Department of Clinical Physiology and Neuroscience, University of Southern California, Los Angeles, CA, USA
| | - Sherise C. Rogers
- Department of Medicine in the College of Medicine, University of Florida, Gainesville, FL, USA
| | - Bodour Salhia
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | | | - Richard Segal
- Department of Pharmaceutical Outcome and Policy, University of Florida, Gainesville, FL, USA
| | | | - Ukamaka Smith
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Li-Ming Su
- Department of Urology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sandra Suther
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida Agricultural and Mechanical University, Tallahassee, FL, USA
| | - Jose Trevino
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Fern J. Webb
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Anna H. Wu
- Department of Translational Genomics, University of Southern California, Los Angeles, CA, USA
| | - Yingwei Yao
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
| | - Diana J. Wilkie
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL, USA
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Cooks EJ, Vilaro MJ, Dyal BW, Wang S, Mertens G, Raisa A, Kim B, Campbell-Salome G, Wilkie DJ, Odedina F, Johnson-Mallard V, Yao Y, Krieger JL. What did the pandemic teach us about effective health communication? Unpacking the COVID-19 infodemic. BMC Public Health 2022; 22:2339. [PMID: 36514047 PMCID: PMC9747260 DOI: 10.1186/s12889-022-14707-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The spread of unvetted scientific information about COVID-19 presents a significant challenge to public health, adding to the urgency for increased understanding of COVID-19 information-seeking preferences that will allow for the delivery of evidence-based health communication. This study examined factors associated with COVID-19 information-seeking behavior. METHODS An online survey was conducted with US adults (N = 1800) to identify key interpersonal (e.g., friends, health care providers) and mediated (e.g., TV, social media) sources of COVID-19 information. Logistic regression models were fitted to explore correlates of information-seeking. RESULTS Study findings show that the first sought and most trusted sources of COVID-19 information had different relationships with sociodemographic characteristics, perceived discrimination, and self-efficacy. Older adults had greater odds of seeking information from print materials (e.g., newspapers and magazines) and TV first. Participants with less educational attainment and greater self-efficacy preferred interpersonal sources first, with notably less preference for mass media compared to health care providers. Those with more experiences with discrimination were more likely to seek information from friends, relatives, and co-workers. Additionally, greater self-efficacy was related to increased trust in interpersonal sources. CONCLUSION Study results have implications for tailoring health communication strategies to reach specific subgroups, including those more vulnerable to severe illness from COVID-19. A set of recommendations are provided to assist in campaign development.
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Affiliation(s)
- Eric J. Cooks
- grid.15276.370000 0004 1936 8091STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Weimer Hall 2043, PO Box 118400, Gainesville, FL 32611-8400 USA
| | - Melissa J. Vilaro
- grid.15276.370000 0004 1936 8091Department of Family, Youth, and Community Sciences, University of Florida, Gainesville, USA
| | - Brenda W. Dyal
- grid.15276.370000 0004 1936 8091Department of Biobehavioral Nursing Science, University of Florida, Gainesville, USA
| | - Shu Wang
- grid.15276.370000 0004 1936 8091Department of Biostatistics, University of Florida, Gainesville, USA
| | - Gillian Mertens
- grid.15276.370000 0004 1936 8091STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Weimer Hall 2043, PO Box 118400, Gainesville, FL 32611-8400 USA
| | - Aantaki Raisa
- grid.15276.370000 0004 1936 8091STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Weimer Hall 2043, PO Box 118400, Gainesville, FL 32611-8400 USA
| | - Bumsoo Kim
- grid.444004.00000 0004 0647 1620Department of Media and Communication, Joongbu University, Geumsan, South Korea
| | - Gemme Campbell-Salome
- grid.280776.c0000 0004 0394 1447Department of Population Health Sciences, Geisinger, Danville, USA
| | - Diana J. Wilkie
- grid.15276.370000 0004 1936 8091Department of Biobehavioral Nursing Science, University of Florida, Gainesville, USA
| | - Folake Odedina
- grid.417467.70000 0004 0443 9942Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, USA
| | | | - Yingwei Yao
- grid.15276.370000 0004 1936 8091Department of Biobehavioral Nursing Science, University of Florida, Gainesville, USA
| | - Janice L. Krieger
- grid.15276.370000 0004 1936 8091STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Weimer Hall 2043, PO Box 118400, Gainesville, FL 32611-8400 USA
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9
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Lee DN, Hutchens MJ, George TJ, Wilson-Howard D, Cooks EJ, Krieger JL. Do they speak like me? Exploring how perceptions of linguistic difference may influence patient perceptions of healthcare providers. Med Educ Online 2022; 27:2107470. [PMID: 35912473 PMCID: PMC9347466 DOI: 10.1080/10872981.2022.2107470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/21/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
The increased utilization of telehealth has provided patients with the opportunity to interact with racially diverse healthcare providers (HCPs). While evidence of racial stereotypes in healthcare is well documented, less is known about whether linguistic cues increase or decrease racial bias in healthcare interactions. The purpose of this pilot study was to use virtual clinicians (VCs) to examine how varying linguistic features affect patient perceptions of Black-identifying HCPs. Participants (N = 282) were recruited to participate in an online pilot study using a two-arm posttest-only experimental design. Participants were randomly assigned to interact with a Black VC that used vocal cues associated with either Standard American English (SAE) or African American English (AAE) on the topic of colorectal cancer. After the interaction, participants completed a posttest questionnaire. Resulting data were analyzed using mediation.
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Affiliation(s)
- Donghee N. Lee
- Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, Worcester, USA
| | - Myiah J. Hutchens
- Department of Public Relations, College of Journalism and Communications, University of Florida, Gainesville, USA
| | - Thomas J. George
- Department of Medicine, College of Medicine, University of Florida and University of Florida Health Cancer Center, Gainesville, USA
| | - Danyell Wilson-Howard
- Department of Natural Sciences, Bethune-Cookman University, Daytona Beach, USA
- STEM Translational Communication Center, University of Florida and University of Florida Health Cancer Center, Gainesville, USA
| | - Eric J. Cooks
- STEM Translational Communication Center, University of Florida and University of Florida Health Cancer Center, Gainesville, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, University of Florida and University of Florida Health Cancer Center, Gainesville, USA
- Department of Advertising, College of Journalism and Communications, Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, USA
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10
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Cooks EJ, Duke KA, Flood-Grady E, Vilaro MJ, Ghosh R, Parker N, Te P, George TJ, Lok BC, Williams M, Carek P, Krieger JL. Can virtual human clinicians help close the gap in colorectal cancer screening for rural adults in the United States? The influence of rural identity on perceptions of virtual human clinicians. Prev Med Rep 2022; 30:102034. [PMID: 36531088 PMCID: PMC9747643 DOI: 10.1016/j.pmedr.2022.102034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022] Open
Abstract
Rural adults experience disparities in colorectal cancer screening, a trend even more distinct among rural Black adults. Healthcare disruptions caused by COVID-19 exacerbated inequities, heightening attention on virtual communication strategies to increase screening. Yet little is known about how rural adults perceive virtual human clinicians (VHCs). Given that identifying as rural influences perceived source credibility often through appearance judgments, the goal of this pilot was to explore how to develop VHCs that individuals highly identified with rurality find attractive. Between November 2018 and April 2019, we tested a culturally tailored, VHC-led telehealth intervention delivering evidence-based colorectal cancer prevention education with White and Black adults (N = 2079) in the United States recruited through an online panel who were non-adherent to screening guidelines and between 50 and 73 years of age. Participants were randomized on three factors (VHC race-matching, VHC gender-matching, Intervention type). Ordinal logistic regression models examined VHC appearance ratings. Participants with a high rural identity (AOR = 1.12, CI = [1.02, 1.23], p =.02) rated the VHCs more attractive. High rural belonging influenced VHC attractiveness for Black participants (AOR = 1.22, CI = [1.03, 1.44], p =.02). Also, Black participants interacting with a Black VHC and reporting high rural self-concept rated the VHC as more attractive (AOR = 2.22, CI = [1.27, 3.91], p =.01). Findings suggest adults for whom rural identity is important have more positive impressions of VHC attractiveness. For patients with strong rural identities, enhancing VHC appearance is critical to tailoring colorectal cancer prevention interventions.
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Affiliation(s)
- Eric J. Cooks
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA,Corresponding author.
| | - Kyle A. Duke
- Department of Statistics, North Carolina State University, USA
| | - Elizabeth Flood-Grady
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA
| | - Melissa J. Vilaro
- Department of Family, Youth, and Community Sciences, University of Florida, USA
| | - Rashi Ghosh
- Department of Computer & Information Science & Engineering, College of Engineering. University of Florida, USA
| | - Naomi Parker
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA
| | - Palani Te
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA
| | - Thomas J. George
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, USA
| | - Benjamin C. Lok
- Department of Computer & Information Science & Engineering, College of Engineering. University of Florida, USA
| | - Maribeth Williams
- Department of Community Health and Family Medicine, University of Florida, USA
| | - Peter Carek
- Department of Community Health and Family Medicine, University of Florida, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, USA
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11
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Vilaro MJ, Wilson-Howard DS, Neil JM, Tavassoli F, Zalake MS, Lok BC, Modave FP, George TJ, Odedina FT, Carek PJ, Mys AM, Krieger JL. A Subjective Culture Approach to Cancer Prevention: Rural Black and White Adults' Perceptions of Using Virtual Health Assistants to Promote Colorectal Cancer Screening. Health Commun 2022; 37:1123-1134. [PMID: 33876658 DOI: 10.1080/10410236.2021.1910166] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In the US, Black adults are less likely than White adults to be screened for colorectal cancer (CRC). This study uses a subjective culture approach to describe and compare perceptions of a CRC screening intervention delivered via virtual health assistants (VHAs) among rural Black and White study participants. We analyzed 28 focus groups with Black (n = 85) and White (n = 69) adults aged 50-73. Participants, largely recruited through community engagement efforts, tested the VHA intervention on mobile phones provided by the research team. Moderated discussions were recorded, transcribed, and analyzed using thematic analysis. All groups preferred the VHA to be friendly. Other important cues included trustworthiness, authority, and expertise. Black participants expressed a preference for receiving information about their CRC risk from the VHA compared with White adults. Black participants also expressed the importance of sharing the intervention and the CRC screening messages with younger members of their networks, including family members who could benefit from screening messages before reaching the recommended age for screening. The key similarities and differences between Black and White adults' perceptions of the intervention that were identified in this study can help inform future efforts to develop effective communication strategies and reduce cancer screening inequities.
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Affiliation(s)
| | | | - Jordan M Neil
- Health Policy Research Center, Department of Medicine, Harvard Medical School
| | | | - Mohan S Zalake
- Computer & Information Science & Engineering, University of Florida
| | - Benjamin C Lok
- Computer & Information Science & Engineering, University of Florida
| | | | | | | | - Peter J Carek
- Community Health & Family Medicine, University of Florida
| | - Aubrey M Mys
- STEM Translational Communication Center, University of Florida
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12
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Neil JM, Parker ND, Levites Strekalova YA, Duke K, George T, Krieger JL. Communicating risk to promote colorectal cancer screening: a multi-method study to test tailored versus targeted message strategies. Health Educ Res 2022; 37:79-93. [PMID: 35234890 PMCID: PMC8947791 DOI: 10.1093/her/cyac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 05/06/2023]
Abstract
Colorectal cancer (CRC) screening rates are suboptimal, partly due to poor communication about CRC risk. More effective methods are needed to educate patients, but little research has examined best practices for communicating CRC risk. This multi-method study tests whether tailoring CRC risk information increases screening intentions. Participants (N = 738) were randomized with a 2:2:1 allocation to tailored, targeted, and control message conditions. The primary outcome was intention to screen for CRC (yes/no). Additional variables include perceived message relevance, perceived susceptibility to CRC, and free-text comments evaluating the intervention. A chi-square test determined differences in the proportion of participants who intended to complete CRC screening by condition. A logistic-based path analysis explored mediation. Free-text comments were analyzed using advanced topic modeling analysis. CRC screening intentions were highest in the tailored intervention and significantly greater than control (P = 0.006). The tailored message condition significantly increased message relevance compared with control (P = 0.027) and targeted conditions (P = 0.002). The tailored condition also increased susceptibility (P < 0.001) compared with control, which mediated the relationship between the tailored condition and intention to screen (b = 0.04, SE = 0.02, 95% confidence interval = 0.02, 0.09). The qualitative data reflect similar trends. The theoretical mechanisms and practical implications of tailoring health education materials about CRC risk are discussed.
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Affiliation(s)
| | - Naomi D Parker
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, 2043 Weimer Hall, Gainesville, FL 32611, USA
| | - Yulia A Levites Strekalova
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, 2043 Weimer Hall, Gainesville, FL 32611, USA
| | - Kyle Duke
- Department of Statistics, North Carolina State University, 2311 Stinson Drive, 5109 SAS Hall, Raleigh, NC 27695, USA
| | - Thomas George
- Department of Medicine, Hematology & Oncology, College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, 2043 Weimer Hall, Gainesville, FL 32611, USA
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13
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Dyal BW, Uscanga ZL, Bailey Z, Schmit S, Hoehn A, Garcia J, Gwede CK, Brownstein N, Powell-Roach K, Johnson-Mallard V, Krieger JL, Kobetz E, Vadaparampil S, Odedina FT, Wilkie DJ. Developing the Florida Academic Cancer Center Alliance Health Disparities Common Measure: The Florida Health and Ancestry Survey. Cancer Control 2022; 29:10732748221110897. [PMID: 35758601 PMCID: PMC9244925 DOI: 10.1177/10732748221110897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose Our specific aim was to develop and assess the consensus-based validity of common measures for understanding health behaviors and ancestry in Florida’s population subgroups and establish the feasibility of wide-scale implementation of the measures and biospecimen collection within three cancer centers’ catchment areas. Methods Using the National Cancer Institute’s Grid-Enabled Measures web-based platform and an iterative process, we developed the Florida Health and Ancestry Survey (FHAS). We then used three sampling approaches to implement the FHAS: community-engaged, panel respondent, and random digit dialing (RDD). We asked a subset of participants to provide a saliva sample for future validation of subjective ancestry report with DNA-derived ancestry markers. Results This process supported the FHAS content validity. As an indicator of feasibility, the goals for completed surveys by sampling approach were met for two of the three cancer centers, yielding a total of 1438 completed surveys. The RDD approach produced the most representative sample. The panel sampling approach produced inadequate representation of older individuals and males. The community-engaged approach along with social media recruitment produced extreme underrepresentation only for males. Two of the cancer centers mailed biospecimen kits, whereas one did not due to resource constraints. On average, the community engaged approach was more productive in obtaining returned biospecimen samples (80%) than the panel approach (48%). Conclusions We successfully developed and implemented the FHAS as a common measure to show its feasibility for understanding cancer health disparities in Florida. We identified sampling approach successes and challenges to obtaining biospecimens for ancestry research.
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Affiliation(s)
- Brenda W Dyal
- College of Nursing, Department of Biobehavioral Nursing Science, 3463University of Florida, Gainesville, FL, USA
| | - Zulema L Uscanga
- The Office of Community Outreach, Engagement and Equity, 25301Moffitt Cancer Center, Tampa, FL, USA
| | - Zinzi Bailey
- University of Miami Miller School of Medicine, Miami, FL, and Division of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, 33315Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Stephanie Schmit
- Cleveland Clinic, Genomic Medicine Institute, Cleveland, OH, US and (2) Population and Cancer Prevention Program, Case Comprehensive Cancer Center, 196246Cleveland Clinic, Genomic Medicine Institute, Cleveland, OH, USA
| | - Alina Hoehn
- Department of Cancer Epidemiology, 25301Moffitt Cancer Center, Tampa, FL, USA
| | - Jennifer Garcia
- Department of Health Outcomes & Behaviors, Moffitt Cancer Center, Tampa, FL, USA
| | - Clement K Gwede
- Department of Health Outcomes & Behaviors, Moffitt Cancer Center, Tampa, FL, USA
| | - Naomi Brownstein
- Department of Biostatistics and Bioinformatics, 25301Moffitt Cancer Center, Tampa, FL, USA
| | - Keesha Powell-Roach
- College of Nursing, Department of Biobehavioral Nursing Science, Gainesville, FL, USA and University of Tennessee Health Science Center, Department of Health Promotion and Disease Prevention, 3463University of Florida, Memphis, TN, USA
| | - Versie Johnson-Mallard
- College of Nursing, Department of Family, Community and Health System Science, 3463University of Florida, Gainesville, Florida, USA
| | - Janice L Krieger
- STEM Translational Communication Center, 3463University of Florida, Gainesville, FL, USA
| | - Erin Kobetz
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, and Division of Medical Oncology, Department of Medicine, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susan Vadaparampil
- Moffitt Cancer Center, The Office of Community Outreach, Engagement and Equity, Tampa, FL, USA.,Moffitt Cancer Center, Department of Health Outcomes & Behaviors, Moffitt Cancer Center, Tampa, FL, USA
| | - Folakemi T Odedina
- Moffitt Cancer Center, Department of Health Outcomes & Behaviors, Moffitt Cancer Center, Tampa, FL, USA
| | - Diana J Wilkie
- College of Nursing, Department of Biobehavioral Nursing Science, 3463University of Florida, Gainesville, FL, USA
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14
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Reed T, Gordon D, Dyal BW, Powell-Roach K, Ezenwa MO, Johnson-Mallard V, Krieger JL, Odedina FT, Yao Y, Wilkie DJ. Abstract PO-012: Demographic factors and rural residence history associated with smoking history. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: Smoking rates are higher in rural regions compared to urban regions. Given the mobility within the United States, rural norms around tobacco use may persist even after individuals move to urban areas. Little research is available regarding the difference in smoking history by demographics and rural residence history. The purpose of the study was to examine the influence of age, race, gender, and rural residence history on smoking history. Methods: In a cross-sectional study, we surveyed 1,786 adults using two sampling approaches: representative panels and a community-engaged sample. Participants were asked to complete the Florida Health and Ancestry Study (FHAS) survey through a link or by the phone with a research assistant. The smoking history question asked whether participants had smoked 100 cigarettes in their lifetime (yes/no). The rural residence question asked participants to indicate (yes/no) whether they have lived in a rural or farming community, or on a farm. We examined associations of smoking history with demographic variables using the Chi-square test and logistic regression including as predictors age group (young=18-30, middle age=31-50, old=51+ years), gender, race, and rural living by gender. Results: Participants were mostly White (16% Black, 84% White), female (47% male) and with a mean age around 50 years (mean 47.9±17.5 years, ranged 18 to 91). 36% of the sample reported a history of rural residence, and 51% reported that they had not smoked 100 cigarettes in their lifetime. A larger proportion of males (61%) smoked at least 100 cigarettes compared to females (37%) (p<.001). A significantly larger proportion of White participants (50%) smoked at least 100 cigarettes in their lifetime than Black participants (39%) (p=.001). A larger proportion of participants who had lived in a rural place (53%) had smoked at least 100 cigarettes compared to those who had not lived in a rural place (46%) (p=.005). Difference in mean age for those with or without a history of smoking 100 cigarettes was not statistically significant in this sample (p=.12). Logistic regression analysis revealed that relative to the old age group, the young age group was less likely (p<.001) and the middle age group was more likely (p=.002) to have smoked 100 cigarettes. Males (p<.001) were more likely to have smoked 100 cigarettes than females. Rural residence was associated with smoking among females (p<.001) but not among males (p=.70). Adjusting for other predictors, the association with race was not statistically significant in this sample (p=.06). Conclusion: Findings that the age group 18-30 years is more likely to have avoided becoming smokers is encouraging but must be analyzed more thoroughly relative to possible use of e-cigarettes and other tobacco products. To reduce individuals becoming smokers, we recommend increased cancer control efforts targeted to males in general and to females with a rural residence history. Additional research is planned to examine additional smoking variables and compare them to national data.
Citation Format: Tyra Reed, Destiny Gordon, Brenda W. Dyal, Keesha Powell-Roach, Miriam O. Ezenwa, Versie Johnson-Mallard, Janice L. Krieger, Folakemi T. Odedina, Yingwei Yao, Diana J. Wilkie. Demographic factors and rural residence history associated with smoking history [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-012.
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Affiliation(s)
- Tyra Reed
- 1University of Florida, Gainesville, FL,
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15
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Flood-Grady E, Solberg LB, Baralt C, Meyer M, Stevens J, Krieger JL. Engaging Institutional Stakeholders to Develop and Implement Guidelines for Recruiting Participants in Research Studies Using Social Media: Mixed Methods, Multi-Phase Process. J Med Internet Res 2021; 23:e23312. [PMID: 34623319 PMCID: PMC8538033 DOI: 10.2196/23312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/24/2020] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Limited regulatory guidance surrounding the use of social media channels for participant recruitment is an interdisciplinary challenge. Establishing stakeholder-informed procedures is essential for ethical and effective use of social media for participant recruitment. Objective This study aims to provide replicable procedures for developing and implementing guidelines for using social media to recruit participants in research studies. Methods Social media use cases at the university were used to identify institutional stakeholders for the initiative. After establishing workflow procedures, a scoping review of web-based materials about recruitment and research on the internet and social media from 19 peer institutions and 2 federal agencies was conducted to inform the structure of the policies and procedures. End users (investigators and study coordinators; N=14) also provided feedback on the policies and procedures and implementation. Results Representatives (n=7) from 5 institutional offices and 15 subject-matter experts from 5 areas were identified as stakeholders in the development of policies and procedures. Peers with web-based materials (n=16) identified in the scoping review revealed 4 themes that served as a basis for developing our policies and procedures. End user feedback further informed the policies and procedures and implementation. A centrally managed social media account for communicating with participants and hosting advertising campaigns on social media was also established and, when combined with the policies and procedures, resulted in 39 advertising campaigns, and 2846 participants were enrolled in health and clinical research studies. Conclusions Our policies and procedures allow research teams to harness the potential of social media to increase study recruitment and participation; the transparent, stakeholder-informed process can be replicated by institutional administrators to establish policies and procedures that meet the interests and needs of their research community.
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Affiliation(s)
- Elizabeth Flood-Grady
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States.,Clinical Translational Science Institute, University of Florida, Gainesville, FL, United States
| | - Lauren B Solberg
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, United States
| | - Claire Baralt
- University of Florida Health, University of Florida, Gainesville, FL, United States
| | - Meghan Meyer
- Clinical Translational Science Institute, University of Florida, Gainesville, FL, United States
| | - Jeff Stevens
- University of Florida Health Web Services, Communications & Information Technology, University of Florida, Gainesville, FL, United States
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States.,Clinical Translational Science Institute, University of Florida, Gainesville, FL, United States
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16
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Wilson-Howard D, Vilaro MJ, Neil JM, Cooks EJ, Griffin LN, Ashley TT, Tavassoli F, Zalake MS, Lok BC, Odedina FG, Modave F, Carek PJ, George TJ, Krieger JL. The development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Applications for and by Black Men: A Qualitative Study. JMIR Form Res 2021; 5:e28709. [PMID: 34780346 PMCID: PMC8751682 DOI: 10.2196/28709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 10/06/2021] [Indexed: 01/06/2023] Open
Abstract
Background Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one’s home. Objective The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user’s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established. The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor,” and participants stated “wanting to interact with ALEX over their regular doctor.” Conclusions Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men.
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Affiliation(s)
- Danyell Wilson-Howard
- Department of Natural Sciences, Bethune Cookman University, 640 Mary McLeod Blvd., Daytona, US.,STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US
| | - Melissa J Vilaro
- STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US
| | - Jordan M Neil
- Harvard Medical School, Haarvard University, Boston, US.,Mongan Institute's Health Policy Research Center, Massachusetts General Hospital, Boston, US
| | - Eric J Cooks
- STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US.,Health Cancer Center, University of Florida, Gainesville, US
| | - Lauren N Griffin
- STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US
| | - Taylor T Ashley
- Department of Natural Sciences, Bethune Cookman University, 640 Mary McLeod Blvd., Daytona, US
| | - Fatemeh Tavassoli
- Computer and Information Science and Engineering, University of Florida, Gainesville, US
| | - Mohan S Zalake
- Computer and Information Science and Engineering, University of Florida, Gainesville, US
| | - Benjamin C Lok
- Computer and Information Science and Engineering, University of Florida, Gainesville, US
| | - Folakemi G Odedina
- College of Pharmacy, University of Florida, Gainesville, US.,College of Medicine, University of Florida, Gainesville, US
| | - Francois Modave
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Floridal, Gainesville, US
| | - Peter J Carek
- Familly Medicine, University of Florida, Gainesville, US
| | - Thomas J George
- Gastrointestinal (GI) Oncology Center, University of Florida, Gainesville, US.,UF Health Medical Oncology - Davis Cancer, University of Florida, Gainesville, US
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism, University of Florida, Gainesville, US.,UF Health Cancer Center, University of Florida, Gainesville, US
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17
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Krieger JL, Neil JM, Duke KA, Zalake MS, Tavassoli F, Vilaro MJ, Wilson-Howard DS, Chavez SY, Laber EB, Davidian M, George TJ, Modave FP, Odedina FT, Lok BC. A Pilot Study Examining the Efficacy of Delivering Colorectal Cancer Screening Messages via Virtual Health Assistants. Am J Prev Med 2021; 61:251-255. [PMID: 33888362 DOI: 10.1016/j.amepre.2021.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/03/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Patients are more likely to complete colorectal cancer screening when recommended by a race-concordant healthcare provider. Leveraging virtual healthcare assistants to deliver tailored screening interventions may promote adherence to colorectal cancer screening guidelines among diverse patient populations. The purpose of this pilot study is to determine the efficacy of the Agent Leveraging Empathy for eXams virtual healthcare assistant intervention to increase patient intentions to talk to their doctor about colorectal cancer screening. It also examines the influence of animation and race concordance on intentions to complete colorectal cancer screening. METHODS White and Black adults (N=1,363) aged 50-73 years and not adherent to colorectal cancer screening guidelines were recruited from Qualtrics Panels in 2018 to participate in a 3-arm (animated virtual healthcare assistant, static virtual healthcare assistant, attention control) message design experiment. In 2020, a probit regression model was used to identify the intervention effects. RESULTS Participants assigned to the animated virtual healthcare assistant (p<0.01) reported higher intentions to talk to their doctor about colorectal cancer screening than participants assigned to the other conditions. There was a significant effect of race concordance on colorectal cancer screening intentions but only in the static virtual healthcare assistant condition (p=0.04). Participant race, age, trust in healthcare providers, health literacy, and cancer information overload were also significant predictors of colorectal cancer screening intentions. CONCLUSIONS Animated virtual healthcare assistants were efficacious compared with the static virtual healthcare assistant and attention control conditions. The influence of race concordance between source and participant was inconsistent across conditions. This warrants additional investigation in future studies given the potential for virtual healthcare assistant‒assisted interventions to promote colorectal cancer screening within guidelines.
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Affiliation(s)
- Janice L Krieger
- STEM Translational Communication Center, College of Journalism and Communication, University of Florida, Gainesville, Florida.
| | - Jordan M Neil
- Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Kyle A Duke
- Department of Statistical Science, Duke University, Raleigh, North Carolina
| | - Mohan S Zalake
- Department of Computer & Information Science & Engineering, College of Engineering, University of Florida, Gainesville, Florida
| | - Fatemeh Tavassoli
- Department of Computer & Information Science & Engineering, College of Engineering, University of Florida, Gainesville, Florida
| | - Melissa J Vilaro
- STEM Translational Communication Center, College of Journalism and Communication, University of Florida, Gainesville, Florida
| | | | - Sarah Y Chavez
- STEM Translational Communication Center, College of Journalism and Communication, University of Florida, Gainesville, Florida
| | - Eric B Laber
- Department of Statistical Science, Duke University, Raleigh, North Carolina
| | - Marie Davidian
- Department of Statistical Science, Duke University, Raleigh, North Carolina
| | - Thomas J George
- Division of Hematology & Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - François P Modave
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida
| | - Folakemi T Odedina
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida
| | - Benjamin C Lok
- Department of Computer & Information Science & Engineering, College of Engineering, University of Florida, Gainesville, Florida
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Vilaro MJ, Wilson-Howard DS, Zalake MS, Tavassoli F, Lok BC, Modave FP, George TJ, Odedina F, Carek PJ, Krieger JL. Key changes to improve social presence of a virtual health assistant promoting colorectal cancer screening informed by a technology acceptance model. BMC Med Inform Decis Mak 2021; 21:196. [PMID: 34158046 PMCID: PMC8218395 DOI: 10.1186/s12911-021-01549-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background Understanding how older, minoritized patients attend to cues when interacting with web-based health messages may provide opportunities to improve engagement with novel health technologies. We assess acceptance-promoting and acceptance-inhibiting cues of a web-based, intervention promoting colorectal cancer (CRC) screening with a home stool test among Black women. Materials and methods Focus group and individual interview data informed iterative changes to a race- and gender-concordant virtual health assistant (VHA). A user-centered design approach was used across 3 iterations to identify changes needed to activate cues described as important; such as portraying authority and expertise. Questionnaire data were analyzed using non-parametric tests for perceptions of cues. Analysis was guided by the Technology Acceptance Model. Results Perceptions of interactivity, social presence, expertise, and trust were important cues in a VHA-delivered intervention promoting CRC screening. Features of the web-based platform related to ease of navigation and use were also discussed. Participant comments varied across the 3 iterations and indicated acceptance of or a desire to improve source cues for subsequent iterations. We highlight the specific key changes made at each of three iterative versions of the interactive intervention in conjunction with user perception of changes. Discussion Virtual agents can be adapted to better meet patient expectations such as being a trustworthy and expert source. Across three evolving versions of a Black, VHA, cues for social presence were particularly important. Social presence cues helped patients engage with CRC screening messages delivered in this novel digital context. Conclusions When using a VHA to disseminate health information, cues associated with acceptability can be leveraged and adapted as needed for diverse audiences. Patient characteristics (age, identity, health status) are important to note as they may affect perceptions of a novel health technologies ease of use and relevancy according to the leading models.
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Affiliation(s)
- Melissa J Vilaro
- STEM Translational Communication Center (STCC), University of Florida, Weimer Hall 2043, PO Box 118400, Gainesville, FL, 32611, USA.
| | | | - Mohan S Zalake
- Computer and Information Science and Engineering, University of Florida, Gainesville, USA
| | - Fatemeh Tavassoli
- Computer and Information Science and Engineering, University of Florida, Gainesville, USA
| | - Benjamin C Lok
- Computer and Information Science and Engineering, University of Florida, Gainesville, USA
| | - François P Modave
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Thomas J George
- Hematology and Oncology, University of Florida, Gainesville, USA
| | - Folakemi Odedina
- College of Pharmacy and College of Medicine, University of Florida, Gainesville, USA
| | - Peter J Carek
- Community Health and Family Medicine, University of Florida, Gainesville, USA
| | - Janice L Krieger
- STEM Translational Communication Center (STCC), University of Florida, Weimer Hall 2043, PO Box 118400, Gainesville, FL, 32611, USA
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James VS, Owens HL, Guralnick RP, Krieger JL. Revealing receiver bias in the communication of mapped biodiversity patterns. Frontiers of Biogeography 2021. [DOI: 10.21425/f5fbg49487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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20
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Paige SR, Flood-Grady E, Krieger JL, Stellefson M, Miller MD. Measuring health information seeking challenges in chronic disease: A psychometric analysis of a brief scale. Chronic Illn 2021; 17:151-156. [PMID: 30889966 PMCID: PMC6752979 DOI: 10.1177/1742395319836476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Information seeking is a cornerstone of patient activation in chronic disease self-management. To date, there are few brief and literacy-sensitive tools to measure intrinsic barriers of health information seeking. The Health Information National Trends Survey includes four items from the Information Seeking Experiences scale to measure frustration, effort, concern, and comprehension of information sought during a recent medical/health information search. Limited evidence exists for its construct validity and use in primary data collection in chronic disease. This measurement study examines the psychometric properties of the scale. Qualtrics Panelists with at least one chronic disease (N = 684) participated in an online survey. The average score was M = 12.85 (SD = 3.97), indicating a moderate degree of health information seeking challenges. Confirmatory factor analysis of data collected using this scale supported unidimensionality (RMSEA = .03; CFI/TLI = .99/.99). There was adequate scale (ω = .83) and item (value = .98) reliabilities. Rasch analyses showed optimal measurement error and response predictability with item-fit (values = .80-1.20). Response option "agree" was less likely to be selected than any other response option, although not posing a threat to scale reliability. Results demonstrate that this brief scale has sufficient measurement properties for its use as a measure of intrinsic health information seeking barriers among patients with chronic disease.
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, USA
| | - Elizabeth Flood-Grady
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, USA
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, USA.,Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, USA.,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, USA
| | - Michael Stellefson
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, USA
| | - M David Miller
- School of Human Development and Organizational Studies in Education, University of Florida, Gainesville, USA
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21
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Algarin AB, Zhou Z, Canidate S, Gebru NM, Krieger JL, Neil JM, Cook RL, Ibañez GE. PrEP awareness among people living with HIV in Florida: Florida Cohort study. AIDS Care 2021; 33:428-433. [PMID: 31960703 PMCID: PMC7371495 DOI: 10.1080/09540121.2020.1717421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/09/2020] [Indexed: 02/02/2023]
Abstract
In 2017, Florida ranked 2nd nationally in prevalence and incidence rates of HIV infections in the United States. Due to the high burden of HIV and low viral suppression in Florida, it is of increased importance to study methods of HIV prevention such as preexposure prophylaxis(PrEP) in this state. Our study aimed to examine correlates of PrEP awareness among PLWH in Florida and describe patterns of PrEP awareness/information sources. Using data collected from the Florida Cohort study between 2014 and 2018, 530 PLWH answered items that were hypothesized to be correlated with PrEP awareness. Of our sample, 53.8% were aware of PrEP. Urban location of recruitment, sexual partner's use of PrEP, use of viral suppression as an HIV prevention strategy, and engagement in transactional sex were all significantly associated with higher odds of PrEP awareness. Care providers and HIV/AIDS support groups were the most frequently listed sources of PrEP awareness, sources of future PrEP information, and most trusted sources for PrEP information. Findings from this study could inform future interventions that aim to increase PrEP awareness among PLWH to increase PrEP awareness and uptake among their HIV-negative social and sexual networks.
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Affiliation(s)
- Angel B. Algarin
- Florida International University, Department of Epidemiology, 11200 SW 8th St., AHC5- 505, Miami, FL, 33199
| | - Zhi Zhou
- University of Florida, Department of Epidemiology, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610
| | - Shantrel Canidate
- University of Florida, Department of Epidemiology, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610
| | - Nioud Mulugeta Gebru
- University of Florida, Department of Health Education & Behavior, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610
| | - Janice L. Krieger
- University of Florida, Department of Advertising, 1885 Stadium Rd, Gainesville, FL 32611
| | - Jordan M Neil
- Mongan Institute Health Policy Center, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114
| | - Robert L. Cook
- University of Florida, Department of Epidemiology, 2004 Mowry Road, PO Box 100231, Gainesville, FL, 32610
| | - Gladys E. Ibañez
- Florida International University, Department of Epidemiology, 11200 SW 8th St., AHC5- 505, Miami, FL, 33199
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22
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Hentschel A, Hsiao CJ, Chen LY, Wright L, Shaw J, Du X, Flood-Grady E, Harle CA, Reeder CF, Francois M, Louis-Jacques A, Shenkman E, Krieger JL, Lemas DJ. Perspectives of Pregnant and Breastfeeding Women on Participating in Longitudinal Mother-Baby Studies Involving Electronic Health Records: Qualitative Study. JMIR Pediatr Parent 2021; 4:e23842. [PMID: 33666558 PMCID: PMC8080167 DOI: 10.2196/23842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/02/2020] [Accepted: 12/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) hold great potential for longitudinal mother-baby studies, ranging from assessing study feasibility to facilitating patient recruitment to streamlining study visits and data collection. Existing studies on the perspectives of pregnant and breastfeeding women on EHR use have been limited to the use of EHRs to engage in health care rather than to participate in research. OBJECTIVE The aim of this study is to explore the perspectives of pregnant and breastfeeding women on releasing their own and their infants' EHR data for longitudinal research to identify factors affecting their willingness to participate in research. METHODS We conducted semistructured interviews with pregnant or breastfeeding women from Alachua County, Florida. Participants were asked about their familiarity with EHRs and EHR patient portals, their comfort with releasing maternal and infant EHR data to researchers, the length of time of the data release, and whether individual research test results should be included in the EHR. The interviews were transcribed verbatim. Transcripts were organized and coded using the NVivo 12 software (QSR International), and coded data were thematically analyzed using constant comparison. RESULTS Participants included 29 pregnant or breastfeeding women aged between 22 and 39 years. More than half of the sample had at least an associate degree or higher. Nearly all participants (27/29, 93%) were familiar with EHRs and had experience accessing an EHR patient portal. Less than half of the participants (12/29, 41%) were willing to make EHR data available to researchers for the duration of a study or longer. Participants' concerns about sharing EHRs for research purposes emerged in 3 thematic domains: privacy and confidentiality, transparency by the research team, and surrogate decision-making on behalf of infants. The potential release of sensitive or stigmatizing information, such as mental or sexual health history, was considered in the decisions to release EHRs. Some participants viewed the simultaneous use of their EHRs for both health care and research as potentially beneficial, whereas others expressed concerns about mixing their health care with research. CONCLUSIONS This exploratory study indicates that pregnant and breastfeeding women may be willing to release EHR data to researchers if researchers adequately address their concerns regarding the study design, communication, and data management. Pregnant and breastfeeding women should be included in EHR-based research as long as researchers are prepared to address their concerns.
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Affiliation(s)
- Austen Hentschel
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Chu J Hsiao
- Department of Anthropology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, United States
| | - Lynn Y Chen
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Lauren Wright
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jennifer Shaw
- Southcentral Foundation, Anchorage, AK, United States
| | - Xinsong Du
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Elizabeth Flood-Grady
- Clinical Translational Science Institute, University of Florida, Gainesville, FL, United States.,STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | - Christopher A Harle
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Callie F Reeder
- Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Magda Francois
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States.,Clinical Translational Science Institute, University of Florida, Gainesville, FL, United States
| | - Adetola Louis-Jacques
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, United States
| | - Elizabeth Shenkman
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States.,Clinical Translational Science Institute, University of Florida, Gainesville, FL, United States
| | - Janice L Krieger
- Clinical Translational Science Institute, University of Florida, Gainesville, FL, United States.,STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | - Dominick J Lemas
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States.,Clinical Translational Science Institute, University of Florida, Gainesville, FL, United States.,Department of Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States
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23
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Staras SAS, Richardson E, Merlo LJ, Bian J, Thompson LA, Krieger JL, Gurka MJ, Sanders AH, Shenkman EA. A feasibility trial of parent HPV vaccine reminders and phone-based motivational interviewing. BMC Public Health 2021; 21:109. [PMID: 33422047 PMCID: PMC7797089 DOI: 10.1186/s12889-020-10132-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background We assessed the feasibility and acceptability of a sequential approach of parent-targeted HPV vaccine reminders and phone-based Motivation Interviewing (MI). Methods In 2016, we selected all 11- to 12-year-old boys and girls seen in one clinic whose vaccine records did not include the HPV vaccine (n=286). By gender, we individually randomized parents of adolescents to an interactive text message (74 girls and 45 boys), postcard reminder (46 boys and no girls because of previously demonstrated efficacy), or standard care group (75 girls and 46 boys). Reminders were sent with medical director permission and a HIPAA waiver. Two months after reminders, among the adolescents whose vaccine records still did not include the HPV vaccine, we selected a gender-stratified random sample of 20 parents for phone-based MI. We assessed the percentage of deliverable messages, the percentage of parents’ responding to the interactive text message, parent acceptability of receiving a text message, and MI parent responsiveness and interviewer competence (MI Treatment Integrity Coding system). Results Nearly all messages were deliverable (98% of postcards and 74% of text messages). Six of the 88 parents (7%) receiving text messages scheduled an appointment through our interactive system. The acceptability survey response rate was 37% (38/102). Respondents were favorable toward vaccine reminders for all parents (82%). Among 20 sampled parents, 17 were reached by phone of whom 7 completed MI, 4 had or were getting the HPV vaccine for their child, and 5 expressed disinterest. Across the 7 MI calls, the interviewer was rated 100% MI adherent and scored an average 4.19 rating for Global Spirit. Conclusion Without providing explicit consent to receive vaccine-related messages, parents nonetheless found postcards and interactive text messages acceptable. Centralizing MI to phone calls with trained staff was acceptable to parents and resulted in highly MI-adherent interviews. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10132-6.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA. .,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Eric Richardson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lisa J Merlo
- The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA.,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- Department of Advertising, College of Journalism and Communication, University of Florida, Gainesville, FL, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ashley H Sanders
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.,The Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL, USA
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24
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Golembiewski EH, Mainous AG, Rahmanian KP, Brumback B, Rooks BJ, Krieger JL, Goodman KW, Moseley RE, Harle CA. An Electronic Tool to Support Patient-Centered Broad Consent: A Multi-Arm Randomized Clinical Trial in Family Medicine. Ann Fam Med 2021; 19:16-23. [PMID: 33431386 PMCID: PMC7800739 DOI: 10.1370/afm.2610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Patients are frequently asked to share their personal health information. The objective of this study was to compare the effects on patient experiences of 3 electronic consent (e-consent) versions asking patients to share their health records for research. METHODS A multi-arm randomized controlled trial was conducted from November 2017 through November 2018. Adult patients (n = 734) were recruited from 4 family medicine clinics in Florida. Using a tablet computer, participants were randomized to (1) a standard e-consent (standard), (2) an e-consent containing standard information plus hyperlinks to additional interactive details (interactive), or (3) an e-consent containing standard information, interactive hyperlinks, and factual messages about data protections and researcher training (trust-enhanced). Satisfaction (1 to 5), subjective understanding (0 to 100), and other outcomes were measured immediately, at 1 week, and at 6 months. RESULTS A majority of participants (94%) consented to future uses of their health record information for research. No differences in study outcomes between versions were observed at immediate or 1-week follow-up. At 6-month follow-up, compared with the standard e-consent, participants who used the interactive e-consent reported greater satisfaction (B = 0.43; SE = 0.09; P <.001) and subjective understanding (B = 18.04; SE = 2.58; P <.001). At 6-month follow-up, compared with the interactive e-consent, participants who used the trust-enhanced e-consent reported greater satisfaction (B = 0.9; SE = 1.0; P <.001) and subjective understanding (B = 32.2; SE = 2.6, P <.001). CONCLUSIONS Patients who used e-consents with interactive research details and trust-enhancing messages reported higher satisfaction and understanding at 6-month follow-up. Research institutions should consider developing and further validating e-consents that interactively deliver information beyond that required by federal regulations, including facts that may enhance patient trust in research.
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Affiliation(s)
| | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida.,Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Kiarash P Rahmanian
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Benjamin J Rooks
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Janice L Krieger
- Department of Advertising, University of Florida, Gainesville, Florida
| | - Kenneth W Goodman
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ray E Moseley
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Christopher A Harle
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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Harle CA, Golembiewski EH, Rahmanian KP, Brumback B, Krieger JL, Goodman KW, Mainous AG, Moseley RE. Does an interactive trust-enhanced electronic consent improve patient experiences when asked to share their health records for research? A randomized trial. J Am Med Inform Assoc 2020; 26:620-629. [PMID: 30938751 DOI: 10.1093/jamia/ocz015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/27/2018] [Accepted: 01/26/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In the context of patient broad consent for future research uses of their identifiable health record data, we compare the effectiveness of interactive trust-enhanced e-consent, interactive-only e-consent, and standard e-consent (no interactivity, no trust enhancement). MATERIALS AND METHODS A randomized trial was conducted involving adult participants making a scheduled primary care visit. Participants were randomized into 1 of the 3 e-consent conditions. Primary outcomes were patient-reported satisfaction with and subjective understanding of the e-consent. Secondary outcomes were objective knowledge, perceived voluntariness, trust in medical researchers, consent decision, and time spent using the application. Outcomes were assessed immediately after use of the e-consent and at 1-week follow-up. RESULTS Across all conditions, participants (N = 734) reported moderate-to-high satisfaction with consent (mean 4.3 of 5) and subjective understanding (79.1 of 100). Over 94% agreed to share their health record data. No statistically significant differences in outcomes were observed between conditions. Irrespective of condition, black participants and those with lower education reported lower satisfaction, subjective understanding, knowledge, perceived voluntariness, and trust in medical researchers, as well as spent more time consenting. CONCLUSIONS A large majority of patients were willing to share their identifiable health records for research, and they reported positive consent experiences. However, incorporating optional additional information and messages designed to enhance trust in the research process did not improve consent experiences. To improve poorer consent experiences of racial and ethnic minority participants and those with lower education, other novel consent technologies and processes may be valuable. (An Interactive Patient-Centered Consent for Research Using Medical Records; NCT03063268).
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Affiliation(s)
- Christopher A Harle
- Department of Health Policy and Management, Indiana University, Indianapolis, Indiana, USA
- Regenstrief Institute Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | | | - Kiarash P Rahmanian
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Janice L Krieger
- Department of Advertising, University of Florida, Gainesville, Florida, USA
| | - Kenneth W Goodman
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Arch G Mainous
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - Ray E Moseley
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
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26
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Vilaro MJ, Wilson‐Howard DS, Griffin LN, Tavassoli F, Zalake MS, Lok BC, Modave FP, George TJ, Carek PJ, Krieger JL. Tailoring virtual human-delivered interventions: A digital intervention promoting colorectal cancer screening for Black women. Psychooncology 2020; 29:2048-2056. [PMID: 32893399 PMCID: PMC7821126 DOI: 10.1002/pon.5538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/18/2020] [Accepted: 08/23/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Despite efforts to reduce cancer disparities, Black women remain underrepresented in cancer research. Virtual health assistants (VHAs) are one promising digital technology for communicating health messages and promoting health behaviors to diverse populations. This study describes participant responses to a VHA-delivered intervention promoting colorectal cancer (CRC) screening with a home-stool test. METHODS We recruited 53 non-Hispanic Black women 50 to 73 years old to participate in focus groups and think-aloud interviews and test a web-based intervention delivered by a race- and gender-concordant VHA. A user-centered design approach prioritized modifications to three successive versions of the intervention based on participants' comments. RESULTS Participants identified 26 cues relating to components of the VHA's credibility, including trustworthiness, expertise, and authority. Comments on early versions revealed preferences for communicating with a human doctor and negative critiques of the VHA's appearance and movements. Modifications to specific cues improved the user experience, and participants expressed increased willingness to engage with later versions of the VHA and the screening messages it delivered. Informed by the Modality, Agency, Interactivity, Navigability Model, we present a framework for developing credible VHA-delivered cancer screening messages. CONCLUSIONS VHAs provide a systematic way to deliver health information. A culturally sensitive intervention designed for credibility promoted user interest in engaging with guideline-concordant CRC screening messages. We present strategies for effectively using cues to engage audiences with health messages, which can be applied to future research in varying contexts.
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Affiliation(s)
- Melissa J. Vilaro
- STEM Translational Communication CenterCollege of Journalism & CommunicationsUniversity of FloridaGainesvilleFloridaUSA
| | | | - Lauren N. Griffin
- STEM Translational Communication CenterCollege of Journalism & CommunicationsUniversity of FloridaGainesvilleFloridaUSA
| | - Fatemeh Tavassoli
- Department of Computer & Information Science & EngineeringCollege of EngineeringUniversity of FloridaGainesvilleFloridaUSA
| | - Mohan S. Zalake
- Department of Computer & Information Science & EngineeringCollege of EngineeringUniversity of FloridaGainesvilleFloridaUSA
| | - Benjamin C. Lok
- Department of Computer & Information Science & EngineeringCollege of EngineeringUniversity of FloridaGainesvilleFloridaUSA
| | - Francois P. Modave
- Department of Health Outcomes & Biomedical InformaticsCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Thomas J. George
- Division of Hematology & OncologyCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Peter J. Carek
- Department of Community Health & Family MedicineCollege of MedicineUniversity of FloridaGainesvilleFloridaUSA
| | - Janice L. Krieger
- STEM Translational Communication CenterCollege of Journalism & CommunicationsUniversity of FloridaGainesvilleFloridaUSA
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Chen LY, Flood-Grady E, Hentschel A, Wright L, Mkuu R, Young A, Francois M, Neu J, Parker LA, Shenkman E, Krieger JL, Lemas DJ. A Qualitative Study of Pregnant Women's Perspectives on Antibiotic Use for Mom and Child: Implications for Developing Tailored Health Education Interventions. Antibiotics (Basel) 2020; 9:antibiotics9100704. [PMID: 33076539 PMCID: PMC7602878 DOI: 10.3390/antibiotics9100704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
The overutilization of antibiotics during pregnancy and early life are associated with adverse health outcomes for mothers and infants. In this study, we explored pregnant women’s opinions and concerns of antibiotics and how perceptions may affect their health-related decision-making. We conducted 18 in-depth, semi-structured interviews with pregnant women and used the Health Belief Model (HBM) as a framework to analyze the data. We found that mothers generally understood the benefits of antibiotics and were aware that antibiotics are clinically effective for treating bacterial infections. Importantly, perceived barriers related to antibiotic use included concerns regarding the impact of antibiotics on breastfeeding efficacy, microbial health, and societal factors such as antimicrobial resistance. The prescription of antibiotics by a healthcare provider was a cue to action for women, as they trusted providers to recommend medications that were safe for them and their infants. Overall, mothers shared that receiving education on the effects of antibiotics would improve their self-efficacy and decision-making surrounding the use of antibiotics for treating illness. Implications for tailored perinatal health education interventions to enhance antibiotic use, knowledge, and decision-making are discussed.
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Affiliation(s)
- Lynn Y. Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
| | - Elizabeth Flood-Grady
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA; (E.F.-G.); (J.L.K.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Austen Hentschel
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
| | - Lauren Wright
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
| | - Rahma Mkuu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Alyson Young
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
| | - Magda Francois
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Josef Neu
- Department of Pediatrics, University of Florida Health, Gainesville, FL 32611, USA;
| | - Leslie A. Parker
- Department of Behavioral Nursing Science, University of Florida, Gainesville, FL 32611, USA;
| | - Elizabeth Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL 32611, USA; (E.F.-G.); (J.L.K.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
| | - Dominick J. Lemas
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32611, USA; (L.Y.C.); (A.H.); (L.W.); (R.M.); (A.Y.); (M.F.); (E.S.)
- Clinical Translational Science Institute, University of Florida, Gainesville, FL 32611, USA
- Correspondence: ; Tel.: +352-294-5971
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Paige SR, Salloum RG, Krieger JL, Williams M, Xue W, Brumback B. Promoting Clinical Conversations about Lung Cancer Screening: Exploring the Role of Perceived Online Social Support. J Health Commun 2020; 25:650-659. [PMID: 33119451 PMCID: PMC8278871 DOI: 10.1080/10810730.2020.1836087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The perceived availability of online social support may contribute to patient-provider conversations about lung cancer screening. This study examines how the perceived availability of instrumental and emotional online social support is associated with patient-provider communication about lung cancer screening among adults who meet U.S. Preventive Services Taskforce (USPSTF) eligibility criteria and live with a COPD diagnosis. In April 2018, 575 adults completed an online survey after being recruited from a large southeastern academic medical center's broad research registry and website listing. Nearly half of the participants were 55-to-80 years old (41%), a current or former smoker who had quit smoking within the past 15 years (42%), and reported a smoking prevalence of 30 pack years or more (PPY; 41%). Results demonstrate that having a COPD diagnosis, identifying as male, and being a current or former tobacco smoker resulted in greater odds of having a clinical conversation about lung cancer screening. Conversely, meeting the 30 PPY smoking and 55-to-80 age thresholds lowered the odds of having these conversations. A high degree of instrumental and emotional online social support was associated with a greater incidence of annual patient-provider conversations about screening. This combination of perceived online social support was especially useful for patients with COPD.
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, University of Florida , Gainesville, FL, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida , Gainesville, FL, USA
- UF Health Cancer Center, University of Florida , Gainesville, FL, USA
| | - Janice L Krieger
- STEM Translational Communication Center, University of Florida , Gainesville, FL, USA
- UF Health Cancer Center, University of Florida , Gainesville, FL, USA
| | - Maribeth Williams
- Department of Community Health and Family Medicine, University of Florida , Gainesville, FL, USA
| | - Wei Xue
- Department of Biostatistics, University of Florida , Gainesville, FL, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida , Gainesville, FL, USA
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Flood-Grady E, Neil JM, Paige SR, Lee D, Damiani RE, Hough D, Savitsky Z, George TJ, Krieger JL. A Pilot Study Determining Comprehension and the Acceptability of a Cancer Research Study Website for Cancer Patients and Caregivers. J Cancer Educ 2020; 35:589-598. [PMID: 30847837 PMCID: PMC7015148 DOI: 10.1007/s13187-019-01501-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The purpose of this pilot study was to determine if a cancer research study website increased comprehension among patients and caregivers and if website evaluations differed across patient and caregiver groups. Participants (N = 200) were cancer patients and caregivers living in the USA. Comprehension was determined by the number of correct responses to a series of questions about key characteristics of cancer research studies that are frequently unknown or misinterpreted by patients and/or caregivers. Quantitative and qualitative analyses were conducted to determine participant evaluations across four domains: perceived website credibility, perceived website attractiveness, perceived information effectiveness, and perceived information clarity. Patients and caregivers perceived the website as highly credible and attractive and the information as both easy to understand and moderately effective in helping them make decisions about CCTs. Qualitative feedback underscores the importance of testimonials to website credibility. However, the range in the number of correct responses of certain items across participants coupled with discrepancies in comprehension between patients and caregivers suggests the need for stronger mechanisms evaluating knowledge outcomes.
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Affiliation(s)
- Elizabeth Flood-Grady
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA.
| | - Jordan M Neil
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Samantha R Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Donghee Lee
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Rachel E Damiani
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Deaven Hough
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Zack Savitsky
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Thomas J George
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL, USA
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Flood-Grady E, Liu J, Paige SR, Lee D, Nelson DR, Shenkman E, Hough D, Krieger JL. Audience segmentation as a strategy for enhancing the use of research registries for recruiting patients into clinical trials. Contemp Clin Trials Commun 2020; 17:100510. [PMID: 31956721 PMCID: PMC6957865 DOI: 10.1016/j.conctc.2019.100510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/10/2019] [Accepted: 12/21/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Health research registries have great potential to increase awareness of research opportunities among diverse patient populations and reduce disparities in clinical trial accrual. However, little research has focused on patients' intentions to participate in clinical trials once they are enrolled in the registry and their intentions to remain in the registry over time. METHODS Patients (N = 312) enrolled in a university-based health research registry (i.e., Consent2Share) in the southeastern region of the US participated in an online survey. RESULTS Health research registry knowledge, perceived values, self-efficacy, trust, having chronic health concerns, and consent recall were positively correlated with intentions to remain enrolled in the research registry and participate in future clinical trials. Health research registry consent recall had significant positive associations with registry knowledge, perceived values, trust, registry retention, and participating in future trials. CONCLUSION The process of consenting patients to the health research registry is important for recruitment, registry retention, and participation in future clinical trials. We identified key points of emphasis to expand participation in research registries as a strategy to increase clinical trial enrollment, such as deploying precision messages and tailored interventions.
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Affiliation(s)
- Elizabeth Flood-Grady
- STEM Translational Communication Center, University of Florida, Gainesville, USA
- Clinical and Translational Science Institute, University of Florida, Gainesville, USA
| | - Jiawei Liu
- School of Journalism and Communication, Jinan University, Guangzhou, People's Republic of China
| | - Samantha R. Paige
- STEM Translational Communication Center, University of Florida, Gainesville, USA
| | - Donghee Lee
- STEM Translational Communication Center, University of Florida, Gainesville, USA
| | - David R. Nelson
- Clinical and Translational Science Institute, University of Florida, Gainesville, USA
| | - Elizabeth Shenkman
- Clinical and Translational Science Institute, University of Florida, Gainesville, USA
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, USA
| | - Deaven Hough
- Clinical and Translational Science Institute, University of Florida, Gainesville, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, USA
- Clinical and Translational Science Institute, University of Florida, Gainesville, USA
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, USA
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, USA
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Paige SR, Damiani RE, Flood-Grady E, Krieger JL, Stellefson M. The Perceived Availability of Online Social Support: Exploring the Contributions of Illness and Rural Identities in Adults with Chronic Respiratory Illness. Int J Environ Res Public Health 2019; 17:ijerph17010242. [PMID: 31905782 PMCID: PMC6982215 DOI: 10.3390/ijerph17010242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022]
Abstract
Joining an online social support group may increase perceived membership to a community, but it does not guarantee that the community will be available when it is needed. This is especially relevant for adults with Chronic Obstructive Pulmonary Disease (COPD), many of whom reside in rural regions and continually negotiate their illness identity. Drawing from social support literature and communication theory of identity, this cross-sectional study explored how COPD illness and geographic identities interact to influence patients’ perceived availability of online social support. In April 2018, 575 adults with a history of respiratory symptoms completed an online survey. Patients with a COPD diagnosis reported greater availability of online support. This was partially mediated by a positive degree of COPD illness identity (i.e., being diagnosed with COPD, a history of tobacco use, severe respiratory symptoms, high disease knowledge, and low income but high education). The relationship between COPD illness identity and the availability of online support was strongest among those with low rural identity; however, at lower levels of COPD illness identity, participants with high rural identity reported the greatest degree of available online support. Results have important implications for tailored education approaches across the COPD care continuum by illness and geographic identities.
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Affiliation(s)
- Samantha R. Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA; (R.E.D.); (E.F.-G.); (J.L.K.)
- Correspondence:
| | - Rachel E. Damiani
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA; (R.E.D.); (E.F.-G.); (J.L.K.)
| | - Elizabeth Flood-Grady
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA; (R.E.D.); (E.F.-G.); (J.L.K.)
- Clinical and Translational Sciences Institute, University of Florida, Gainesville, FL 32610, USA
| | - Janice L. Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL 32611, USA; (R.E.D.); (E.F.-G.); (J.L.K.)
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858, USA;
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Paige SR, Stellefson M, Krieger JL, Miller MD, Cheong J, Anderson-Lewis C. Transactional eHealth Literacy: Developing and Testing a Multi-Dimensional Instrument. J Health Commun 2019; 24:737-748. [PMID: 31583963 PMCID: PMC7366705 DOI: 10.1080/10810730.2019.1666940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Theoretically informed measures of eHealth literacy that consider the social affordances of eHealth are limited. This study describes the psychometric testing of a multi-dimensional instrument to measure functional, communicative, critical, and translational eHealth literacies, as informed by the Transactional Model of eHealth Literacy (TMeHL). A 3-phase rating scale construction process was conducted to engage eHealth experts and end-users. In Phase 1, Experts (N = 5) and end-users (N = 25) identified operational behaviors to measure each eHealth literacy dimension. End-users (N = 10) participated in think-aloud interviews to provide feedback on items reviewed and approved by experts. A field test was conducted with a random sample of patients recruited from a university-based research registry (N = 283). Factor analyses and Rasch procedures examined the internal structure of the scores produced by each scale. Pearson's r correlations provided evidence for external validity of scores. The instrument measures four reliable (ω = .92-.96) and correlated (r= .44-.64) factors: functional (4 items), communicative (5 items), critical (5 items), and translational (4 items). Researchers and providers can use this new instrument as a theory-driven instrument to measure four eHealth literacies that are fundamental to the social affordances of the eHealth experience.
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Michael Stellefson
- Department of Health Education & Promotion, East Carolina University, Greenville, NC, USA
| | - Janice L Krieger
- STEM Translational Communication Center, Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - M David Miller
- School of Human Development & Organizational Studies, University of Florida, Gainesville, FL, USA
| | - Jeewon Cheong
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
| | - Charkarra Anderson-Lewis
- College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS, USA
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Neil JM, Gough A, Kee F, George TJ, Pufahl J, Krieger JL. The Influence of Patient Identification and Narrative Transportation on Intentions to Participate in Cancer Research. J Cancer Educ 2019; 34:725-734. [PMID: 29721780 PMCID: PMC7055730 DOI: 10.1007/s13187-018-1364-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cancer decision-making interventions commonly utilize narratives as a persuasive strategy to increase identification with the message source, promote involvement with the topic, and elicit greater willingness to adopt recommended behaviors. However, there is little empirical research examining the mechanisms underlying the effectiveness of this strategy in the context of cancer research participation. Data for the current manuscript were collected as part of a larger study conducted with cancer patients (N = 413) from the USA, UK, and the Republic of Ireland. Participants viewed and evaluated video-recorded vignettes, illustrating different strategies for discussing clinical trials participation with family members. Results showed nationality was a significant predictor of identification with the main character (i.e., patient) in the vignette. Unexpectedly, these cross-national differences in identification disappeared when patients currently undergoing treatment had higher perceived susceptibility of their cancer. Identification with the main character in the vignettes was a significant predictor of intentions to participate in cancer research, but only when the mediating role of narrative transportation was considered. The findings demonstrate the importance of considering how individual and social identities influence identification with characters in cancer narratives and yield practical guidance for developing arts-based interventions to increase cancer research participation.
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Affiliation(s)
- Jordan M Neil
- Mongan Institute Health Policy Center, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA.
| | - Aisling Gough
- United Kingdom Clinical Research Collaboration Centre of Excellence in Public Health Northern Ireland, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- United Kingdom Clinical Research Collaboration Centre of Excellence in Public Health Northern Ireland, School of Medicine, Dentistry & Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Thomas J George
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jeffrey Pufahl
- Center for Arts in Medicine, The College of Arts, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL, USA
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, USA
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Abstract
The present study seeks to understand how parents as prevention agents approach substance use prevention messages during the period of early adolescence. Students (N = 410) in a drug prevention trial completed surveys from 7th to 9th grade. Using longitudinal data, a series of latent transition analyses was conducted to identify major trends of parent-adolescent drug talk styles (i.e., never talked, situated direct, ongoing direct, situated indirect, and ongoing indirect) in control and treatment conditions. Findings demonstrate a developmental trend in drug talk styles toward a situated style of talk as youth transitioned from 7th grade to 9th grade. Findings also show that even though the drug prevention trial did not specifically target parental communication, parents in the treatment condition provide more ongoing substance use prevention messages to their adolescent children than do parents in the control condition. The present study discusses relevant developmental issues, potential intervention effects, and future research directions for communication research in substance use prevention.
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Affiliation(s)
- YoungJu Shin
- Hugh Downs School of Human Communication, Arizona State University
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Paige SR, Krieger JL. Recruitment in online research for COPD: leveraging social media and research registries. ERJ Open Res 2019; 5:00167-2018. [PMID: 30972351 PMCID: PMC6452045 DOI: 10.1183/23120541.00167-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/24/2019] [Indexed: 11/05/2022] Open
Abstract
Social media and research registries effectively reach diverse subgroups of patients with obstructive lung conditions. Patient co-created mail and e-mail pre-notifications that precede a formal e-mail invitation can enhance enrolment in online research. http://ow.ly/gQQt30o6Bcw.
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL, USA.,Clinical and Translational Sciences Recruitment Center, University of Florida, Gainesville, FL, USA.,Dept of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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Abstract
Background The Internet is an important tool for empowering patients with Chronic Obstructive Pulmonary Disease (COPD) to learn about and self-manage their condition. Purpose To understand which aspects of the online experience facilitates or hinders the perceived ability of patients with COPD to achieve their information and self-management goals. Methods Semi-structured interviews were conducted with medically underserved patients with COPD (N = 25) who access the Internet for health. A conventional content analysis approach was applied and data were analyzed with the constant comparative method. Results The following themes were derived: (1) desire to associate with "in-group" members; (2) relationship building with other online users; (3) security of information and identity; (4) source and channel credibility appraisal; (5) user assistance and tutorials; and (6) strategies to adapt technological functions. Discussion Success in using the Internet was dependent on the functional use of technology and the ability and resilience to engage with similar online users to build meaningful and trustworthy connections. Translation to Health Education Practice Prior to directing patients with COPD to a disease-specific online support platform, certified health education specialists must assess patients' information goals and their skills to critically appraise and communicate with other online users.
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, Department of Health Education and Behavior, University of Florida, Gainesville FL 32611
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville NC 27858
| | - Janice L Krieger
- STEM Translational Communication Center, Department of Advertising, Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville FL 32611
| | - Julia M Alber
- Kinesiology Department, California Polytechnic State University, San Luis Obispo CA 93407
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Abstract
The U.S. Food and Drug Administration (FDA) recently made changes to the nutrition facts label so that calories will be emphasized over all other nutrient information (U.S. Food and Drug Administration (FDA), 2016a, August 3). In light of calories' increased visibility, strategic health communicators need to understand both how individuals perceive calorie information and how calories influence consumption decisions. Therefore, a qualitative study was conducted to analyze the metaphors that structure consumers' thoughts about calorie information and food choices. In-depth interviews were conducted with 34 women from diverse racial/ethnic and socioeconomic backgrounds. Through the interviews and subsequent thematic analysis, metaphors were gathered that explained perceptions of different kinds of calories and how calories function in the diet. Five conceptual metaphors were uncovered. The metaphors individuals used varied based on their eating paradigms, and the metaphors were related to different approaches to consumption decisions. The implications of using these different calorie metaphors for translational communication interventions are further discussed.
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Affiliation(s)
- Lauren C Bayliss
- a Department of Communication Arts , Georgia Southern University , Statesboro , GA , USA
| | - Janice L Krieger
- b College of Journalism and Communications , University of Florida , Gainesville , FL , USA
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Paige SR, Stellefson M, Krieger JL, Anderson-Lewis C, Cheong J, Stopka C. Proposing a Transactional Model of eHealth Literacy: Concept Analysis. J Med Internet Res 2018; 20:e10175. [PMID: 30279155 PMCID: PMC6231800 DOI: 10.2196/10175] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/18/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts. Objective The objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC. Methods Walker and Avant’s concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC. Results Systematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of “communication” in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions. Conclusions The Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of “noise” (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply).
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Affiliation(s)
- Samantha R Paige
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States.,Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - Janice L Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
| | | | - JeeWon Cheong
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
| | - Christine Stopka
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, United States
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Palmer-Wackerly AL, Dailey PM, Krok-Schoen JL, Rhodes ND, Krieger JL. Patient Perceptions of Illness Identity in Cancer Clinical Trial Decision-Making. Health Commun 2018; 33:1045-1054. [PMID: 28622019 PMCID: PMC6145173 DOI: 10.1080/10410236.2017.1331189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
When patients are diagnosed with cancer, they begin to negotiate their illness identity in relation to their past and future selves, their relationships, and their group memberships. Thus, how patients view their cancer in relation to their other identities may affect how and why they make particular decisions about treatment options. Using the Communication Theory of Identity (CTI), the current study explores: (1) how and why illness identity is framed across identity layers in relation to one particular cancer treatment: participation in a cancer clinical trial (CT); and (2) how and why patients experience identity conflicts while making their treatment decisions. Semi-structured, in-depth interviews were analyzed for 46 cancer patients who were offered a CT. Results of a grounded theory analysis indicated that patients expressed separate identity frames (e.g., personal, relational, and communal), aligned identity frames (e.g., personal and communal), and identity conflicts (e.g., personal-personal). This study theoretically shows how and why patient illness identity relates to cancer treatment decision-making as well as how and why patients relate (and conflict) with the cancer communal identity frame. Practical implications include how healthcare providers and family members can support patient decision-making through awareness of and accommodating to identity shifts.
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Affiliation(s)
- Angela L. Palmer-Wackerly
- Correspondence concerning this manuscript should be addressed to Angela L. Palmer-Wackerly, Department of Communication Studies, The University of Nebraska-Lincoln, Lincoln, NE 68588, USA.
| | | | | | - Nancy D. Rhodes
- Department of Advertising & Public Relations, Michigan State University
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Paige SR, Miller MD, Krieger JL, Stellefson M, Cheong J. Electronic Health Literacy Across the Lifespan: Measurement Invariance Study. J Med Internet Res 2018; 20:e10434. [PMID: 29986848 PMCID: PMC6056742 DOI: 10.2196/10434] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/17/2018] [Accepted: 06/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Electronic health (eHealth) information is ingrained in the healthcare experience to engage patients across the lifespan. Both eHealth accessibility and optimization are influenced by lifespan development, as older adults experience greater challenges accessing and using eHealth tools as compared to their younger counterparts. The eHealth Literacy Scale (eHEALS) is the most popular measure used to assess patient confidence locating, understanding, evaluating, and acting upon online health information. Currently, however, the factor structure of the eHEALS across discrete age groups is not well understood, which limits its usefulness as a measure of eHealth literacy across the lifespan. Objective The purpose of this study was to examine the structure of eHEALS scores and the degree of measurement invariance among US adults representing the following generations: Millennials (18-35-year-olds), Generation X (36-51-year-olds), Baby Boomers (52-70-year-olds), and the Silent Generation (71-84-year-olds). Methods Millennials (N=281, mean 26.64 years, SD 5.14), Generation X (N=164, mean 42.97 years, SD 5.01), and Baby Boomers/Silent Generation (N=384, mean 62.80 years, SD 6.66) members completed the eHEALS. The 3-factor (root mean square error of approximation, RMSEA=.06, comparative fit index, CFI=.99, Tucker-Lewis index, TLI=.98) and 4-factor (RMSEA=.06, CFI=.99, TLI=.98) models showed the best global fit, as compared to the 1- and 2-factor models. However, the 4-factor model did not have statistically significant factor loadings on the 4th factor, which led to the acceptance of the 3-factor eHEALS model. The 3-factor model included eHealth Information Awareness, Search, and Engagement. Pattern invariance for this 3-factor structure was supported with acceptable model fit (RMSEA=.07, Δχ2=P>.05, ΔCFI=0). Compared to Millennials and members of Generation X, those in the Baby Boomer and Silent Generations reported less confidence in their awareness of eHealth resources (P<.001), information seeking skills (P=.003), and ability to evaluate and act on health information found on the Internet (P<.001). Results Young (18-48-year olds, N=411) and old (49-84-year olds, N=419) adults completed the survey. A 3-factor model had the best fit (RMSEA=.06, CFI=.99, TLI=.98), as compared to the 1-factor, 2-factor, and 4-factor models. These 3-factors included eHealth Information Awareness (2 items), Information Seeking (2 items), and Information and Evaluation (4 items). Pattern invariance was supported with the acceptable model fit (RMSEA=.06, Δχ2=P>.05, ΔCFI=0). Compared with younger adults, older adults had less confidence in eHealth resource awareness (P<.001), information seeking skills (P<.01), and ability to evaluate and act upon online health information (P<.001). Conclusions The eHEALS can be used to assess, monitor uniquely, and evaluate Internet users’ awareness of eHealth resources, information seeking skills, and engagement abilities. Configural and pattern invariance was observed across all generation groups in the 3-factor eHEALS model. To meet gold the standards for factor interpretation (ie, 3 items or indicators per factor), future research is needed to create and assess additional eHEALS items. Future research is also necessary to identify and test items for a fourth factor, one that captures the social nature of eHealth.
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Affiliation(s)
- Samantha R Paige
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States.,STEM Translational Communication Center, University of Florida, Gainesville, FL, United States
| | - M David Miller
- School of Human Development and Organizational Studies in Education, University of Florida, Gainesville, FL, United States
| | - Janice L Krieger
- STEM Translational Communication Center, University of Florida, Gainesville, FL, United States.,Department of Advertising, University of Florida, Gainesville, FL, United States.,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, United States
| | - Michael Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, United States
| | - JeeWon Cheong
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States
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Shin Y, Miller-Day M, Hecht ML, Krieger JL. Entertainment-Education Videos as a Persuasive Tool in the Substance Use Prevention Intervention "keepin' it REAL". Health Commun 2018; 33:896-906. [PMID: 28586239 PMCID: PMC6050515 DOI: 10.1080/10410236.2017.1321163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Based on social cognitive theory and narrative engagement theory, the current study examined hypothesized indirect effects of engagement with keepin' it REAL (kiR) curriculum entertainment-education (E-E) videos on youth alcohol use via youth drug offer refusal efficacy. Students in 7th grade (N = 1,464) at 25 public schools in two Midwestern states were randomly assigned to one of the two versions of the kiR curriculum, the kiR urban version and the kiR rural version. Each version had their own set of five culturally-grounded E-E videos depicting communicative skills to refuse drug offers. Differential effects for engagement components were expected depending on the degree of cultural matching. Pre/post surveys were administered at the beginning and the end of 7th grade. Structural equation modeling analysis resulted in partial support for the research hypotheses. Rural youth receiving the urban curriculum who reported higher interest in the E-E videos were more likely to report having higher refusal efficacy, and in turn, less likely to use alcohol. Rural youth receiving the rural curriculum who identified with the E-E video main characters were more likely to report having higher refusal efficacy, and in turn, less likely to use alcohol. Implications for E-E health promotion are discussed.
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Affiliation(s)
- YoungJu Shin
- Hugh Downs School of Human Communication, Arizona State University
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42
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Paige SR, Alber JM, Stellefson ML, Krieger JL. Missing the mark for patient engagement: mHealth literacy strategies and behavior change processes in smoking cessation apps. Patient Educ Couns 2018; 101:951-955. [PMID: 29153592 PMCID: PMC5911212 DOI: 10.1016/j.pec.2017.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/02/2017] [Accepted: 11/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To examine how Transtheoretical Model (TTM)'s processes of change and mHealth literacy strategies are employed in mobile smoking cessation apps. METHODS A purposive sample of 100 iTunes apps were coded to assess descriptive (price, type, developer, user-rating) and engagement metrics, including processes of change and mHealth literacy strategies (plain language, usability, interactivity). One-way ANOVAs and independent samples t-tests examined associations between descriptive and engagement metrics. RESULTS Over half of the apps included 7 (78%) processes of change. Fewer included self-liberation (36%) and reinforcement management (34%). Most apps incorporated plain language, but few integrated usability and interactivity strategies. Hypnotherapy and informational apps included more behavioral processes of change than apps incorporating a combination of features, including gaming, cigarette trackers, and motivational coaching (p<0.01). CONCLUSION Apps included behavior change processes but rarely incorporated usability and interactivity features to promote patient engagement. Engagement metrics did not vary by app user-ratings, price-to-download, or developer, including for-profit organizations or government and educational institutions. PRACTICE IMPLICATIONS Providers should acknowledge the popularity of smoking cessation apps as potential cessation aids and communicate their benefits and drawbacks to patients. Future efforts to improve smoking cessation apps should focus on enhancing the quality of tailored and interactive content.
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Affiliation(s)
- Samantha R Paige
- Department of Health Education & Behavior, University of Florida, Gainesville FL, USA; STEM Translational Communication Center, University of Florida, Gainesville FL, USA.
| | - Julia M Alber
- Kinesiology Department, California Polytechnic State University, San Luis Obispo CA, USA
| | - Michael L Stellefson
- Department of Health Education and Promotion, East Carolina University, Greenville NC, USA
| | - Janice L Krieger
- STEM Translational Communication Center, University of Florida, Gainesville FL, USA; Department of Health Outcomes & Policy, University of Florida, Gainesville FL, USA; Department of Advertising, University of Florida, Gainesville FL, USA
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43
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Pettigrew J, Miller-Day M, Shin YJ, Krieger JL, Hecht ML, Graham JW. Parental Messages about Substance Use in Early Adolescence: Extending a Model of Drug-Talk Styles. Health Commun 2018; 33:349-358. [PMID: 28278609 PMCID: PMC6086348 DOI: 10.1080/10410236.2017.1283565] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study extends a typology of parent-offspring drug talk styles to early adolescents and investigates associations with adolescent substance use. Data come from a self-report survey associated with a school-based, 7th grade drug prevention curriculum. Mixed methods were used to collect data across four measurement occasions spanning 30 months. Findings highlight the frequencies of various drug-talk styles over time (i.e., situated direct, ongoing direct, situated indirect, ongoing indirect, never talked), messages adolescents hear from parents, and comparisons of alcohol, cigarette, and marijuana use by drug-talk style. This study advances an understanding of parent-adolescent communication about substances and holds practical implications for drug prevention efforts.
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Affiliation(s)
- Jonathan Pettigrew
- Department of Communication Arts & Sciences, The Pennsylvania State University
- Now at Hugh Downs School of Human Communication, Arizona State University
| | - Michelle Miller-Day
- Department of Communication Arts & Sciences, The Pennsylvania State University
- Now at Department of Communication Studies, Chapman University
| | - Young Ju Shin
- Department of Communication Arts & Sciences, The Pennsylvania State University
- Now at Hugh Downs School of Human Communication, Arizona State University
| | | | - Michael L. Hecht
- Department of Communication Arts & Sciences, The Pennsylvania State University
- REAL Prevention, LLC
| | - John W. Graham
- REAL Prevention, LLC
- Department of Biobehavioral Health, The Pennsylvania State University
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44
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Harle CA, Golembiewski EH, Rahmanian KP, Krieger JL, Hagmajer D, Mainous AG, Moseley RE. Patient preferences toward an interactive e-consent application for research using electronic health records. J Am Med Inform Assoc 2017; 25:360-368. [PMID: 29272408 DOI: 10.1093/jamia/ocx145] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/07/2017] [Accepted: 11/17/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess patient perceptions of using an interactive electronic consent (e-consent) application when deciding whether or not to grant broad consent for research use of their identifiable electronic health record (EHR) information. MATERIALS AND METHODS For this qualitative study, we conducted a series of 42 think-aloud interviews with 32 adults. Interview transcripts were coded and analyzed using a modified grounded theory approach. RESULTS We identified themes related to patient preferences, reservations, and mixed attitudes toward consenting electronically; low- and high-information-seeking behavior; and an emphasis on reassuring information, such as data protections and prohibitions against sharing data with pharmaceutical companies. Participants expressed interest in the types of information contained in their EHRs, safeguards protecting EHR data, and specifics on studies that might use their EHR data. DISCUSSION This study supports the potential value of interactive e-consent applications that allow patients to customize their consent experience. This study also highlights that some people have concerns about e-consent platforms and desire more detailed information about administrative processes and safeguards that protect EHR data used in research. CONCLUSION This study contributes new insights on how e-consent applications could be designed to ensure that patients' information needs are met when seeking consent for research use of health record information. Also, this study offers a potential electronic approach to meeting the new Common Rule requirement that consent documents contain a "concise and focused" presentation of key information followed by more details.
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Affiliation(s)
- Christopher A Harle
- Department of Health Policy and Management, Indiana University, Indianapolis, IN, USA
| | | | - Kiarash P Rahmanian
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
| | - Janice L Krieger
- Department of Advertising, University of Florida, Gainesville, FL, USA
| | - Dorothy Hagmajer
- Department of Advertising, University of Florida, Gainesville, FL, USA
| | - Arch G Mainous
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA.,Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Ray E Moseley
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
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Flood-Grady E, Clark VC, Bauer A, Morelli L, Horne P, Krieger JL, Nelson DR. Evaluating the Efficacy of a Registry linked to a Consent to Re-Contact Program and Communication Strategies for Recruiting and Enrolling Participants into Clinical Trials. Contemp Clin Trials Commun 2017; 8:62-66. [PMID: 29503877 PMCID: PMC5831259 DOI: 10.1016/j.conctc.2017.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Although registries can rapidly identify clinical study participants, it is unknown which follow up methods for recruiting are most effective. Our goal is to examine the efficacy of three communication strategies for recruiting and enrolling patients who were identified via a contact registry (i.e., registry linked to a consent to re-contact program). METHODS Patients who met the study criteria were identified via the contact registry and targeted for recruitment. In condition 1, patients established in the university hepatology specialty clinics were contacted one time via phone call by the study coordinator and asked to participate (C1). In condition 2, non-established specialty clinic patients were mailed an IRB-approved letter with study information and instructions for calling the study coordinator to participate (C2). Condition 2A included patients who called within two weeks of receiving the letter (C2A); condition 2B included patients who did not call after receiving the letter but were subsequently contacted via phone call. RESULTS A registry identified 1,060 patients, of which 661were eligible and targeted for recruiting. All 37 patients were reached in C1 and 17 (45.9%) were recruited. Nineteen of the 624 patients in C2A were reached and 10 were recruited whereas 120 of the 605 patients in C2B were reached and 53 (8.7%) were recruited. Seventy patients enrolled with C2B being the most effective (total, cost) recruitment strategy (n = 50) (p < .001). CONCLUSION The efficacy of enrolling patients identified via a contact registry into clinical trials varies based on the communication strategies used for recruiting.
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Affiliation(s)
- Elizabeth Flood-Grady
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
- Clinical and Translational Science Institute (CTSI), University of Florida, Gainesville, FL, United States
| | - Virginia C. Clark
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
| | - Angie Bauer
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
| | - Lauren Morelli
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
| | - Patrick Horne
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
| | - Janice L. Krieger
- STEM Translational Communication Center, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
- Clinical and Translational Science Institute (CTSI), University of Florida, Gainesville, FL, United States
- Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL, United States
- Department of Health Outcomes and Policy, College of Medicine, University of Florida, Gainesville, FL, United States
| | - David R. Nelson
- Clinical and Translational Science Institute (CTSI), University of Florida, Gainesville, FL, United States
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition Section of Hepatobiliary Diseases and Liver Transplantation, University of Florida, United States
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Paige SR, Krieger JL, Stellefson M, Alber JM. Corrigendum to "eHealth literacy in chronic disease patients: An item response theory analysis of the eHealth literacy scale (eHEALS)" [Patient Educ. Counseling 100 (2) (February 2017) 320-326]. Patient Educ Couns 2017; 100:2362. [PMID: 28803754 DOI: 10.1016/j.pec.2017.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Samantha R Paige
- University of Florida, Department of Health Education and Behavior, PO Box 118210, Gainesville, FL 32611, USA.
| | - Janice L Krieger
- University of Florida, STEM Translational Communication Center, 2024 Weimer Hall, Gainesville, FL 32611, USA
| | - Michael Stellefson
- University of Florida, Department of Health Education and Behavior, PO Box 118210, Gainesville, FL 32611, USA
| | - Julia M Alber
- University of Pennsylvania, Center for Health Behavior Research,110 Blockley Hall, Philadelphia, PA 19104, USA
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Abstract
Social media provide a unique channel for disseminating evidence-based information to diverse audiences and organizational and private stakeholders, thus facilitating a dialog about health and health risks. Guided by the social amplification of risk framework, the goal of this study was to assess the level of audience engagement with messages posted on the National Cancer Institute (NCI) Facebook page and evaluate the differences in the audience information behavior toward risk-related and non-risk posts. Data included 1,975 posts published on the NCI Facebook page as well as the corresponding 4,537 comments, 77,298 shares, and 145,462 likes. Links and images were the top two most frequent types of content for both risk-related and non-risk posts, but risk-related messages were more amplified through comments, shares, and likes. Comparing the modality of risk-related messages, videos, contrary to the prediction, were not more effective in attracting audience engagement than images. Finally, comments to risk-related posts did not repeat risk-related language suggesting that future studies should examine risk signal recognition and dissemination as separate behaviors. This study's findings emphasize the importance of focused investigation of message design strategies and message effects on the dissemination and amplification of communication related to health risks.
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Affiliation(s)
- Yulia A Strekalova
- a College of Journalism and Communications , University of Florida , Gainesville , Florida , USA
| | - Janice L Krieger
- a College of Journalism and Communications , University of Florida , Gainesville , Florida , USA
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Abstract
The current study uses a multiple goal theoretical perspective to explore how Somali immigrant families living in Ohio, USA, make decisions regarding whether to vaccinate their children against human papillomavirus (HPV)-a leading cause of cervical cancer. A focus was placed on the communication goals of parents in HPV vaccine discussions with their child and health care provider. Semi-structured interviews were audiotaped, transcribed, and analyzed using a grounded theory approach. Key themes are the implications of the vaccine for early sexual activity, confusion between HPV and HIV (human immunodeficiency virus), the perception that the HPV vaccine is unnecessary, uncertainty about the vaccine's efficacy and side effects, avoidance of parent-child communication about the vaccine, and a preference for framing the vaccine as a health promotion behavior. Framing the threat of HPV in the context of initiation of sexual activity, uncertainty regarding vaccine efficacy, and anticipated regret account for the inconsistency in HPV vaccine uptake among Somali parents. Clinicians should consider talking about HPV as a distal versus an immediate threat and HPV vaccine uptake as a health-promotion behavior rather than a sexually transmitted infection prevention behavior.
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Affiliation(s)
- Phokeng M Dailey
- School of Communication, The Ohio State University, 3041 Derby Hall, 154 North Oval Mall, Columbus, OH, 43210, USA.
| | - Janice L Krieger
- STEM Translational Communication Research Program, Department of Advertising, College of Journalism and Communications, University of Florida, Gainesville, FL, USA
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Krieger JL, Krok-Schoen JL, Dailey PM, Palmer-Wackerly AL, Schoenberg N, Paskett ED, Dignan M. Distributed Cognition in Cancer Treatment Decision Making: An Application of the DECIDE Decision-Making Styles Typology. Qual Health Res 2017; 27:1146-1159. [PMID: 27179018 DOI: 10.1177/1049732316645321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Distributed cognition occurs when cognitive and affective schemas are shared between two or more people during interpersonal discussion. Although extant research focuses on distributed cognition in decision making between health care providers and patients, studies show that caregivers are also highly influential in the treatment decisions of patients. However, there are little empirical data describing how and when families exert influence. The current article addresses this gap by examining decisional support in the context of cancer randomized clinical trial (RCT) decision making. Data are drawn from in-depth interviews with rural, Appalachian cancer patients ( N = 46). Analysis of transcript data yielded empirical support for four distinct models of health decision making. The implications of these findings for developing interventions to improve the quality of treatment decision making and overall well-being are discussed.
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Affiliation(s)
| | | | | | | | | | | | - Mark Dignan
- 4 University of Kentucky, Lexington, Kentucky, USA
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50
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Abstract
The National Cancer Institute (NCI) provides pertinent information about cancer prevention, treatment, and research advancements that is considered objective and accurate. NCI's presence on social media is an example of a growing effort in promoting and facilitating audience engagement with evidence-based information about health and cancer. However, it is unknown what strategies are most effective for engaging audiences via this communication platform. To evaluate this important question, we analyzed data on posts, associated comments, and meta-data from official NCI Facebook page between July 2010 and February 2015 (end of data collection). Results show that audience engagement is associated with the format of cancer-related social media posts. Specifically, posts with photos received significantly more likes, comments, and shares than videos, links, and status updates. The findings have important implications for how social media can be more effectively utilized to promote public engagement with important public health issues.
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Affiliation(s)
- Yulia A Strekalova
- College of Journalism and Communications, University of Florida, Weimer 2016, Gainesville, FL, 32610, USA.
| | - Janice L Krieger
- STEM Translational Communication Research Program, College of Journalism and Communications, University of Florida, Gainesville, FL, USA
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