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Koay WLA, Aware Y, Andine T, Cruz Figueroa GM, Selekman RE, Bryant Y, Rakhmanina NY. Patient Perspectives on Telehealth for HIV and Mental Health Care at a Pediatric and Adolescent HIV Clinic in Washington, DC. AIDS Behav 2024; 28:993-1001. [PMID: 37843684 DOI: 10.1007/s10461-023-04209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
Despite the scale-up of telehealth for children and youth living with HIV during the COVID-19 pandemic, their experience and interest in continued telehealth use in the future is unknown. We conducted a quality improvement project to identify areas for improvement of telehealth delivery to children and youth living with HIV and evaluate youth's experiences when using telehealth for mental health services. Children and youth living with HIV (up to 24 years) seen at a specialty HIV program during 2020-2021 were surveyed regarding technology access, telehealth knowledge, barriers to telehealth use and interest in future telehealth use for HIV care. Youth (12-<24 years) who used telehealth for mental health services were surveyed regarding their experiences. Data were analyzed using descriptive statistics. Of the 170 patients in care, we surveyed 103 children and youth living with HIV (median age 17.6 years, 88.3% Black, 52.4% female, 77.7% perinatally infected), of whom 69.9% had prior telehealth use for their clinical visit. Most patients had access to a device with internet (99%) and were interested in future telehealth use for HIV care (87.4%). Reasons for not wanting to use telehealth included privacy concerns, distrust, discomfort with telehealth, preferring in-person visits, technology access issues and needing translation services. Most youth (81%) surveyed regarding telehealth for mental health services were satisfied and very likely to recommend it to others. Despite some reported barriers to telehealth, there is a high desirability for continued telehealth use among children and youth receiving HIV care.
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Affiliation(s)
- Wei Li Adeline Koay
- Department of Pediatrics, Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA.
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA.
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
| | - Yashvi Aware
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Tsion Andine
- College of Medicine, Howard University, Washington, DC, USA
| | | | - Rachel E Selekman
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
- Division of Urology, Children's National Hospital, Washington, DC, USA
| | | | - Natella Y Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
- Elizabeth Glaser Pediatrics AIDS Foundation, Washington, DC, USA
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Kaswa R, De Villiers M. Primary health care providers' views on managing substance use among people living with HIV. Afr J Prim Health Care Fam Med 2023; 15:e1-e11. [PMID: 37782240 PMCID: PMC10476231 DOI: 10.4102/phcfm.v15i1.3984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/20/2023] [Accepted: 05/28/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The growing culture of substance use among people living with human immunodeficiency virus (PLWH) is a serious threat to the human immunodeficiency virus (HIV) pandemic. As the gatekeepers of comprehensive care, primary care providers are responsible for screening, assessing, and managing individuals who use substances. AIM This study aimed to evaluate primary care providers' views and approaches to substance use management among PLWH who attend primary care services in Mthatha. SETTING This study was conducted at Ngangelizwe and Mbekweni Community Health Centres (CHCs) in the Eastern Cape province's King Sabata Dalindyebo (KSD) sub-district municipality. METHODS This qualitative phenomenological study involved the views of primary care providers. This study included 32 primary health care (PHC) providers. All participants were female except one male with a mean age of 48.6 years (range 27-64 years). Semi-structured interviews were conducted until saturation of the theme was reached. Then, the data from the transcribed interview were analysed with a thematic framework. RESULTS Substance use among PLWH was reported to be associated with poor clinical outcomes and disruption of antiretroviral therapy (ART) adherence. The significant barriers reported for substance use management in PHC settings were a lack of resources, skilled providers and poor community participation. CONCLUSION Substance use management programmes are not commonly offered in PHC because of the lack of human and infrastructural resources, the lack of skilled providers and poor community engagement.Contribution: This study provides a context-specific PHC providers' approach to substance use management.
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Affiliation(s)
- Ramprakash Kaswa
- Department of Family Medicine and Rural Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa; and Division of Family Medicine and Primary Care, Faculty of Health Sciences, Stellenbosch University, Cape Town.
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Navarra AMD, Rosenberg MG, Gormley M, Bakken S, Fletcher J, Whittemore R, Gwadz M, Cleland C, Melkus GD. Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected (HIV+) Adolescents and Young Adults (AYA). AIDS Behav 2023; 27:1807-1823. [PMID: 36574184 PMCID: PMC9792943 DOI: 10.1007/s10461-022-03913-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 12/28/2022]
Abstract
Effective antiretroviral therapy (ART) adherence strategies for HIV+ adolescents and young adults (AYA) are needed to prevent HIV-related morbidity, mortality, and onward transmission. In the Adherence Connection for Counseling, Education, and Support (ACCESS) pilot, an exploratory sequential mixed-methods design was used to develop and test a peer-led, mobile health (mHealth) cognitive behavioral ART adherence intervention. HIV+ AYA (ages 16-29 years) with unsuppressed plasma HIV RNA (HIV viral load) were eligible for this five-session intervention directed to improving ART adherence and HIV viral load. A total of 78 peer-led remote videoconferencing sessions (via WebEx) were delivered to 16 participants. High completion rates (97.5%) and client satisfaction scores (mean = 29.13 of 32; SD = 2.45) were observed. Self-reported ART adherence improved (32% increase in doses taken; 95th CI 11.2-53.3) with an annualized average rate of 47.5% (0.28 log10) reduction in HIV viral load. We established proof of concept for the ACCESS peer-led, mHealth cognitive behavioral ART adherence intervention, with promising adherence and virologic outcome data.
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Affiliation(s)
| | - Michael G Rosenberg
- Division of Infectious Diseases, Department of Pediatrics, Jacobi Medical Center, Bronx, NY, USA
| | - Maurade Gormley
- University of Connecticut, School of Nursing, Storrs, CT, USA
| | - Suzanne Bakken
- Columbia University School of Nursing, Columbia University, New York, NY, USA
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | | | - Marya Gwadz
- Silver School of Social Work, New York University, New York, NY, USA
| | - Charles Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Gail D'Eramo Melkus
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
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Gerke DR, Glotfelty J, Slovacek S, Freshman M, Schlueter J, Plax K. More than just Reminders: Using text Messaging to Improve HIV care Outcomes Among Youth and Young Adults Living with HIV. AIDS Behav 2023:10.1007/s10461-023-04022-2. [PMID: 36849570 DOI: 10.1007/s10461-023-04022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
This study evaluated engagement, satisfaction, and efficacy of an automated and live two-way text messaging intervention that linked youth and young adults at high risk for poor HIV outcomes to their medical case managers, with the aims of increasing viral load suppression rates and improving medical visit attendance. Participants (N = 100) were an average age of 22-23 years old. Most were Black (93%) and men who have sex with men (82%). A total of 89,681 automated text messages were sent to participants; and 62% of participants engaged in monthly text-message exchanges with medical case managers. McNemar's test results indicated that a significantly greater proportion of intervention participants were virally suppressed at 6 and 12 month follow-up than at enrollment. Adjusted odds ratio results showed a significant association between likelihood of achieving viral suppression at 6 and 12 months, and a greater number of participant responses to automated text messages. Future research should prospectively compare outcomes between usual care case management and usual care plus text-messaging to test for significant differences between groups.
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Affiliation(s)
- Donald R Gerke
- Graduate School of Social Work, University of Denver, Denver, CO, USA.
| | - Jeff Glotfelty
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Stacey Slovacek
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Maria Freshman
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Julia Schlueter
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Katie Plax
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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Goodyear T, Richardson C, Aziz B, Slemon A, Gadermann A, Daly Z, McAuliffe C, Pumarino J, Thomson KC, Jenkins EK. Mental distress and virtual mental health resource use amid the COVID-19 pandemic: Findings from a cross-sectional study in Canada. Digit Health 2023; 9:20552076231173528. [PMID: 37163172 PMCID: PMC10164262 DOI: 10.1177/20552076231173528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/14/2023] [Indexed: 05/11/2023] Open
Abstract
Objective This paper characterizes levels of mental distress among adults living in Canada amid the COVID-19 pandemic and examines the extent of virtual mental health resource use, including reasons for non-use, among adults with moderate to severe distress. Methods Data are drawn from a cross-sectional monitoring survey (29 November to 7 December 2021) on the mental health of adults (N = 3030) in Canada during the pandemic. Levels of mental distress were assessed using the Kessler Psychological Distress Scale. Descriptive statistics were used to examine virtual mental health resource use among participants with moderate to severe distress, including self-reported reasons for non-use. Results Levels of mental distress were classified as none to low (48.8% of participants), moderate (36.6%), and severe (14.6%). Virtual mental health resource use was endorsed by 14.2% of participants with moderate distress and 32% of those with severe distress. Participants with moderate to severe distress reported a range of reasons for not using virtual mental health resources, including not feeling as though they needed help (37.4%), not thinking the supports would be helpful (26.2%), and preferring in-person supports (23.4%), among other reasons. Conclusions This study identified a high burden of mental distress among adults in Canada during the COVID-19 pandemic alongside an apparent mismatch between actual and perceived need for support, including through virtual mental health resources. Findings on virtual mental health resource use, and reasons for non-use, offer directions for mental health promotion and health communication related to mental health literacy and the awareness and appropriateness of virtual mental health resources.
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Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Chris Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
| | - Bilal Aziz
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Allie Slemon
- School of Nursing, University of Victoria, Victoria, Canada
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Zachary Daly
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Corey McAuliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Javiera Pumarino
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kimberly C Thomson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Emily K Jenkins
- School of Nursing, University of British Columbia, Vancouver, Canada
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Arayasirikul S, Turner CM, Trujillo D, Maycott J, Wilson EC. The Dose Response Effects of Digital HIV Care Navigation on Mental Health and Viral Suppression Among Young People Living With HIV: Single-Arm, Prospective Study With a Pre-Post Design. J Med Internet Res 2022; 24:e33990. [PMID: 35849442 PMCID: PMC9345131 DOI: 10.2196/33990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The HIV epidemic has revealed considerable disparities in health among sexual and gender minorities of color within the Unites States, disproportionately affecting cisgender men who have sex with men (MSM) and trans women. Social inequities further disadvantage those with intersectional identities through homophobia, antitrans discrimination, and racism, shaping not only those at risk for HIV infection but also HIV prevention and care outcomes. Digital interventions have great potential to address barriers and improve HIV care among cisgender MSM and trans women; however, efficacy of digital HIV care interventions vary and need further examination. OBJECTIVE This study assessed the 12-month efficacy of a 6-month digital HIV care navigation intervention among young people living with HIV in San Francisco, California. We examined dose-response relationships among intervention exposure (eg, text messaging), viral suppression, and mental health. Health electronic navigation (eNav) is a 6-month, text message-based, digital HIV care navigation intervention, in which young people living with HIV are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. METHODS This study had a single-arm, prospective, pre-post design. Eligibility criteria for the study included the following: identifying as cisgender MSM or trans women, being between the ages of 18 and 34 years, being newly diagnosed with HIV, or not being engaged or retained in HIV care or having a detectable viral load. We assessed and analyzed sociodemographics, intervention exposure, and HIV care and mental health outcome data for participants who completed the 6-month Health eNav intervention. We assessed all outcomes using generalized estimating equations to account for within-subjects correlation, and marginal effects of texting engagement on all outcomes were calculated over the entire 12-month study period. Finally, we specified an interaction between texting engagement and time to evaluate the effects of texting engagement on outcomes. RESULTS Over the entire 12-month period, this study shows that every one-text increase in engagement was associated with an increased odds of undetectable viral load (adjusted odds ratio 1.01, 95% CI 1.00-1.02; P=.03). Mean negative mental health experiences decreased significantly at 12 months compared to baseline for every one-text increase in engagement (coefficient on interaction term 0.97, 95% CI 0.96-0.99; P<.01). CONCLUSIONS Digital care navigation interventions including Health eNav may be a critical component in the health delivery service system as the digital safety net for those whose social vulnerability is exacerbated in times of crisis, disasters, or global pandemics owing to multiple social inequities. We found that increased engagement in a digital HIV care navigation intervention helped improve viral suppression and mental health-intersecting comorbid conditions-6 months after the intervention concluded. Digital care navigation may be a promising, effective, sustainable, and scalable intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/16406.
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Affiliation(s)
- Sean Arayasirikul
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Caitlin M Turner
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Dillon Trujillo
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jarett Maycott
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
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Monaghan M, Bryant BL, Inverso H, Moore HR, Streisand R. Young Children with Type 1 Diabetes: Recent Advances in Behavioral Research. Curr Diab Rep 2022; 22:247-256. [PMID: 35435615 PMCID: PMC9013975 DOI: 10.1007/s11892-022-01465-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW This review provides a recent update of behavioral research pertinent to young children with T1D and addresses current priorities and future directions. RECENT FINDINGS Rates of type 1 diabetes (T1D) in young children (ages 1-7) are continuing to rise. Since 2014, changes to diabetes care and management have impacted young children and reinforced the need for increased attention and interventions to support diabetes management, especially in caregivers who are primarily responsible for their young child's diabetes management. T1D is associated with unique physiologic challenges in young children, with constant management demands elevating parental diabetes-related stress and fear of hypoglycemia. Diabetes technology use has significantly increased in young children, contributing to improvements in glycemic levels and parent and child psychosocial functioning. Yet despite the positive outcomes demonstrated in select clinical behavioral interventions, research with this young child age group remains limited in scope and quantity.
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Affiliation(s)
- Maureen Monaghan
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
- grid.253615.60000 0004 1936 9510George Washington University School of Medicine, Washington, DC USA
| | - Breana L. Bryant
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
| | - Hailey Inverso
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
| | - Hailey R. Moore
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
| | - Randi Streisand
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
- grid.253615.60000 0004 1936 9510George Washington University School of Medicine, Washington, DC USA
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McCray SH, Ward-Sutton C, Moore CL, Ole Koissaba BR, Starr R, Manyibe EO. A Scoping Review of Opioid Use Disorder Treatment Barriers and Telehealth for African Americans with Disabilities in Rural Communities. JOURNAL OF REHABILITATION 2022; 88:74-87. [PMID: 38528879 PMCID: PMC10961997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
This article provided a comprehensive overview of challenges that African Americans with disabilities residing in rural areas often face in the United States when accessing telehealth treatment to mitigate opioid misuse. A scoping literature review was conducted focusing on this target population, telehealth, disabilities, opioid treatment, and rural healthcare systems. Systematic searches on eight electronic databases were carried out in line with the study's aims. The results identified treatment benefits and advantages, expansion challenges, and multicultural considerations for telehealth delivery. There may be a need to increase rehabilitation research in this area to inform needed changes in policies and practice.
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Duffy M, Ghosh A, Geltman A, Mahaniah GK, Higgins-Biddle M, Clark M. Coordinating Systems of Care for HIV and Opioid Use Disorder: A Systematic Review of Enablers and Barriers to Integrated Service Access, and Systems and Tools Required for Implementation. Med Care Res Rev 2021; 79:618-639. [PMID: 34634961 PMCID: PMC9397399 DOI: 10.1177/10775587211051182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Individuals who have HIV who also use drugs experience increased age-matched morbidity and mortality in comparison with those with HIV who do not use drugs. A systematic review was conducted to describe models of integrated HIV and opioid use disorder (OUD) services, enablers of and barriers to integrated service access, and the coordinated systems and tools at the state and service delivery levels required for implementation. Database searches yielded 235 candidate articles, of which 22 studies met the inclusion criteria. Analysis found that integrated programs operated with minimal coordinated policy and systems guidance at the state level. Service delivery systems and tools used for integration, including use of integrated protocols, risk assessment tools, case management tools, and referral systems, were similar across integration models. Concerted efforts to coordinate state-level systems and develop supportive policies, guidelines, and standardized tools may facilitate integration at the service delivery level.
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Affiliation(s)
- Malia Duffy
- JSI Research & Training Institute, Inc., Boston, MA, USA
| | - Anna Ghosh
- JSI Research & Training Institute, Inc., Boston, MA, USA
| | - Ana Geltman
- JSI Research & Training Institute, Inc., Boston, MA, USA
| | | | | | - Michele Clark
- JSI Research & Training Institute, Inc., Boston, MA, USA
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Abebe SY, Goldsby EA, Renbarger KM. Telehealth for Pregnant Women With Opioid Use Disorder: A Theory-Based Approach. J Psychosoc Nurs Ment Health Serv 2021; 58:13-20. [PMID: 33238022 DOI: 10.3928/02793695-20201112-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pregnant women with opioid use disorder (OUD) face barriers to receiving substance use treatment and prenatal care, which can lead to adverse health outcomes. The purpose of the current article is to inform practice through the design of an innovative, nurse-led approach derived from King's Theory of Goal Attainment to care for pregnant women with OUD using telehealth technologies. The practice model encompasses King's theory using telehealth by addressing perceptions in the nurse-client interaction, establishing effective communication in nurse-client interactions, building mutual goal setting and decision making, and promoting clients' goal attainment using nurses' knowledge and skills. This theory-based approach using telehealth technologies can provide nurses the opportunity to increase effectiveness in nurse-client interactions, use evidence-based communication strategies for expanded access, and deliver safe care for pregnant women with OUD. [Journal of Psychosocial Nursing and Mental Health Services, 58(12), 13-20.].
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Lockhart E, Turner D, Ficek J, Livingston T, Logan RG, Marhefka SL. Understanding Technology Fit Among People with HIV Based on Intersections of Race, Sex, and Sexual Behavior: An Equitable Approach to Analyzing Differences Across Multiple Social Identities. AIDS Behav 2021; 25:2618-2629. [PMID: 33751311 PMCID: PMC7982513 DOI: 10.1007/s10461-021-03223-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/25/2022]
Abstract
HIV disproportionately impacts individuals based on intersecting categories (e.g. gender, race/ethnicity, behavior), with groups most at-risk deemed priority populations. Using weighted effects coding to account for differential group sizes, this study used multilevel mixed logistic models to investigate differences in eHealth use and willingness to use eHealth for HIV-related information among priority populations. Compared to the sample average, Black men who had sex with women were less likely to use all technologies except cellphones with text-messaging and less likely to be willing to use computers and tablets. White and Hispanic men who had sex with men were more likely to use all technologies. No significant differences existed for use or willingness to use cellphones with text-messaging. Future research should consider approaches used here to account for equity and multiple intersecting social identities; practitioners may use these findings or similar local data to ensure fit between eHealth programs and priority populations.
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Affiliation(s)
- Elizabeth Lockhart
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - DeAnne Turner
- Yale AIDS Prevention Training Program (Y-APT), Center for Interdisciplinary Research On AIDS (CIRA), Yale University, 135 College St. Suite 200, New Haven, CT, 06510, USA
| | - Joseph Ficek
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL, 33612, USA
| | - Taylor Livingston
- University of Nebraska-Lincoln, 816 Oldfather Hall, Lincoln, NE, 68588-0368, USA
| | | | - Stephanie L Marhefka
- College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd., Tampa, FL, 33612, USA.
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Chai PR, Bustamante MJ, Goodman G, Mohamed Y, Najarro J, Sullivan MC, Castillo-Mancilla J, Coyle RP, Mayer KH, Rosen RK, Baumgartner SL, Alpert PE, Boyer EW, O'Cleirigh C. A Brief Training Program to Support the Use of a Digital Pill System for Medication Adherence: Pilot Descriptive Study. JMIR Form Res 2021; 5:e26213. [PMID: 33890863 PMCID: PMC8105755 DOI: 10.2196/26213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/04/2021] [Accepted: 04/09/2021] [Indexed: 01/31/2023] Open
Abstract
Background Digital pill systems (DPSs), which comprise ingestible radiofrequency sensors integrated into a gelatin capsule that overencapsulates a medication, can directly measure ingestion events. Objective Teaching users to operate a DPS is vital to ensure the collection of actionable ingestion and adherence data. In this study, we aim to develop and pilot a training program, grounded in the Technology Acceptance Model, to instruct individuals on DPS operation. Methods A two-part training program, comprising in-person and text message–based components, was used with HIV-negative men who have sex with men with nonalcohol substance use, who had enrolled in a 90-day pilot demonstration study using the DPS to measure adherence to pre-exposure prophylaxis. We assessed the number of responses to text check-ins, the number and types of episodes where technical support was requested, the resolutions of such issues, and engagement with the program over the study period. Participant feedback on the program was evaluated through qualitative user experience interviews. Results A total of 15 participants were enrolled in and completed the program. Seven technical challenges related to DPS operations were reported across 5 participants. Most commonly, participants requested support connecting the wearable Reader device with their smartphone, charging the Reader, and operating the mobile app. A total of 6 issues were resolved asynchronously or in real time via phone; 1 required in-person evaluation and resolution. Preliminary qualitative findings indicate that both the in-person and remote follow-up components of the training program were perceived as acceptable. Suggested improvements included repeated DPS refresher sessions at in-person follow-up visits and enhanced written materials for the independent resolution of technological issues. Conclusions A brief two-part DPS training program, drawing from individuals’ experiences and from the Technology Acceptance Model, can provide valuable insights for users. The program also identifies and addresses several areas of actual or potential challenges related to operating a DPS and allows for the resolution of such issues within the first week of DPS use.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.,The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,The Fenway Institute, Boston, MA, United States.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States
| | | | - Georgia Goodman
- The Fenway Institute, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Matthew C Sullivan
- The Fenway Institute, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Jose Castillo-Mancilla
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan P Coyle
- Division of Infectious Disease, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, United States.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Rochelle K Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | | | | | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States.,The Fenway Institute, Boston, MA, United States
| | - Conall O'Cleirigh
- The Fenway Institute, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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13
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McCuistian C, Wootton AR, Legnitto-Packard D, Gruber VA, Dawson-Rose C, Johnson MO, Saberi P. Addressing HIV care, mental health and substance use among youth and young adults in the Bay Area: description of an intervention to improve information, motivation and behavioural skills. BMJ Open 2021; 11:e042713. [PMID: 38058024 PMCID: PMC8039246 DOI: 10.1136/bmjopen-2020-042713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Youth represent a population disparately impacted by the HIV epidemic. With most new HIV diagnoses occurring among adolescents and young adults, novel approaches to address this disparity are necessary. The objective of the current study was to describe the Youth to Telehealth and Text to Improve Engagement in Care (Y2TEC) intervention, which aims to fill this gap. The Y2TEC intervention (trial registration NCT03681145) offers an innovative approach to improve HIV treatment engagement among youth living with HIV by focusing on treatment barriers related to mental health and substance use. This allows for a holistic approach to providing culturally informed intervention strategies for this population. PARTICIPANTS AND SETTING The Y2TEC intervention was developed for youth with HIV in the large metropolitan area of the San Francisco Bay Area. The Y2TEC intervention was developed based on formative interdisciplinary research and is grounded in the information-motivation-behavioural skills model. RESULTS The intervention includes 12 sessions each lasting 20-30 minutes, which are delivered through videoconferencing and accompanying bidirectional text messaging. The intervention sessions are individualised, with session dosage in each major content area determined by participant's level of acuity. CONCLUSIONS The Y2TEC intervention is well positioned to help decrease HIV-related disparities in youth living with HIV through its innovative use of video-counselling technologies and an integrated focus on HIV, mental health and substance use.
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Affiliation(s)
- Caravella McCuistian
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Angie R Wootton
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Dominique Legnitto-Packard
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Valerie A Gruber
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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14
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Borghouts J, Eikey E, Mark G, De Leon C, Schueller SM, Schneider M, Stadnick N, Zheng K, Mukamel D, Sorkin DH. Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. J Med Internet Res 2021; 23:e24387. [PMID: 33759801 PMCID: PMC8074985 DOI: 10.2196/24387] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Background Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
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Affiliation(s)
| | - Elizabeth Eikey
- University of California San Diego, San Diego, CA, United States
| | - Gloria Mark
- University of California Irvine, Irvine, CA, United States
| | | | | | | | - Nicole Stadnick
- University of California San Diego, San Diego, CA, United States
| | - Kai Zheng
- University of California Irvine, Irvine, CA, United States
| | - Dana Mukamel
- University of California Irvine, Irvine, CA, United States
| | - Dara H Sorkin
- University of California Irvine, Irvine, CA, United States
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15
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Jackman KMP, Kane J, Kharrazi H, Johnson RM, Latkin C. Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study. J Med Internet Res 2021; 23:e18750. [PMID: 33565987 PMCID: PMC7935249 DOI: 10.2196/18750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/24/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight examining constructs of innovation attributes and performance expectations as key determinants of behavioral intentions and the use of new web-based health technologies. However, behavioral intentions to use patient portals for HIV and other STI prevention and care among SMM is understudied. Objective The aim of this study is to develop a brief instrument for measuring attitudes focused on using patient portals for STI prevention and care among a nationwide sample of SMM. Methods A total of 12 items of the American Men’s Internet Survey-Patient Portal Sexual Health Instrument (AMIS-PPSHI) were adapted from a previous study. Psychometric analyses of the AMIS-PPSHI items were conducted among a randomized subset of 2018 AMIS participants reporting web-based access to their health records (N=1375). Parallel analysis and inspection of eigenvalues in a principal component analysis (PCA) informed factor retention in exploratory factor analysis (EFA). After EFA, Cronbach α was used to examine the internal consistency of the scale and its subscales. Confirmatory factor analysis (CFA) was used to assess the goodness of fit of the final factor structure. We calculated the total AMIS-PPSHI scale scores for comparisons within group categories, including age, STI diagnosis history, recency of testing, serious mental illness, and anticipated health care stigma. Results The AMIS-PPSHI scale resulting from EFA consisted of 12 items and had good internal consistency (α=.84). The EFA suggested 3 subscales: sexual health engagement and awareness (α=.87), enhancing dyadic communication (α=.87), and managing sexual health care (α=.79). CFA demonstrated good fit in the 3-factor PPSHI structure: root mean square error of approximation=0.061, comparative fit index=0.964, Tucker-Lewis index=0.953, and standardized root mean square residual=0.041. The most notable differences were lower scores on the enhanced dyadic communication subscale among people living with HIV. Conclusions PPSHI is a brief instrument with strong psychometric properties that may be adapted for use in large surveys and patient questionnaires in other settings. Scores demonstrate that patient portals are favorable web-based solutions to deliver health services focused on STI prevention and care among SMM in the United States. More attention is needed to address the privacy implications of interpersonal use of patient portals outside of traditional health settings among persons with HIV.
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Affiliation(s)
- Kevon-Mark P Jackman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, NY, NY, United States
| | - Hadi Kharrazi
- Department of Health Policy and Management, Center for Population Health IT, Johns Hopkins Bloomberg School of Public Health, Batimore, MD, United States
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Blooomberg School of Public Health, Baltimore, MD, United States
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16
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Saberi P, McCuistian C, Agnew E, Wootton AR, Legnitto Packard DA, Dawson-Rose C, Johnson MO, Gruber VA, Neilands TB. Video-Counseling Intervention to Address HIV Care Engagement, Mental Health, and Substance Use Challenges: A Pilot Randomized Clinical Trial for Youth and Young Adults Living with HIV. TELEMEDICINE REPORTS 2021; 2:14-25. [PMID: 33575683 PMCID: PMC7869821 DOI: 10.1089/tmr.2020.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 05/04/2023]
Abstract
Background: Substance use and mental health are two barriers to engagement in care and antiretroviral therapy (ART) adherence among youth and young adults living with HIV (YLWH). The consequences of suboptimal adherence in YLWH are increased risk of HIV transmission and a future generation of immunodeficient adults with drug-resistant virus. Methods: The Youth to Telehealth and Texting for Engagement in Care (Y2TEC) study was a pilot randomized crossover trial that examined the feasibility and acceptability of a novel video-counseling series and accompanying text messages aimed at mental health, substance use, and HIV care engagement for YLWH. The intervention consisted of twelve 20-30-min weekly video-counseling sessions focused on identifying and addressing barriers to HIV care, mental health, and substance use challenges. Participants completed quantitative surveys at baseline, 4 months, and 8 months. Feasibility and acceptability were evaluated using prespecified benchmarks. Results: Fifty YLWH aged 18-29 years living in the San Francisco Bay Area were enrolled. Eighty-six percent and 75% of participants were retained at 4 and 8 months, respectively. A total of 455 (76%) video-counseling sessions were completed. In 82% of sessions, participants responded that they strongly agreed/agreed with this statement: "I felt heard, understood, and respected by the counselor." In 81% of sessions, participants responded that they strongly agreed/agreed with this statement: "Overall, today's session was right for me." At baseline, among participants reporting mental health challenges, only 10% noted having ever received mental health services, and among those who reported substance use challenges, ∼19% reported ever receiving substance use services. After 4 months of the Y2TEC intervention, participants reported slightly higher ART adherence and HIV knowledge, decreased depression and anxiety, and reduced stigma related to mental health and substance use. Conclusions: The Y2TEC intervention using video-counseling and text messaging was feasible and acceptable for YLWH. ClinicalTrials.gov ID: NCT03681145.
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Affiliation(s)
- Parya Saberi
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
- Address correspondence to: Parya Saberi, PharmD, MAS, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, UCSF Box 0886, 550 16th Street, 3rd Floor, San Francisco, CA 94143, USA
| | - Caravella McCuistian
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Emily Agnew
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Angie R. Wootton
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Dominique A. Legnitto Packard
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Carol Dawson-Rose
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Mallory O. Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - Valerie A. Gruber
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA
| | - Torsten B. Neilands
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
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17
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Saberi P. Research in the Time of Coronavirus: Continuing Ongoing Studies in the Midst of the COVID-19 Pandemic. AIDS Behav 2020; 24:2232-2235. [PMID: 32303924 PMCID: PMC7165077 DOI: 10.1007/s10461-020-02868-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Parya Saberi
- Center for AIDS Prevention Studies, University of California San Francisco, UCSF, Box 0886, San Francisco, CA, 94143, USA.
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