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Dinh M, Lin CC, Whitfield C, Farhan Z, Meurer WJ, Bailey S, Skolarus LE. Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial. JMIR Form Res 2024; 8:e54010. [PMID: 38805251 DOI: 10.2196/54010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease-related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. OBJECTIVE The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. METHODS Reach Out was a randomized, controlled, mobile health-based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message-linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). RESULTS Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. CONCLUSIONS Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. TRIAL REGISTRATION ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718.
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Affiliation(s)
- Mackenzie Dinh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Chun Chieh Lin
- Division of Health Services Research, Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Candace Whitfield
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Zahera Farhan
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Bailey
- Bridges into the Future, Flint, MI, United States
| | - Lesli E Skolarus
- Davee Department of Neurology, Northwestern University, Chicago, IL, United States
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Heaton-Shrestha C, Hanson K, Quirke-McFarlane S, Delaney N, Vandrevala T, Bearne L. Exploring how members of the public access and use health research and information: a scoping review. BMC Public Health 2023; 23:2179. [PMID: 37936117 PMCID: PMC10629152 DOI: 10.1186/s12889-023-16918-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Making high-quality health and care information available to members of the general public is crucial to support populations with self-care and improve health outcomes. While attention has been paid to how the public accesses and uses health information generally (including personal records, commercial product information or reviews on healthcare practitioners and organisations) and how practitioners and policy-makers access health research evidence, no overview exists of the way that the public accesses and uses high quality health and care information. PURPOSE This scoping review aimed to map research evidence on how the public accesses and uses a specific type of health information, namely health research and information that does not include personal, product and organisational information. METHODS Electronic database searches [CINAHL Plus, MEDLINE, PsycInfo, Social Sciences Full Text, Web of Science and SCOPUS] for English language studies of any research design published between 2010-2022 on the public's access and use of health research or information (as defined above). Data extraction and analysis was informed by the Joanna Briggs Institute protocol for scoping reviews, and reported in accordance with the PRISMA extension for scoping reviews. RESULTS The search identified 4410 records. Following screening of 234 full text studies, 130 studies were included. One-hundred-and-twenty-nine studies reported on the public's sources of health-research or information; 56 reported the reasons for accessing health research or information and 14 reported on the use of this research and information. The scoping exercise identified a substantial literature on the broader concept of 'health information' but a lack of reporting of the general public's access to and use of health research. It found that 'traditional' sources of information are still relevant alongside newer sources; knowledge of barriers to accessing information focused on personal barriers and on independent searching, while less attention had been paid to barriers to access through other people and settings, people's lived experiences, and the cultural knowledge required. CONCLUSIONS The review identified areas where future primary and secondary research would enhance current understanding of how the public accesses and utilises health research or information, and contribute to emerging areas of research.
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Affiliation(s)
- Celayne Heaton-Shrestha
- Kingston University, Faculty of Health, Science, Social Care and Education, Kingston-upon-Thames, KT27LB, UK
| | - Kristin Hanson
- Kingston University, Faculty of Health, Science, Social Care and Education, Kingston-upon-Thames, KT27LB, UK
| | | | - Nancy Delaney
- Guy's and St Thomas' NHS Foundation Trust, Department of Physiotherapy, London, SE1 7EH, UK
| | - Tushna Vandrevala
- Kingston University, Faculty of Health, Science, Social Care and Education, Kingston-upon-Thames, KT27LB, UK
| | - Lindsay Bearne
- Kingston University, Faculty of Health, Science, Social Care and Education, Kingston-upon-Thames, KT27LB, UK.
- St George's, University of London, Population Health Research Institute, 1st Floor Jenner Wing, Cranmer Terrace, London, SW17 0RE, UK.
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Radu I, Scheermesser M, Spiess MR, Schulze C, Händler-Schuster D, Pehlke-Milde J. Digital Health for Migrants, Ethnic and Cultural Minorities and the Role of Participatory Development: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6962. [PMID: 37887700 PMCID: PMC10606156 DOI: 10.3390/ijerph20206962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
Digital health interventions (DHIs) are increasingly used to address the health of migrants and ethnic minorities, some of whom have reduced access to health services and worse health outcomes than majority populations. This study aims to give an overview of digital health interventions developed for ethnic or cultural minority and migrant populations, the health problems they address, their effectiveness at the individual level and the degree of participation of target populations during development. We used the methodological approach of the scoping review outlined by Tricco. We found a total of 2248 studies, of which 57 were included, mostly using mobile health technologies, followed by websites, informational videos, text messages and telehealth. Most interventions focused on illness self-management, mental health and wellbeing, followed by pregnancy and overall lifestyle habits. About half did not involve the target population in development and only a minority involved them consistently. The studies we found indicate that the increased involvement of the target population in the development of digital health tools leads to a greater acceptance of their use.
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Affiliation(s)
- Irina Radu
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Mandy Scheermesser
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Martina Rebekka Spiess
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Christina Schulze
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Daniela Händler-Schuster
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
- UMIT TIROL Institute for Nursing Science, Private University of Health Sciences and Health Technology, 6060 Hall in Tirol, Austria
- School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington 6012, New Zealand
| | - Jessica Pehlke-Milde
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
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Nair US, Kue J, Athilingam P, Rodríguez CS, Menon U. Application of the ConNECT Framework to achieve digital health equity. Nurs Outlook 2023; 71:101991. [PMID: 37302261 DOI: 10.1016/j.outlook.2023.101991] [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: 01/01/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The emphasis on digital technology and informatics in health care (digital health) has introduced innovative ways to deliver health care and engage populations in health research. However, inadequate attention to the development and implementation of digital health interventions can exacerbate health disparities. PURPOSE We applied the transdisciplinary ConNECT Framework principles within the context of digital health, with an aim to describe strategies to achieve digital health equity. METHODS We described the five ConNECT principles of (a) integrating context, (b) fostering a norm of inclusion, (c) ensuring equitable diffusion of innovations, (d) harnessing communication technology, and (e) prioritizing specialized training within the framework of achieving digital health equity. FINDINGS AND DISCUSSION We describe proactive, actionable strategies for the systematic application of the ConNECT Framework principles to address digital health equity. Recommendations to reduce the digital health divide in nursing research and practice are also described.
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Affiliation(s)
- Uma S Nair
- College of Nursing, University of South Florida, Tampa, FL.
| | - Jennifer Kue
- College of Nursing, University of South Florida, Tampa, FL
| | | | | | - Usha Menon
- College of Nursing, University of South Florida, Tampa, FL
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McCrimmon J, Widman L, Javidi H, Brasileiro J, Hurst J. Evaluation of a Brief Online Sexual Health Program for Adolescents: A Randomized Controlled Trial. Health Promot Pract 2023:15248399231162379. [PMID: 37013260 DOI: 10.1177/15248399231162379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Adolescents are at increased risk of acquiring sexually transmitted infections (STIs) and experiencing unintended pregnancy. In particular, adolescents from marginalized communities experience significant sexual health disparities compared to their more advantaged peers. Digital sexual health programs, such as HEART (Health Education and Relationship Training), may be effective in reducing these risks and addressing these disparities. HEART is a web-based intervention focused on the promotion of positive sexual health outcomes, such as sexual decision-making skills, sexual communication skills, sexual health knowledge, and sexual norms and attitudes. The current study evaluates the efficacy of HEART, and examines whether effects were moderated by gender, socioeconomic status (SES), race, English as a second language, and sexual orientation to ensure the program is effective for diverse groups of adolescents. Participants were 457 high school students (Meanage=15.06, 59% girls, 35% White, 78% heterosexual, 54% receive free or reduced-price lunch). Students were randomized to HEART or an attention matched control and assessed at pretest and immediate posttest. HEART was effective in increasing sexual assertiveness, sexual communication intentions, HIV/STI knowledge, condom attitudes, and safer sex self-efficacy compared to the control condition. There were no significant interactions by gender, SES, race, English as a second language, or sexual orientation, suggesting the program worked equally well for all groups of youth. The findings of this study suggest that HEART may be a promising avenue for the promotion of positive sexual health outcomes for diverse groups of youth.
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Affiliation(s)
| | - Laura Widman
- North Carolina State University, Raleigh, NC, USA
| | - Hannah Javidi
- Indiana University Bloomington, Bloomington, IN, USA
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Hodges JC, Calvo R. Teleservices use among Latinx immigrant families during the Covid-19 pandemic. CHILDREN AND YOUTH SERVICES REVIEW 2023; 145:106778. [PMID: 36575705 PMCID: PMC9780638 DOI: 10.1016/j.childyouth.2022.106778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/09/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Remote services are a promising option to reduce access to services inequities among underserved populations, such as immigrants families. There is evidence that Latinx immigrant families have used teleservices at lower rates than other families during the pandemic. This research explored the factors that prevented Latinxs immigrant families from engaging in teleservices during the Covid-19 pandemic. Using an inductive thematic approach, we interviewed 21 providers of services and key informants who worked with Latinxs families. Nonparticipation was driven by services unawareness, documentation requirements, a digital divide, and safety concerns. Implications for policy and practice concerning the implementation of remote services for immigrant families are discussed.
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Affiliation(s)
- James C Hodges
- Boston College, School of Social Work, 304 McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, United States
| | - Rocío Calvo
- Boston College, School of Social Work, 304 McGuinn Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, United States
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Wileden L, Anthony D, Campos-Castillo C, Morenoff J. Resident Willingness to Participate in Digital Contact Tracing in a COVID-19 Hotspot: Findings From a Detroit Panel Study. JMIR Public Health Surveill 2023; 9:e39002. [PMID: 36240029 PMCID: PMC9855617 DOI: 10.2196/39002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/06/2022] [Accepted: 10/13/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Digital surveillance tools and health informatics show promise in counteracting diseases but have limited uptake. A notable illustration of the limits of such tools is the general failure of digital contact tracing in the United States in response to COVID-19. OBJECTIVE We investigated the associations between individual characteristics and the willingness to use app-based contact tracing in Detroit, a majority-minority city that experienced multiple waves of COVID-19 outbreaks and deaths since the start of the pandemic. The aim of this study was to examine variations among residents in the willingness to download a contact tracing app on their phones to provide public health officials with information about close COVID-19 contact during summer 2020. METHODS To examine residents' willingness to participate in digital contact tracing, we analyzed data from 2 waves of the Detroit Metro Area Communities Study, a population-based survey of Detroit, Michigan residents. The data captured 1873 responses from 991 Detroit residents collected in June and July 2020. We estimated a series of multilevel logit models to gain insights into differences in the willingness to participate in digital contact tracing across a variety of individual attributes, including race/ethnicity, degree of trust in the government, and level of education, as well as interactions among these variables. RESULTS Our results reflected widespread reluctance to participate in digital contact tracing in response to COVID-19, as less than half (826/1873, 44.1%) of the respondents said they would be willing to participate in app-based contact tracing. Compared to White respondents, Black (odds ratio [OR] 0.45, 95% CI 0.23-0.86) and Latino (OR 0.32, 95% CI 0.11-0.99) respondents were significantly less willing to participate in digital contact tracing. Trust in the government was positively associated with the willingness to participate in digital contact tracing (OR 1.17, 95% CI 1.07-1.27), but this effect was the strongest for White residents (OR 2.14, 95% CI 1.55-2.93). We found similarly divergent patterns of the effects of education by race. While there were no significant differences among noncollege-educated residents, White college-educated residents showed greater willingness to use app-based contact tracing (OR 6.12, 95% CI 1.86-20.15) and Black college-educated residents showed less willingness (OR 0.46, 95% CI 0.26-0.81). CONCLUSIONS Trust in the government and education contribute to Detroit residents' wariness of digital contact tracing, reflecting concerns about surveillance that cut across race but likely arise from different sources. These findings point to the importance of a culturally informed understanding of health hesitancy for future efforts hoping to leverage digital contact tracing. Though contact tracing technologies have the potential to advance public health, unequal uptake may exacerbate disparate impacts of health crises.
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Affiliation(s)
- Lydia Wileden
- Mansueto Institute for Urban Innovation, University of Chicago, Chicago, IL, United States
- Division of the Social Sciences, University of Chicago, Chicago, IL, United States
| | - Denise Anthony
- Department of Health Management & Policy, School of Public Health, University of Michigan, Ann Arbor, MI, United States
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Department of Sociology, University of Michigan, Ann Arbor, MI, United States
| | - Celeste Campos-Castillo
- Department of Media & Information, Michigan State University, East Lansing, MI, United States
| | - Jeffrey Morenoff
- Department of Sociology, University of Michigan, Ann Arbor, MI, United States
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, United States
- Population Studies Center, University of Michigan, Ann Arbor, MI, United States
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Richwine C, Johnson C, Patel V. Disparities in patient portal access and the role of providers in encouraging access and use. J Am Med Inform Assoc 2023; 30:308-317. [PMID: 36451262 PMCID: PMC9846679 DOI: 10.1093/jamia/ocac227] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to identify racial and ethnic disparities in patient portal offers, access, and use and to examine the role of providers in facilitating access to electronic health information (EHI) by offering patient portals and encouraging their use. MATERIALS AND METHODS Using nationally representative survey data from 2019 and 2020 (N = 8028), we examined disparities in patients being offered access to a portal by their provider and differences in subsequent access and use. Using multivariable models, we estimated the effect of race and ethnicity on the likelihood of being offered, accessing or using a portal. Among those offered, we examined the relationship between provider encouragement and portal access; and for those who did not access their portal, we explored reasons for nonuse. RESULTS Black and Hispanic individuals were offered and accessed patient portals at significantly lower rates than White individuals. Compared to Whites, Black and Hispanic individuals were 5.2 percentage-points less likely to be offered a portal (P < .05) and, among those offered, 7.9 percentage-points less likely to access their portal (P < .05). Black and Hispanic individuals who were offered and accessed a portal were 12 percentage-points more likely than Whites to use it to download or transmit information (P < .01). Individuals who were offered a portal and encouraged to use it were 21 percentage-points more likely to access it. DISCUSSION Differences in patient portal access and use are likely driven by disparities in which groups of patients reported being offered a portal. CONCLUSIONS Providers play an important role in increasing access to EHI by facilitating access to patient portals.
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Affiliation(s)
- Chelsea Richwine
- Office of the National Coordinator for Health Information Technology, Office of Technology, Washington, District of Columbia, USA
| | - Christian Johnson
- Office of the National Coordinator for Health Information Technology, Office of Technology, Washington, District of Columbia, USA
| | - Vaishali Patel
- Office of the National Coordinator for Health Information Technology, Office of Technology, Washington, District of Columbia, USA
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MyLynch: A Patient-Facing Clinical Decision Support Tool for Genetically-Guided Personalized Medicine in Lynch Syndrome. Cancers (Basel) 2023; 15:cancers15020391. [PMID: 36672340 PMCID: PMC9856567 DOI: 10.3390/cancers15020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
Lynch syndrome (LS) is a hereditary cancer susceptibility condition associated with varying cancer risks depending on which of the five causative genes harbors a pathogenic variant; however, lifestyle and medical interventions provide options to lower those risks. We developed MyLynch, a patient-facing clinical decision support (CDS) web application that applies genetically-guided personalized medicine (GPM) for individuals with LS. The tool was developed in R Shiny through a patient-focused iterative design process. The knowledge base used to estimate patient-specific risk leveraged a rigorously curated literature review. MyLynch informs LS patients of their personal cancer risks, educates patients on relevant interventions, and provides patients with adjusted risk estimates, depending on the interventions they choose to pursue. MyLynch can improve risk communication between patients and providers while also encouraging communication among relatives with the goal of increasing cascade testing. As genetic panel testing becomes more widely available, GPM will play an increasingly important role in patient care, and CDS tools offer patients and providers tailored information to inform decision-making. MyLynch provides personalized cancer risk estimates and interventions to lower these risks for patients with LS.
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Pregnant Through the COVID-19 Chaos: Insights on How Women Use Information in the Perinatal Period During a Pandemic. CLIN NURSE SPEC 2022; 36:298-308. [PMID: 36279491 PMCID: PMC9560905 DOI: 10.1097/nur.0000000000000705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To gain insights in how women use technology to address health information needs during the prenatal and postpartum time frame.
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Byrne KA, Ghaiumy Anaraky R. Identifying Racial and Rural Disparities of Cognitive Functioning Among Older Adults: The Role of Social Isolation and Social Technology Use. J Gerontol B Psychol Sci Soc Sci 2022; 77:1779-1790. [PMID: 35312775 PMCID: PMC9535781 DOI: 10.1093/geronb/gbac055] [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: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Social isolation is associated with poorer cognitive outcomes among older adults. The use of online social technology platforms may provide a means to reduce social isolation. However, research examining whether social technology can mitigate the negative effects of social isolation on cognitive functioning is limited. This study investigates the interaction between social isolation and social technology use on cognitive functioning among older adults and seeks to identify racial and rural-urban differences in this relationship. METHOD Data were obtained from the Health and Retirement Study 2014-2018 waves (N = 5,358). Participants (aged 50-102) completed self-report measures of social isolation, loneliness, and frequency of online social communication and completed the modified Telephone Interview for Cognitive Status, which assesses cognitive functioning. Examinations of race focused on differences between Black/African American and White/Caucasian groups; rurality was operationalized using Beale Rural-Urban Continuum Codes. Data were analyzed using structural equation models. RESULTS Social technology use moderated the negative relationship between social isolation and cognitive functioning, controlling for age, education, gender, wealth, and general computer usage. Greater social technology use was associated with better cognitive functioning among socially isolated older adults. Results showed evidence of racial, but not rural-urban, differences in the relationship between social technology use and cognitive functioning. Regardless of the degree of social isolation, frequent social technology use was associated with improved cognitive functioning in Black/African American older adults but not White/Caucasians older adults. DISCUSSION Social technology may represent a way to mitigate cognitive decline, particularly among Black/African American older adults.
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Affiliation(s)
- Kaileigh A Byrne
- Address correspondence to: Clemson University, 418 Brackett Hall, Clemson, SC 29634, USA. E-mail:
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DeWitt A, Kientz J, Coker TR, Liljenquist K. mHealth Technology Design and Evaluation for Early Childhood Health Promotion: Systematic Literature Review. JMIR Pediatr Parent 2022; 5:e37718. [PMID: 36201391 PMCID: PMC9585442 DOI: 10.2196/37718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent increases in smartphone ownership among underserved populations have inspired researchers in medicine, computing, and health informatics to design and evaluate mobile health (mHealth) interventions, specifically for those supporting child development and growth. Although these interventions demonstrate possible effectiveness at larger scales, few of these interventions are evaluated to address racial disparities and health equity, which are known factors that affect relevance, uptake, and adherence in target populations. OBJECTIVE In this study, we aimed to identify and document the current design and evaluation practices of mHealth technologies that promote early childhood health, with a specific focus on opportunities for those processes to address health disparities and health equity. METHODS We completed a systematic literature review of studies that design and evaluate mHealth interventions for early childhood health promotion. We then analyzed these studies to identify opportunities to address racial disparities in early- and late-stage processes and to understand the potential efficacy of these interventions. RESULTS Across the literature from medical, computing, and health informatics fields, we identified 15 articles that presented a design or evaluation of a parent-facing health intervention. We found that using mobile-based systems to deliver health interventions was generally well accepted by parents of children aged <5 years. We also found that, when measured, parenting knowledge of early childhood health topics and confidence to engage in health-promoting behaviors improved. Design and evaluation methods held internal consistency within disciplines (eg, experimental study designs were the most prevalent in medical literature, while computing researchers used user-centered design methods in computing fields). However, there is little consistency in design or evaluation methods across fields. CONCLUSIONS To support more interventions with a comprehensive design and evaluation process, we recommend attention to design at the intervention (eg, reporting content sources) and system level; interdisciplinary collaboration in early childhood health intervention development can lead to large-scale deployment and success among populations. TRIAL REGISTRATION PROSPERO CRD42022359797; https://tinyurl.com/586nx9a2.
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Affiliation(s)
- Akeiylah DeWitt
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Julie Kientz
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Tumaini R Coker
- Seattle Childrens Research Institute, Seattle, WA, United States
| | - Kendra Liljenquist
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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White-Williams C, Liu X, Shang D, Santiago J. Use of Telehealth Among Racial and Ethnic Minority Groups in the United States Before and During the COVID-19 Pandemic. Public Health Rep 2022; 138:149-156. [PMID: 36113138 PMCID: PMC9482875 DOI: 10.1177/00333549221123575] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has propelled the use of technology for health care services delivery. Because of inequities in health care and technology access, we investigated the use of telehealth services among racial and ethnic minority groups before and during the COVID-19 pandemic. METHODS For this retrospective study, we examined the electronic health records of privately insured patients in the Healthjump database, provided by the COVID-19 Research Database Consortium. We examined 17.98 million unique visit records of 2.93 million patients from March through December 2019 and 22.17 million records of 3.55 million patients from March through December 2020. We conducted a descriptive analysis and used multiple logistic regression to examine differences in the use of telehealth services among 3 racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic people. RESULTS Telehealth visits before and during COVID-19 accounted for 8.3% and 10.9% of total visits, respectively, with a peak of 15.5% in April 2020. Pre-COVID-19, Hispanic patients had a significantly lower monthly utilization rate (5.3%) than non-Hispanic White patients (8.4%, P < .001) and non-Hispanic Black patients (10.4%, P = .001). During the pandemic study period, Hispanic patients were 41% less likely than non-Hispanic White patients to have a telehealth visit, controlling for age and sex. CONCLUSIONS The likelihood of using telehealth was lower among Hispanic patients than among non-Hispanic White and non-Hispanic Black patients during the pandemic. Culturally sensitive measures are needed to support telehealth use among the Hispanic population.
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Affiliation(s)
- Cynthia White-Williams
- Center for Aging Research, Brooks College of Health, University of North Florida, Jacksonville, FL, USA,School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, USA,Cynthia White-Williams, PhD, MHA, PT, University of Central Florida, School of Global Health Management and Informatics, 12494 University Blvd, Orlando, FL 32816, USA.
| | - Xinliang Liu
- Department of Community and Population Health, Lehigh University, Bethlehem, PA, USA
| | - Di Shang
- Coggin College of Business, University of North Florida, Jacksonville, FL, USA
| | - Jared Santiago
- Center for Aging Research, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
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14
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Community-based, cluster-randomized pilot trial of a cardiovascular mHealth intervention: Rationale, design, and baseline findings of the FAITH! Trial. Am Heart J 2022; 247:1-14. [PMID: 35065922 PMCID: PMC9037298 DOI: 10.1016/j.ahj.2022.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Compared to whites, African-Americans have lower prevalence of ideal cardiovascular health (CVH) based on the American Heart Association Life's Simple 7 (LS7). These CVH inequities have worsened during the COVID-19 pandemic. Ideal LS7 health-promoting behaviors and biological risk factors (eg, diet, blood pressure) are associated with improved CVH outcomes. The FAITH! (Fostering African-American Improvement in Total Health) App, a community-informed, mobile health (mHealth) intervention, previously demonstrated significant improvements in LS7 components among African-Americans, suggesting that mHealth interventions may be effective in improving CVH. This paper presents the FAITH! Trial design, baseline findings, and pandemic-related lessons learned. METHODS Utilizing a community-based participatory research approach, this study assessed the feasibility/preliminary efficacy of a refined FAITH! App for promoting LS7 among African-Americans in faith communities using a cluster, randomized controlled trial. Participants received the FAITH! App (immediate intervention) or were assigned to a delayed intervention comparator group. Baseline data were collected via electronic surveys and health assessments. Primary outcomes are change in LS7 score from baseline to 6-months post-intervention and app engagement/usability. RESULTS Of 85 enrolled individuals, 76 completed baseline surveys/health assessments, for a participation rate of 89% (N = 34 randomized to the immediate intervention, N = 42 to delayed intervention). At baseline, participants were predominantly female (54/76, 71%), employed (56/76, 78%) and of high cardiometabolic risk (72/76, 95% with hypertension and/or overweight/obesity) with mean LS7 scores in the poor range (6.8, SD = 1.9). CONCLUSIONS The FAITH! Trial recruitment was feasible, and its results may inform the use of mHealth tools to increase ideal CVH among African-Americans.
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15
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Ford KL, West AB, Bucher A, Osborn CY. Personalized Digital Health Communications to Increase COVID-19 Vaccination in Underserved Populations: A Double Diamond Approach to Behavioral Design. Front Digit Health 2022; 4:831093. [PMID: 35493533 PMCID: PMC9051039 DOI: 10.3389/fdgth.2022.831093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/25/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic exacerbated pre-existing health disparities. People of historically underserved communities, including racial and ethnic minority groups and people with lower incomes and educational attainments, experienced disproportionate premature mortality, access to healthcare, and vaccination acceptance and adoption. At the same time, the pandemic increased reliance on digital devices, offering a unique opportunity to leverage digital communication channels to address health inequities, particularly related to COVID-19 vaccination. We offer a real-world, systematic approach to designing personalized behavior change email and text messaging interventions that address individual barriers with evidence-based behavioral science inclusive of underserved populations. Integrating design processes such as the Double Diamond model with evidence-based behavioral science intervention development offers a unique opportunity to create equitable interventions. Further, leveraging behavior change artificial intelligence (AI) capabilities allows for both personalizing and automating that personalization to address barriers to COVID-19 vaccination at scale. The result is an intervention whose broad component library meets the needs of a diverse population and whose technology can deliver the right components for each individual.
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16
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Resnick D, Kearney MD, Smith JM, Bautista A, Jones L, Schapira MM, Aysola J. Designing a Cancer Prevention Collaborative Goal-Setting Mobile App for Non-Hispanic Black Primary Care Patients: An Iterative, Qualitative Patient-Led Process. JMIR Form Res 2022; 6:e28157. [PMID: 35323124 PMCID: PMC8990368 DOI: 10.2196/28157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There remains a need to engage at-risk primary care populations in cancer prevention behaviors, yet primary care physicians often lack the time or resources to discuss these behaviors with their patients. OBJECTIVE The objective of this study is to evaluate the content, usability, and acceptability of a mobile app that leverages insights from goal-setting and social network literature to facilitate cancer prevention goal setting, tracking, and sharing between non-Hispanic Black primary care patients and their social ties. METHODS We recruited eligible non-Hispanic Black primary care patients (aged ≥18 years) from 2 practice sites in West Philadelphia, using nonprobabilistic purposive sampling. We conducted semistructured interviews with 5 to 7 participants over 3 weeks to solicit feedback on paper mock-ups of the app, iteratively adapting these mock-ups after each set of interviews. Thereafter, and informed by initial feedback, we created an electronic beta version of the app and sought acceptability and usability feedback from a different set of participants. Then, we conducted content analysis of all user responses to search for unifying themes on acceptability and usability of both the initial mock-ups and beta version of the app. We further assessed app usability using questions derived from the System Usability Scale. RESULTS A total of 33 non-Hispanic Black primary care patients participated in this study. The mean age was 49 (SD 13) years, and 26 (79%) out of 33 participants identified as female. Semistructured interviews revealed three primary generalizable insights from our target population: the framing of each goal and its relevance to cancer impacted the likelihood that the goal would be chosen, participants thought that sharing health goals with others facilitates health behaviors, and most participants found it motivating to see other users' goal progress, while still collaborating with these users on their health goals. An overarching insight that permeated across each theme was the participants' desire to customize and personalize the app. Usability testing revealed that 100% (33/33) of participants found the app easy to use, and 76% (25/33) of participants reported that they would like to use this app frequently. CONCLUSIONS Cancer prevention in the modern era must include options that are accessible to all, but this does not mean that all options must be universal. This study's iterative process led to the development of a cancer prevention mobile app that non-Hispanic Black primary care patients deemed usable and acceptable and yielded noteworthy insights about what intended end users value in setting and accomplishing health goals.
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Affiliation(s)
- Daniel Resnick
- Department of Medicine, Emory University School of Medicine, Atalnta, GA, United States
| | - Matthew D Kearney
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jazmine M Smith
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Allison Bautista
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Liz Jones
- Transmogrify, Conshohocken, PA, United States
| | - Marilyn M Schapira
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,The Center for Health Equity Research and Promotion, Michael J Crescenz Veterans Administration Medical Center, Philadelphia, PA, United States
| | - Jaya Aysola
- Penn Medicine Center for Health Equity Advancement, Office of the Chief Medical Officer, University of Pennsylvania Health System and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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17
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Thompson TA, Northcraft D, Carrión F. Addressing Structural Inequities, a Necessary Step Toward Ensuring Equitable Access to Telehealth for Medication Abortion Care During and Post COVID-19. Front Glob Womens Health 2022; 3:805767. [PMID: 35368993 PMCID: PMC8967978 DOI: 10.3389/fgwh.2022.805767] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Telehealth, one of the newest health innovations, has been promoted as a tool to enhance access to health care services in ways that center patient needs. However, integrating telehealth within an inequitable health system undermines its potential. This perspective highlights policies and practices that foster structural inequities and names their impact on the use and acceptability of telehealth for medication abortion among specific communities of color. Communities of color have a higher prevalence of abortion use but face many barriers, including financial and geographic barriers, to abortion access. Preliminary evidence on telehealth for medication abortion shows that it is highly acceptable, accommodating of patient needs, and may allow patients to access abortion care at earlier gestational ages. However, evidence during the COVID-19 pandemic shows that utilization of telehealth is lower among communities of color. We describe how systemic barriers, including regulations on or laws banning telehealth for medication abortion, disinvestments in digital access, and restrictions on public insurance coverage, could perpetuate lower utilization of telehealth for medication abortion care among communities of color. We call for systems changes that will remove these barriers and make this health care innovation available to all who may desire it.
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Affiliation(s)
| | - Dana Northcraft
- Expanding Medication Abortion Access (EMAA) Project, Washington, DC, United States
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18
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Na L, Sheu JJ. Health and Information Disparities among Non-Adopters of Smartphones. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Byrne KA, Anaraky RG, Dye C, Ross LA, Chalil Madathil K, Knijnenburg B, Levkoff S. Examining Rural and Racial Disparities in the Relationship Between Loneliness and Social Technology Use Among Older Adults. Front Public Health 2021; 9:723925. [PMID: 34532308 PMCID: PMC8438168 DOI: 10.3389/fpubh.2021.723925] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/09/2021] [Indexed: 12/25/2022] Open
Abstract
Loneliness, the subjective negative experience derived from a lack of meaningful companionship, is associated with heightened vulnerability to adverse health outcomes among older adults. Social technology affords an opportunity to cultivate social connectedness and mitigate loneliness. However, research examining potential inequalities in loneliness is limited. This study investigates racial and rural-urban differences in the relationship between social technology use and loneliness in adults aged 50 and older using data from the 2016 wave of the Health and Retirement Study (N = 4,315). Social technology use was operationalized as the self-reported frequency of communication through Skype, Facebook, or other social media with family and friends. Loneliness was assessed using the UCLA Loneliness scale, and rural-urban differences were based on Beale rural-urban continuum codes. Examinations of race focused on differences between Black/African-American and White/Caucasian groups. A path model analysis was performed to assess whether race and rurality moderated the relationship between social technology use and loneliness, adjusting for living arrangements, age, general computer usage. Social engagement and frequency of social contact with family and friends were included as mediators. The primary study results demonstrated that the association between social technology use and loneliness differed by rurality, but not race. Rural older adults who use social technology less frequently experience greater loneliness than urban older adults. This relationship between social technology and loneliness was mediated by social engagement and frequency of social contact. Furthermore, racial and rural-urban differences in social technology use demonstrated that social technology use is less prevalent among rural older adults than urban and suburban-dwelling older adults; no such racial differences were observed. However, Black older adults report greater levels of perceived social negativity in their relationships compared to White older adults. Interventions seeking to address loneliness using social technology should consider rural and racial disparities.
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Affiliation(s)
- Kaileigh A. Byrne
- Department of Psychology, Clemson University, Clemson, SC, United States
| | - Reza Ghaiumy Anaraky
- Department of Human-Centered Computing, Clemson University, Clemson, SC, United States
| | - Cheryl Dye
- Department of Psychology, Clemson University, Clemson, SC, United States
| | - Lesley A. Ross
- Department of Psychology, Clemson University, Clemson, SC, United States
| | - Kapil Chalil Madathil
- Department of Civil Engineering, Clemson University, Clemson, SC, United States
- Department of Industrial Engineering, Clemson University, Clemson, SC, United States
| | - Bart Knijnenburg
- Department of Human-Centered Computing, Clemson University, Clemson, SC, United States
| | - Sue Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, United States
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20
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Nouri SS, Adler-Milstein J, Thao C, Acharya P, Barr-Walker J, Sarkar U, Lyles C. Patient characteristics associated with objective measures of digital health tool use in the United States: A literature review. J Am Med Inform Assoc 2021; 27:834-841. [PMID: 32364238 DOI: 10.1093/jamia/ocaa024] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/09/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The study sought to determine which patient characteristics are associated with the use of patient-facing digital health tools in the United States. MATERIALS AND METHODS We conducted a literature review of studies of patient-facing digital health tools that objectively evaluated use (eg, system/platform data representing frequency of use) by patient characteristics (eg, age, race or ethnicity, income, digital literacy). We included any type of patient-facing digital health tool except patient portals. We reran results using the subset of studies identified as having robust methodology to detect differences in patient characteristics. RESULTS We included 29 studies; 13 had robust methodology. Most studies examined smartphone apps and text messaging programs for chronic disease management and evaluated only 1-3 patient characteristics, primarily age and gender. Overall, the majority of studies found no association between patient characteristics and use. Among the subset with robust methodology, white race and poor health status appeared to be associated with higher use. DISCUSSION Given the substantial investment in digital health tools, it is surprising how little is known about the types of patients who use them. Strategies that engage diverse populations in digital health tool use appear to be needed. CONCLUSION Few studies evaluate objective measures of digital health tool use by patient characteristics, and those that do include a narrow range of characteristics. Evidence suggests that resources and need drive use.
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Affiliation(s)
- Sarah S Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Crishyashi Thao
- Center for Clinical Informatics and Improvement Research, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Prasad Acharya
- Chronic Disease Control Branch, Center for Healthy Communities, California Department of Public Health, Sacramento, California, USA
| | - Jill Barr-Walker
- Zuckerberg San Francisco General Hospital Library, University of California, San Francisco, San Francisco, California, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Courtney Lyles
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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21
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Kim HS, Kim HJ, Juon HS. Racial/Ethnic Disparities in Patient-Provider Communication and the Role of E-Health Use. JOURNAL OF HEALTH COMMUNICATION 2021; 26:194-203. [PMID: 33899688 DOI: 10.1080/10810730.2021.1919248] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Although the health care industry has strived to address racial/ethnic disparities in health communication, several gaps remain. Previous findings suggest that communication technology might help narrow the gaps; however, they do not provide a comprehensive picture of how or why. To answer these questions, we examined the potential role of communication technology in mitigating the racial/ethnic disparities in patient-provider communication. Data analysis of the 2018 Health Information National Trends Survey (N= 3,504) revealed that the levels of perceived quality of communication with health care providers were lower among Asians and Hispanics than non-Hispanic Whites while no difference emerged between Blacks and non-Hispanic Whites. Although the adoption of communication technology was relatively high across minority groups, its use appeared to play different roles in different racial/ethnic populations. The Internet and patient portals showed no particular associations with patient-provider communication except for Black Internet users, who reported poorer experiences with patient-provider communication than non-users. Among Asians and Hispanics, social media and mobile communication appeared to play different roles in impacting communication experiences with health care providers. The findings suggest that communication technologies need to be strategically utilized and tailored to better meet the communication needs of racial/ethnic minorities.
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Affiliation(s)
- Hyang-Sook Kim
- Department of Mass Communication, Towson University, Towson, Maryland, USA
| | - Hee Jun Kim
- College of Nursing, Ajou University, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Hee-Soon Juon
- Department of Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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22
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Brewer LC, Kumbamu A, Smith C, Jenkins S, Jones C, Hayes SN, Burke L, Cooper LA, Patten CA. A Cardiovascular Health and Wellness Mobile Health Intervention Among Church-Going African Americans: Formative Evaluation of the FAITH! App. JMIR Form Res 2020; 4:e21450. [PMID: 33200999 PMCID: PMC7709003 DOI: 10.2196/21450] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In light of the scarcity of culturally tailored mobile health (mHealth) lifestyle interventions for African Americans, we designed and pilot tested the Fostering African-American Improvement in Total Health (FAITH!) App in a community-based participatory research partnership with African American churches to promote cardiovascular health and wellness in this population. OBJECTIVE This report presents the results of a formative evaluation of the FAITH! App from participants in an intervention pilot study. METHODS We included 2 semistructured focus groups (n=4 and n=5) to explore participants' views on app functionality, utility, and satisfaction as well as its impact on healthy lifestyle change. Sessions were audio-recorded and transcribed verbatim, and qualitative data were analyzed by using general inductive analysis to generate themes. RESULTS In total, 6 overarching themes emerged among the 9 participants: overall impression, content usefulness, formatting, implementation, impact, and suggestions for improvement. Underpinning the themes was a high level of agreement that the intervention facilitated healthy behavioral change through cultural tailoring, multimedia education modules, and social networking. Suggestions for improvement were streamlining the app self-monitoring features, prompts to encourage app use, and personalization based on individuals' cardiovascular risk. CONCLUSIONS This formative evaluation found that the FAITH! App had high reported satisfaction and impact on the health-promoting behaviors of African Americans, thereby improving their overall cardiovascular health. Further development and testing of the app among African Americans is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT03084822; https://clinicaltrials.gov/ct2/show/NCT03084822.
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Affiliation(s)
- LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States.,Center for Healthy Equity and Community Engagement Research, Mayo Clinic, Rochester, MN, United States
| | - Ashok Kumbamu
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Christina Smith
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States
| | - Sarah Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | | | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Lora Burke
- School of Nursing, Department of Health and Community Systems, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lisa A Cooper
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States
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23
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Impact of a self-monitoring application on pediatric asthma disparities. Int J Med Inform 2020; 144:104294. [PMID: 33080504 DOI: 10.1016/j.ijmedinf.2020.104294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/27/2020] [Accepted: 10/01/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We previously reported improved outcomes after implementing the electronic-AsthmaTracker (e-AT), a self-monitoring tool for children with asthma, at 11 ambulatory pediatric clinics. This study assesses e-AT adherence and impact across race/ethnicity subgroups. STUDY DESIGN Secondary data analysis of a prospective cohort study of children ages 2-17 years with persistent asthma, enrolled from January 2014 to December 2015 to use the e-AT for 1 year. Survival analysis was used to compare e-AT use adherence and generalized estimating equation models to compare outcomes pre- and post e-AT initiation, between race/ethnicity subgroups. RESULTS Data from 318 children with baseline measurements were analyzed: 76.4 % white, 11.3 % Hispanic, 7.8 % "other", and 4.4 % unknown race/ethnicity subgroups. Mean e-AT adherence was 82 % (95 %CI: 79-84 %, reference) for whites, 73 % (64-81 %, p = 0.025) for Hispanics, and 78 % (69-86 %, p = 0.373) for other minorities. Compared to whites, Cox proportional hazard ratio for study dropout risk was 2.14 (1.31-3.77, p = 0.001) for Hispanics and 0.95 (0.60-1.50, p = 0.834) for other minorities. Disparities existed at baseline, with lower QOL (74.9 vs 80.6; p = 0.025) and asthma control (18.4 vs 19.7; p = 0.027) among Hispanics, compared to whites. After e-AT initiation, disparities disappeared at 3 months for QOL (87.2 vs 90.5; p = 0.159) and asthma control (23.1 vs 22.4; p = 0.063), persisting until study end. Disparities also existed at baseline, with lower QOL (74.6 vs. 80.6; p = 0.042) and asthma control (18.2 vs. 19.7, p = 0.024) among "other" minorities, compared to whites, and disappeared at 3 months for QOL (92.7 vs. 90.5, p = 0.432) and asthma control (22.7 vs 22.4; p = 0.518), persisting until study end. Subgroup analysis was underpowered to detect a difference in oral steroid use or ED/hospital admissions. CONCLUSIONS Our study shows improved asthma control and QOL among minorities and disparity elimination after e-AT implementation. Future adequately powered studies will explore the impact on oral steroid and ED/hospital use disparities.
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24
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Rodriguez-Villa E, Rauseo-Ricupero N, Camacho E, Wisniewski H, Keshavan M, Torous J. The digital clinic: Implementing technology and augmenting care for mental health. Gen Hosp Psychiatry 2020; 66:59-66. [PMID: 32688094 PMCID: PMC7324929 DOI: 10.1016/j.genhosppsych.2020.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/25/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
Increasing both access to and quality of mental healthcare is a global priority. One solution is to integrate technologies such as smartphone apps and sensors directly into care. Acknowledging many prior attempts and barriers, we introduce the Digital Clinic which is an already functioning clinic using smartphone apps to augment and extend care today at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts. In this piece, we outline the theoretical foundation of the Digital Clinic and its emphasis on the therapeutic alliance, measurement-based care, and shared decision making. We explore both workflow and engagement challenges as well as solutions including a new care team member, the Digital Navigator, and the customization of technology. Acknowledging that the Digital Clinic is an evolving program, we offer details on our implementation in order to allow others to replicate, expand on, and improve these initial efforts.
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Affiliation(s)
- Elena Rodriguez-Villa
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Natali Rauseo-Ricupero
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Erica Camacho
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Hannah Wisniewski
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America.
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25
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Prasad P, Branch M, Asemota D, Elsayed R, Addison D, Brown SA. Cardio-Oncology Preventive Care: Racial and Ethnic Disparities. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00650-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Sewell AA, Pingel ES. The dual contingencies of ethnoraciality: Status-context disparities in health information sources among sexual minorities. SOCIAL SCIENCE RESEARCH 2020; 87:102395. [PMID: 32279856 DOI: 10.1016/j.ssresearch.2019.102395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 06/11/2023]
Abstract
Researchers often explore health (care) beliefs as a function of individual characteristics; yet, few consider the role of context in shaping both beliefs and the behaviors that are informed by them. As a sociopolitical construct, ethnoraciality provides a concerning source of bias in studies of health (care) beliefs because it inhabits both individual and contextual forms. This study examines whether the ethnoracial context of the residential area where sexual minorities live is associated with a particular health (care) belief - sources of trustworthy health information - and considers how ethnoracial group membership status differentiates these ecological associations drawing on mediation and moderation models. Using data from the 2010 Social Justice Sexuality Project, our analysis shows that sexual minorities who live with high concentrations of Latinos and Whites are less likely to rely exclusively on medical professionals for trustworthy health information than those who live with high concentrations of Blacks. Moreover, exclusive reliance on medical professionals for health information among Black and Latino sexual minorities is stronger in co-ethnic communities (predominately Black and Latino areas, respectively). The analysis also documents status and contextual differentials and status-context contingencies of reliance on the Internet, social networks, and multiple agents ("triangulation") as sources of health information. Findings suggest that place-based co-ethnic networks may facilitate disease prevention among Black and Latino sexual minorities by improving the quality of their relationships with sick role gatekeepers and breaking down the silos of the medical complex. The study concludes by considering the value of a place-based approach to alleviating health disparities among sexual minorities vis-à-vis the health care system.
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Brewer LC, Fortuna KL, Jones C, Walker R, Hayes SN, Patten CA, Cooper LA. Back to the Future: Achieving Health Equity Through Health Informatics and Digital Health. JMIR Mhealth Uhealth 2020; 8:e14512. [PMID: 31934874 PMCID: PMC6996775 DOI: 10.2196/14512] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 09/05/2019] [Accepted: 10/16/2019] [Indexed: 12/12/2022] Open
Abstract
The rapid proliferation of health informatics and digital health innovations has revolutionized clinical and research practices. There is no doubt that these fields will continue to have accelerated growth and a substantial impact on population health. However, there are legitimate concerns about how these promising technological advances can lead to unintended consequences such as perpetuating health and health care disparities for underresourced populations. To mitigate this potential pitfall, it is imperative for the health informatics and digital health scientific communities to understand the challenges faced by disadvantaged groups, including racial and ethnic minorities, which hinder their achievement of ideal health. This paper presents illustrative exemplars as case studies of contextually tailored, sociotechnical mobile health interventions designed with community members to address health inequities using community-engaged research approaches. We strongly encourage researchers and innovators to integrate community engagement into the development of data-driven, modernized solutions for every sector of society to truly achieve health equity for all.
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Affiliation(s)
- LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | | | | | - Robert Walker
- Massachusetts Department of Mental Health, Boston, MA, United States
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Lisa A Cooper
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Brewer LC, Hayes SN, Caron AR, Derby DA, Breutzman NS, Wicks A, Raman J, Smith CM, Schaepe KS, Sheets RE, Jenkins SM, Lackore KA, Johnson J, Jones C, Radecki Breitkopf C, Cooper LA, Patten CA. Promoting cardiovascular health and wellness among African-Americans: Community participatory approach to design an innovative mobile-health intervention. PLoS One 2019; 14:e0218724. [PMID: 31430294 PMCID: PMC6701808 DOI: 10.1371/journal.pone.0218724] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/07/2019] [Indexed: 11/22/2022] Open
Abstract
Background Despite improvements in mortality rates over the past several decades, cardiovascular (CV) disease remains the leading cause of death for African-Americans (AAs). Innovative approaches through mobile health (mHealth) interventions have the potential to support lifestyle change for CV disease prevention among AAs. We aimed to translate a behavioral theory–informed, evidence-based, face-to-face health education program into an mHealth lifestyle intervention for AAs. We describe the design and development of a culturally relevant, CV health and wellness digital application (app) and pilot testing using a community-based participatory research (CBPR) approach with AA churches. Methods This mixed methods study used a 4-phase iterative development process for intervention design with the AA community. Phase 1 included focus groups with AA community members and church partners (n = 23) to gain insight regarding potential app end user preferences. In Phase 2, the interdisciplinary research team synthesized Phase 1 input for preliminary app design and content development. Phase 3 consisted of a sequential 3-meeting series with church partners (n = 13) for iterative app prototyping (assessment, cultural tailoring, final review). Phase 4, a single group pilot study among AA church congregants (n = 50), assessed app acceptability, usability, and satisfaction. Results Phase 1 focus groups indicated general and health-related apps preferences: multifunctional, high-quality graphics/visuals, evidence-based, yet simple health information and social networking capability. Phase 2 integrated these preferences into the preliminary app prototype. Phase 3 feedback was used to refine the app prototype for pilot testing. Phase 4 pilot testing indicated high app acceptability, usability, and satisfaction. Conclusions This study illustrates integration of formative and CBPR approaches to design a culturally relevant, mHealth lifestyle intervention to address CV health disparities among AAs. Given the positive app perceptions, our study supports the use of an iterative development process by others interested in implementing an mHealth lifestyle intervention for racial/ethnic minority communities. Trial registration Clinicaltrials.gov NCT03084822.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Amber R. Caron
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - David A. Derby
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Nicholas S. Breutzman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Amy Wicks
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jeyakumar Raman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christina M. Smith
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Karen S. Schaepe
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ruth E. Sheets
- Department of Research Administration, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Sarah M. Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Kandace A. Lackore
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Jacqueline Johnson
- Christ’s Church of the Jesus Hour, Rochester, Minnesota, United States of America
| | - Clarence Jones
- Hue-MAN Partnership, Minneapolis, Minnesota, United States of America
| | - Carmen Radecki Breitkopf
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Christi A. Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, United States of America
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Brewer LC, Hayes SN, Jenkins SM, Lackore KA, Breitkopf CR, Cooper LA, Patten CA. Improving Cardiovascular Health Among African-Americans Through Mobile Health: the FAITH! App Pilot Study. J Gen Intern Med 2019; 34:1376-1378. [PMID: 30887434 PMCID: PMC6667579 DOI: 10.1007/s11606-019-04936-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kandace A Lackore
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Lisa A Cooper
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Lawson WB. The one hundredth and tenth anniversary. J Natl Med Assoc 2018; 110:529-530. [PMID: 30446078 DOI: 10.1016/j.jnma.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ingersoll K, Frederick C, MacDonnell K, Ritterband L, Lord H, Jones B, Truwit L. A Pilot RCT of an Internet Intervention to Reduce the Risk of Alcohol-Exposed Pregnancy. Alcohol Clin Exp Res 2018; 42:1132-1144. [PMID: 29741798 PMCID: PMC5984155 DOI: 10.1111/acer.13635] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 03/18/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preventing alcohol-exposed pregnancies (AEPs) could reduce the incidence of fetal alcohol spectrum disorders. Previous face-to-face interventions significantly reduced risk for AEP, but a scalable intervention is needed to reach more women at risk. METHODS This study compared a 6 Core automated, interactive, and tailored Internet intervention, the Contraception and Alcohol Risk Reduction Internet Intervention (CARRII), to a static patient education (PE) website for its effect on AEP risk. Participants were recruited online to a pilot randomized clinical trial (RCT) with baseline, 9 weeks posttreatment, and 6-month (6-M) follow-up assessments. Seventy-one women completed online questionnaires and telephone interviews and were randomized to CARRII (n = 36) or PE (n = 35). Primary outcomes were rates of risky drinking, unprotected sex episodes, and AEP risk, collected from online prospective diaries. RESULTS CARRII participants showed significant reductions in rate of unprotected sex from pretreatment (88.9%) to posttreatment (70.6%) (p < 0.04) and to 6-M follow-up (51.5%) (p = 0.001); rate of risky drinking from pretreatment (75.0%) to posttreatment (50.0%) (p < 0.02), but insignificant change from pretreatment to 6-M follow-up (57.6%) (p < 0.09); and rate of AEP risk from pretreatment (66.7%) to posttreatment (32.4%) (p = 0.001) and to 6-M follow-up (30.3%) (p = 0.005). PE participants demonstrated no significant changes on all 3 variables across all time points. Intent-to-treat group-by-time tests were not significant, but power was limited by missing diaries. Over 72% of CARRII participants completed all 6 Cores. Exploratory analyses suggest that higher program utilization is related to change. CONCLUSIONS These data show that CARRII was acceptable, feasible, promising to reduce AEP risk, and merits further testing in a fully powered RCT.
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Affiliation(s)
- Karen Ingersoll
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Christina Frederick
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Kirsten MacDonnell
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Lee Ritterband
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Holly Lord
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Brogan Jones
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Lauren Truwit
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
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Adjei Boakye E, Mohammed KA, Geneus CJ, Tobo BB, Wirth LS, Yang L, Osazuwa-Peters N. Correlates of health information seeking between adults diagnosed with and without cancer. PLoS One 2018; 13:e0196446. [PMID: 29746599 PMCID: PMC5945015 DOI: 10.1371/journal.pone.0196446] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/14/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To examine predictors of information seeking behavior among individuals diagnosed with cancer versus those without. METHODS Cross-sectional data from the Health Information National Trends Survey 4 Cycles 1-3 (October 2011 to November 2013) were analyzed for 10,774 survey respondents aged ≥18 years. Binary logistic regression was used to examine the effect of socio-demographic and behavioral factors on health information seeking. RESULTS Cancer diagnosis did not predict health information seeking. However, respondents diagnosed with cancer were more likely to seek health information from a healthcare practitioner. Compared to males, females were more likely to seek health information irrespective of cancer diagnosis. Regardless of cancer diagnosis, those without a regular healthcare provider were less likely to seek health information. Likelihood of seeking health information declined across education strata, and significantly worsened among respondents without high school diplomas irrespective of cancer diagnosis. CONCLUSIONS Respondents sought health information irrespective of cancer diagnosis. However, the source of health information sought differed by cancer diagnosis. Gender, education, and having a regular healthcare provider were predictors of health information seeking. Future health communication interventions targeting cancer patients and the general public should consider these findings for tailored interventions to achieve optimal results.
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Affiliation(s)
- Eric Adjei Boakye
- Saint Louis University Center for Health Outcomes Research (SLUCOR), Saint Louis University, Saint Louis, Missouri, United States of America
| | - Kahee A. Mohammed
- Saint Louis University Center for Health Outcomes Research (SLUCOR), Saint Louis University, Saint Louis, Missouri, United States of America
| | - Christian J. Geneus
- Department of Environmental and Occupational Health, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Betelihem B. Tobo
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Lorinette S. Wirth
- Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Lei Yang
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, United States of America
- Saint Louis University Cancer Center, Saint Louis, Missouri, United States of America
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, Saint Louis, Missouri, United States of America
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Brewer LC, Jenkins S, Lackore K, Johnson J, Jones C, Cooper LA, Radecki Breitkopf C, Hayes SN, Patten C. mHealth Intervention Promoting Cardiovascular Health Among African-Americans: Recruitment and Baseline Characteristics of a Pilot Study. JMIR Res Protoc 2018; 7:e31. [PMID: 29386174 PMCID: PMC5812978 DOI: 10.2196/resprot.8842] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/30/2017] [Accepted: 12/02/2017] [Indexed: 01/21/2023] Open
Abstract
Background Mobile health (mHealth) interventions are promising avenues to promote cardiovascular (CV) health among African-Americans (AAs) and culturally tailored technology-based interventions are emerging for this population. Objective The objectives of this study were to use a community-based participatory research (CBPR) approach to recruit AAs into a pilot intervention study of an innovative mHealth CV health promotion program and to characterize technology use patterns and eHealth literacy (EHL). Methods Community partners from five predominately AA churches in southeast Minnesota collaborated with our academic institution to recruit AA congregants into the pilot study. Field notes as well as communications between the study team and community partners were used to design the recruitment strategy and its implementation with a goal of enrolling 50 participants. At its core, the recruitment strategy included community kickoff events to detail the state-of-the-art nature of the mHealth intervention components, the utility of CV health assessments (physical examination, laboratory studies and surveys) and the participants’ role in advancing our understanding of the efficacy of mHealth interventions among racial/ethnic minority groups. Detailed recruitment data were documented throughout the study. A self-administered, electronic survey measured sociodemographics, technology use and EHL (eHEALS scale). Results A total of 50 participants (70% women) from five AA churches were recruited over a one-month period. The majority (>90%) of participants reported using some form of mobile technology with all utilizing these technologies within their homes. Greater than half (60% [30/50]) reported being “very comfortable” with mobile technologies. Overall, participants had high EHL (84.8% [39/46] with eHEALS score ≥26) with no differences by sex. Conclusions This study illustrates the feasibility and success of a CBPR approach in recruiting AAs into mHealth intervention research and contributes to the growing body of evidence that AAs have high EHL, are high-users of mobile technologies, and thus are likely to be receptive to mHealth interventions.
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Affiliation(s)
- LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Sarah Jenkins
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Kandace Lackore
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | | | - Clarence Jones
- Southside Community Health Services, Incorporated, Minneapolis, MN, United States
| | - Lisa A Cooper
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Sharonne N Hayes
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States
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Srivastava G, Palmer KD, Ireland KA, McCarthy AC, Donovan KE, Manders AJ, McDougal J, Lenders CM, Apovian CM. Shape-Up and Eat Right Families Pilot Program: Feasibility of a Weight Management Shared Medical Appointment Model in African-Americans With Obesity at an Urban Academic Medical Center. Front Pediatr 2018; 6:101. [PMID: 29707530 PMCID: PMC5906543 DOI: 10.3389/fped.2018.00101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/27/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Disparities in obesity care exist among African-American children and adults. We sought to test the feasibility of a pilot program, a 1-year family-based intervention for African-American families with obesity [shape up and eat right (SUPER)], adopting the shared medical appointment model (SMA) at an urban safety net hospital. OUTCOMES Primary outcomes: (1) family attendance rate and (2) program satisfaction. Secondary outcomes: change in body mass index (BMI), eating behaviors, and sedentary activity. METHODS Adult parents (BMI ≥ 25 kg/m2) ≥18 years and their child(ren) (BMI ≥ 85th percentile) ages 6-12 years from adult or pediatric weight management clinics were recruited. One group visit per month (n = 12) consisting of a nutrition and exercise component was led by a nurse practitioner and registered dietitian. Height and weight were recorded during each visit. Participants were queried on program satisfaction, food logs and exercise journals, Food Stamp Program's Food Behavior, and the Expanded Food and Nutrition Education Program food checklists. RESULTS Thirteen participants from lower socioeconomic zip codes consented [n = 5 mothers mean age 33 years, BMI of 47.4 kg/m2 (31.4-73.6 kg/m2); n = 8 children; mean age 9 years, BMI of 97.6th percentile (94-99th percentile); 60% enrolled in state Medicaid]. Average individual attendance was 23.4% (14-43%; n = 13); monthly session attendance rates declined from 100 to 40% by program completion; two families completed the program in entirety. Program was rated (n = 5 adults) very satisfactory (40%) and extremely satisfactory (60%). Pre-intervention, families rated their eating habits as fair and reported consuming sugar-sweetened beverages or sports drinks, more so than watching more than 1 h of television (p < 0.002) or video game/computer activity (p < 0.006) and consuming carbonated sodas (p < 0.004). Post-intervention, reducing salt intake was the only statistically significant variable (p < 0.029), while children watched fewer hours of television and spent less time playing video games (from average 2 to 3 h daily; p < 0.03). CONCLUSION Attendance was lower than expected though children seemed to decrease screen time and the program was rated satisfactory. Reported socioeconomic barriers precluded families from attending most sessions. Future reiterations of the intervention could be enhanced with community engagement strategies to increase participant retention.
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Affiliation(s)
- Gitanjali Srivastava
- Nutrition and Weight Management Research Center, Boston Medical Center, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, United States
| | - Kenya D Palmer
- Nutrition and Weight Management Research Center, Boston Medical Center, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, United States
| | - Kathy A Ireland
- Nutrition and Fitness for Life Program, Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Ashley C McCarthy
- Nutrition and Weight Management Research Center, Boston Medical Center, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, United States
| | - Kate E Donovan
- Nutrition and Fitness for Life Program, Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Aaron J Manders
- Nutrition and Fitness for Life Program, Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Juhee McDougal
- Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Carine M Lenders
- Nutrition and Fitness for Life Program, Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States
| | - Caroline M Apovian
- Nutrition and Weight Management Research Center, Boston Medical Center, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University School of Medicine, Boston, MA, United States
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