Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data

Community engagement in the development of health-related data visualizations: a scoping review

OBJECTIVE

This scoping review aims to address a gap in the literature on community engagement in developing data visualizations intended to improve population health. The review objectives are to: (1) synthesize literature on the types of community engagement activities conducted by researchers working with community partners and (2) characterize instances of "creative data literacy" within data visualizations developed in community-researcher partnerships.

METHODS

Using the 2018 PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, the review focuses on peer-reviewed journal articles from 2010 to 2022 in PubMed, Web of Science, and Google Scholar. A community engagement tool was applied to the studies by independent reviewers to classify levels of community engagement, social determinants, and vulnerable populations.

RESULTS

Twenty-seven articles were included in the scoping review. Twelve articles worked with vulnerable populations. Four articles attempted to alleviate barriers to representation in their respective studies, with addressing language barriers being the most prevalent approach. Thirteen articles considered social determinants of health. Sixteen studies engaged in iterative approaches with intended users when developing the visualization or tool.

DISCUSSION

Only a few significant examples of creative data literacy are incorporated in the studies. We recommend a specific focus on engaging intended users at every step of the development process, addressing language and cultural differences, and empowering intended users as data storytellers.

CONCLUSIONS

There is room for deeper and more meaningful community involvement in the development of health-related data visualizations geared towards them.

Developing, optimizing, and evaluating patient infographics for diagnosing cardiac amyloidosis

Objective

Advancements in diagnostics and treatment options for cardiac amyloidosis have improved patient outcomes, yet few patient education materials exist to help patients understand the disease and diagnosis process. We sought to develop and evaluate a set of plain language, patient-centered infographics describing the condition and common diagnostic tests.

Methods

Using health literacy best practices, we developed 7 infographics which were further revised based on multilevel stakeholder feedback. To evaluate the materials, we recruited 100 patients from healthcare settings in Chicago, IL; participants completed a web-assisted interview during which they were randomized 1:1 to first view either our infographics or a standard material. Participants completed a knowledge assessment on their assigned material and subsequently reported impressions of both materials.

Results

No differences were found between study arms in knowledge. The infographics took significantly less time to read and were more highly rated by participants in terms of appearance and understandability. Over two-thirds of participants preferred the infographics to the standard.

Conclusions

The infographics created may improve the learning process about a complex condition and diagnosis process unknown to most adults.

Innovation

These infographics are the first of their kind for cardiac amyloidosis and were created using health literacy best practices.

Feasibility, Acceptability and Appropriateness of MedViewer: A Novel Hair-Based Antiretroviral Real-Time Clinical Monitoring Tool Providing Adherence Feedback to Patients and Their Providers

Antiretroviral therapy (ART) adherence is key to achieving viral load suppression and ending the HIV epidemic but monitoring and supporting adherence using current interventions is challenging. We assessed the feasibility, acceptability and appropriateness of MedViewer (MV), a novel intervention that provides real-time adherence feedback for patients and providers using infra-red matrix-assisted laser desorption electrospray ionization (IR-MALDESI) for mass spectrometry imaging of daily ART concentrations in patients' hair. We used mixed methods to feasibility test MV at a busy Infectious Diseases (ID) clinic, enrolling 16 providers and 36 patients. Providers underwent standardized training; patients and providers watched an 8-min informational video about MV. We collected patient and provider data at baseline and within 24 h of clinic visits and, with patients, approximately 1 month after clinic visits. MedViewer was feasible, liked by patients and providers, and perceived to help facilitate adherence conversations and motivate patients to improve adherence. Trial Registration: NCT04232540.

Mass spectrometry imaging of hair identifies daily maraviroc adherence in HPTN 069/ACTG A5305

Objective measures of adherence for antiretrovirals used as pre-exposure prophylaxis (PrEP) are critical for improving preventative efficacy in both clinical trials and real-world application. Current objective adherence measures either reflect only recent behavior (eg days for plasma or urine) or cumulative behavior (eg months for dried blood spots). Here, we measured the accumulation of the antiretroviral drug maraviroc (MVC) in hair strands by infrared matrix-assisted laser desorption electrospray ionization (IR-MALDESI) mass spectrometry imaging (MSI) to evaluate adherence behavior longitudinally at high temporal resolution. An MSI threshold for classifying daily adherence was established using clinical samples from healthy volunteers following directly observed dosing of 1 to 7 doses MVC/week. We then used the benchmarked MSI assay to classify adherence to MVC-based PrEP regimens in hair samples collected throughout the 48-week HPTN069/ACTGA5305 study. We found that only ~32% of investigated hair samples collected during the study's active dosing period showed consistent daily PrEP adherence throughout a retrospective period of 30 days, and also found that profiles of daily individual adherence from MSI hair analysis could identify when patients were and were not taking study drug. The assessment of adherence from MSI hair strand analysis was 62% lower than adherence classified using paired plasma samples, the latter of which may be influenced by white-coat adherence. These findings demonstrate the ability of MSI hair analysis to examine daily variability of adherence behavior over a longer-term measurement and offer the potential for longitudinal comparison with risk behavior to target patient-specific adherence interventions and improve outcomes.

Investigation of a Novel Activity-Based Checks (ABC) Functional Pain Scale in the Post-Operative Urologic Surgery Patient

Introduction

The authors investigated a novel functional pain scale, the Activity-Based Checks (ABCs) of Pain, following open urologic surgery. The primary objectives were to establish the strength of the correlation between the ABCs and the numeric rating scale (NRS) and determine the impact of functional pain on the patient's opioid requirements. We hypothesized that ABC score would correlate strongly with NRS and that the ABC score during hospitalization would be more closely correlated with the number of opioids prescribed and used.

Methods

This prospective study included patients at a tertiary academic hospital undergoing nephrectomy and cystectomy. The NRS and ABCs were collected pre-operatively, during the inpatient stay, and at the one-week follow-up. Milligrams of morphine equivalents (MMEs) prescribed at discharge and the MME reportedly taken during the first post-operative week were recorded. Spearman's Rho was used to assess the correlation between scale variables.

Results

Fifty-seven patients were enrolled. The ABCs correlated strongly with the NRS at baseline and post-operative appointments (r = 0.716, p < 0.001 and 0.643, p < 0.001). Neither the NRS nor the composite ABCs score was predictive of outpatient MME requirements; the ABCs function, "Walking outside the room" significantly correlated to MMEs taken after discharge (r = 0.471, p = 0.011). The greatest predictor of MMEs taken was the number of MMEs prescribed (0.493, p = 0.001).

Conclusions

This study highlighted the importance of post-operative pain assessment that takes functional pain into consideration to evaluate pain, inform management decisions, and reduce opiate reliance. It also emphasized the strong relationship between opioids prescribed and opioids consumed.

Working with Data in Adult English Classrooms: Lessons Learned about Communicative Justice during the COVID-19 Pandemic

Throughout COVID-19, health officials have relied on data visualizations to communicate urgent messages about the spread of the virus and preventative measures. Relatively few efforts have employed participatory engagement with communities who have experienced a disproportionate burden of COVID-19 illness to shape these communications. Sociologist W.E.B. Du Bois viewed data visualization as an approach to changing the way people think about themselves. This paper describes a community-engaged approach to data literacy skill-building with bilingual Latina learners in an adult English program in Northern California, Bay Area. The curriculum combines data visualization activities with language instruction and preventive health themes. Early work on COVID-19 in 2020-21 emphasized improving health knowledge and message interpretation but later shifted to a critical data literacy perspective, focusing on myth-busting, improving risk messaging in their own social networks, and supporting learners to see the power of their own experiences in data story-telling processes. This pedagogical approach, guided by Charles Brigg's idea of communicative justice priorities, locates adult learners' data visualization work as part of a broader effort to be included in the perspectives that shape knowledge production in today's healthcare system. This approach can be used to examine disparities in information access in linguistically minoritized communities and guide future education interventions.

Mass Spectroscopy Imaging of Hair Strands Captures Short-Term and Long-Term Changes in Emtricitabine Adherence

Most measures of adherence to antiretroviral therapy require a blood sample, and none capture longitudinal daily adherence. A new noninvasive method for measuring daily adherence to antiretroviral regimens containing emtricitabine (FTC) was developed for intact hair strands using infrared matrix-assisted laser desorption electrospray ionization (IR-MALDESI) mass spectrometry imaging (MSI). A directly observed therapy study of daily and intermittent (3, 1, and 0 doses/week) FTC dosing (n = 12) benchmarked adherence in hair, revealing distinct accumulation patterns and median FTC signal abundance (1,702, 495, 352, and 0, respectively) with each dosing frequency. A threshold value of FTC_{signal abundance} of 500 differentiated daily dosing from 3 or fewer doses/week (specificity, 100%; sensitivity, 100% over 30 days and 80% over 60 days). Using these criteria, daily FTC hair adherence was classified in young men (n = 8) who have sex with men (YMSM) engaged in or initiating preexposure prophylaxis (PrEP). Four types of adherence profiles were observed in sequential 30-day periods: consistently high, occasional missed doses, improvement following study initiation, and intermittent. Discrete days of nonadherence were identified across the 60-day window, with the average number of consecutive days classified as nonadherent increasing across the four profile types (1, 2, 19, and 58 days, respectively). Additionally, cumulative FTC response in hair (60-day average) significantly correlated with dried blood spot tenofovir diphosphate concentrations collected simultaneously (r_s = 0.79, P = 0.03). Based on these data, IR-MALDESI FTC adherence classification in hair strands can better delineate short-term changes in adherence behaviors over a long retrospective window, offering great potential for noninvasive adherence monitoring and quick supportive interventions.

Preference for and understanding of graphs presenting health risk information. The role of age, health literacy, numeracy and graph literacy

OBJECTIVE

To investigate 1) younger (< 65) and older (> 65) adults' preference for and understanding of graph formats presenting risk information, and 2) the contribution of age, health literacy, numeracy and graph literacy in understanding information.

MATERIALS AND METHODS

To assess preferences, participants (n = 219 < 65 and n = 227>65) were exposed to a storyboard presenting six types of graphs. Understanding (verbatim and gist knowledge) was assessed in an experiment using a 6 (graphs: clock, bar, sparkplug, table, pie vs pictograph) by 2 (age: younger [<65] vs older [>65]) between-subjects design.

RESULTS

Most participants preferred clock, pie or bar chart. Pie was not well understood by both younger and older people, and clock not by older people. Bar was fairly well understood in both groups. Table yielded high knowledge scores, particularly in the older group. Lower age, higher numeracy and higher graph literacy contributed to higher verbatim knowledge scores. Higher health literacy and graph literacy were associated with higher gist knowledge.

DISCUSSION AND CONCLUSION

Although not the preferred format, tables are best understood by older adults.

PRACTICE IMPLICATIONS

Graph literacy skills are essential for both verbatim and gist understanding, and are important to take into account when developing risk information.

Presenting time-based risks of stroke and death for Patients facing carotid stenosis treatment options: Patients prefer pie charts over icon arrays

OBJECTIVE

To user-test graphical display formats (icon arrays, pie, bar, and line charts) to identify preferred formats and metrics ('probability of death or stroke' or 'proportion of time lived without death or stroke') in order to display time-dependent risks of stroke or death for three carotid stenosis treatments: endarterectomy (surgery), stenting, and medical therapy.

METHODS

Iterative cycles of semi-structured interviews with patients recruited from a Vascular Clinic.

RESULTS

A total of 27 patients (mean age = 68; range: 50-85) were interviewed over four cycles. Patients strongly preferred the pie chart over icon arrays, and over bar or line graphs. The preference was based on patient recognition of the time-based increase in risk for stroke or death for treatment options. Patients preferred data presented as probabilities instead of the proportion of time lived. We did not assess patients' understanding.

CONCLUSION

Patients preferred the pie chart formats and reported better realization that risks increase with time for each option and that tradeoffs exist when surgery has a higher short-term risk than medical therapy.

PRACTICE IMPLICATIONS

There remains debate on how best to convey time-dependent risk information to patients, especially where low literacy and numeracy might exist.