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Beauchemin MP, Solomon S, Michaels CL, McHenry K, Turi E, Khurana R, Sanabria G. Toward identification and intervention to address financial toxicity and unmet health-related social needs among adolescents and emerging adults with cancer and their caregivers: A cross-cultural perspective. Cancer Med 2024; 13:e7197. [PMID: 38659403 PMCID: PMC11043682 DOI: 10.1002/cam4.7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE We qualitatively explored the unique needs and preferences for financial toxicity screening and interventions to address financial toxicity among adolescents and emerging adults (younger AYAs: 15-25 years) with cancer and their caregivers. METHODS We recruited English- or Spanish-speaking younger AYAs who were treated for cancer within the past 2 years and their caregivers. Semi-structured interviews were conducted to explore preferences for screening and interventional study development to address financial toxicity. The data were coded using conventional content analysis. Codes were reviewed with the study team, and interviews continued until saturation was reached; codes were consolidated into categories and themes during consensus discussions. RESULTS We interviewed 17 participants; nine were younger AYAs. Seven of the 17 preferred to speak Spanish. We identified three cross-cutting themes: burden, support, and routine, consistent, and clear. The burden came in the form of unexpected costs such as transportation to appointments, as well as emotional burdens such as AYAs worrying about how much their family sacrificed for their care or caregivers worrying about the AYA's physical and financial future. Support, in the form of familial, community, healthcare institution, and insurance, was critical to mitigating the effects of financial toxicity in this population. Participants emphasized the importance of meeting individual financial needs by routinely and consistently asking about financial factors and providing clear guidance to navigate these needs. CONCLUSION Younger AYAs and their caregivers experience significant financial challenges and unmet health-related social needs during cancer treatment and often rely on key supports to alleviate these unmet needs. When developing interventions to mitigate financial toxicity, clinicians and health systems should prioritize clear, consistent, and tailorable approaches to support younger AYA cancer survivors and their families.
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Affiliation(s)
- Melissa P. Beauchemin
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Samrawit Solomon
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Claudia L. Michaels
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Kathryn McHenry
- School of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Eleanor Turi
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Rhea Khurana
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
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Sanabria G, Chavez M, Velez M, Munoz LP, Bastardo J, Belen A, Solis I, Barden S, Doss B, Martinez-Tyson D. Navigating norms and expectations: the influence of culture on Latino couples and their interpersonal communication and coping post-breast cancer diagnosis. Ethn Health 2024; 29:164-178. [PMID: 37936411 DOI: 10.1080/13557858.2023.2279482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Cultural norms shape expectations, care, and communication. Effective interpersonal communication is a prominent predictor of patient-partner cancer management, improving the overall quality of life for the dyad by increasing their ability to cope with cancer. However, couples-based cancer interventions often do not consider cultural factors. Additionally, although Latinas have a high incidence of breast cancer, few studies focus on Latino couples and the influence of culture in cancer care interventions. This study focuses on understanding how Latino culture's norms and expectations influence how couples communicate and cope post-breast cancer diagnosis. DESIGN This study conducted interviews and focus groups with a purposive sample of Spanish-speaking Latina breast cancer survivors (N = 21) and intimate partners (N = 5). In the focus group and interviews, participants were asked about the influence cancer had on their relationship, with specific questions focusing on communication within the dyad. The study team used CARV: Community-Engaged Adaptation with Rapid Analysis and Visualization framework to identify cultural considerations and recurring themes. RESULTS The cross-cutting cultural considerations and themes found were: the negative influence of gendered and social norms on managing emotions and coping; the silent struggle with physical intimacy; and the inability to discuss the topic - or even say the word 'cancer.' CONCLUSION Understanding the role of Latino culture in how couples cope with and communicate about cancer post-diagnosis is essential. This understanding will help strengthen the dyad by assisting with positive interpersonal support, which contributes to a better quality of life. These findings will also help providers assist dyads in navigating the cancer diagnosis and journey, helping to lessen the interpersonal stress and tensions that can occur after diagnosis.
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Affiliation(s)
| | - Melody Chavez
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Marangelie Velez
- Marriage and Family Research Institute, University of Central Florida, Orlando, FL, USA
| | | | - Janna Bastardo
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Audry Belen
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Isabela Solis
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Sejal Barden
- Marriage and Family Research Institute, University of Central Florida, Orlando, FL, USA
| | - Brian Doss
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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Stonbraker S, Sanabria G, Tagliaferri Rael C, George M, Amesty S, Abraído-Lanza AF, Rowell-Cunsolo T, Centi S, McNair B, Bakken S, Schnall R. A pilot test of an infographic-based health communication intervention to enhance patient education among Latino persons with HIV. J Am Med Inform Assoc 2024; 31:329-341. [PMID: 37615971 PMCID: PMC10797274 DOI: 10.1093/jamia/ocad157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/20/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To pilot test an infographic-based health communication intervention that our team rigorously designed and explore whether its implementation leads to better health outcomes among Latino persons with HIV (PWH). MATERIALS AND METHODS Latino PWH (N = 30) living in New York City received the intervention during health education sessions at 3 study visits that occurred approximately 3 months apart. At each visit, participants completed baseline or follow-up assessments and laboratory data were extracted from patient charts. We assessed 6 outcomes (HIV-related knowledge, self-efficacy to manage HIV, adherence to antiretroviral therapy, CD4 count, viral load, and current and overall health status) selected according to a conceptual model that describes pathways through which communication influences health outcomes. We assessed changes in outcomes over time using quantile and generalized linear regression models controlling for the coronavirus disease 2019 (COVID-19) research pause and new patient status (new/established) at the time of enrollment. RESULTS Most participants were male (60%) and Spanish-speaking (60%); 40% of participants identified as Mixed Race/Mestizo, 13.3% as Black, 13.3% as White, and 33.3% as "other" race. Outcome measures generally improved after the second intervention exposure. Following the third intervention exposure (after the COVID-19 research pause), only the improvements in HIV-related knowledge and current health status were statistically significant. DISCUSSION AND CONCLUSION Our infographic-based health communication intervention may lead to better health outcomes among Latino PWH, but larger trials are needed to establish efficacy. From this work, we contribute suggestions for effective infographic use for patient-provider communication to enhance patient education in clinical settings.
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Affiliation(s)
- Samantha Stonbraker
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gabriella Sanabria
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Maureen George
- School of Nursing, Columbia University, New York, New York, USA
| | - Silvia Amesty
- Department of Medical Humanities and Ethics Columbia University Irving Medical Center, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | | | - Tawandra Rowell-Cunsolo
- Sandra Rosenbaum School of Social Work, University of Wisconsin—Madison, Madison, Wisconsin, USA
| | - Sophia Centi
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Bryan McNair
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Suzanne Bakken
- School of Nursing, Columbia University, New York, New York, USA
| | - Rebecca Schnall
- School of Nursing, Columbia University, New York, New York, USA
- Department of Medical Humanities and Ethics Columbia University Irving Medical Center, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
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Alvarez G, Sanabria G, Jia H, Cho H, Reynolds NR, Gradilla M, Olender S, Mohr DC, Schnall R. Do Walk Step Reminders Improve Physical Activity in Persons Living With HIV in New York City?-Results From a Randomized Clinical Trial. J Assoc Nurses AIDS Care 2023; 34:527-537. [PMID: 37747318 PMCID: PMC10592070 DOI: 10.1097/jnc.0000000000000427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
ABSTRACT Supervised physical activity can increase functional capacity in persons with HIV (PWH); however, aerobic interventions have shown little improvement in overall physical activity in PWH. In response, we sought to assess the effect of wearing a fitness tracker (FitBit) paired with walk step reminders delivered through an mHealth application to improve physical activity and decreasing body mass index among PWH in New York City. There was no significant difference in the frequency of walk steps between participants in the control group and intervention group from baseline to 6-month follow-up. These findings show that walk step reminders alone were inadequate for sustained improvement of physical activity. This study highlights the need to develop and test the comparative efficacy of physical activity interventions that are tailored to the unique needs and capabilities of PWH. Future interventions should incorporate fitness tracking with tailored interventions focused on the promotion of physical activity.Clinical Trials.Gov Registration number: NCT03205982.
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Affiliation(s)
| | - Gabriella Sanabria
- Community and Family Health, College of Public Health University of South Florida, Tampa, Florida, USA
| | - Haomiao Jia
- Columbia University School of Nursing, New York, New York, USA
| | - Hwayoung Cho
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Nancy R. Reynolds
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | - Susan Olender
- Division of Infectious Disease, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - David C. Mohr
- Center for Behavioral Intervention Technologies (CBITs), Department of Preventive Medicine, Medical Social Sciences and Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Rebecca Schnall
- Disease Prevention and Health Promotion, Columbia University School of Nursing, Columbia University, New York, New York, USA
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Sanabria G, Stonbraker S, Bateman M, Halpern M, Amesty S. Impact of an STI Diagnosis on People Living With HIV in La Romana, Dominican Republic: A Cross-Sectional, Qualitative, Descriptive Study. J Assoc Nurses AIDS Care 2023; 34:582-589. [PMID: 37787718 DOI: 10.1097/jnc.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
ABSTRACT The objective of this study was to explore how receiving a sexually transmitted infection (STI) diagnosis affects subsequent STI knowledge and sexual risk behavior among key populations in La Romana, Dominican Republic (DR) who participated in a parent study 12 to 24 months before the current study. Nine participants, with a mean age of 37 years (range 20-54 years) and a female majority (89%), who were recruited from the parent study completed in-depth interviews, questionnaires assessing STI knowledge, and received STI testing. Interviews were analyzed using qualitative descriptive methodology and questionnaire data, comparing individual's responses between the parent and current studies. Participants reported safer sexual behaviors after original STI diagnosis, such as more frequent condom use. Questionnaires showed improvement in STI knowledge between the parent and current studies. Three participants had an STI reinfection. Findings warrant further exploration into more comprehensive and targeted STI treatment methods for key populations in the DR.
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Affiliation(s)
- Gabriella Sanabria
- Gabriella Sanabria, MEd, is a Doctoral Student, University of South Florida, College of Public Health, Tampa, Florida, USA. Samantha Stonbraker, PhD, MPH, RN, is an Assistant Professor, College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Mark Bateman, MD, is an Assistant Professor of Medicine, Department of Medicine, Columbia University Medical Center, New York, New York, USA. Mina Halpern, MPH, is a Executive Director, Clínica de Familia, La Romana, Dominican Republic. Silvia Amesty, MD, MPH, MSEd, is an Associate Professor, Department of Medicine and Population and Family Health and Medical Humanities and Ethics, Center for Family and Community Medicine and Department of Medical Humanities and Ethics, Columbia University Irving Medical Center, and Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
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Sanabria G, Bushover B, Ashrafnia S, Cordoba E, Schnall R. Understanding Physical Activity Determinants in an HIV Self-Management Intervention: Qualitative Analysis Guided by the Theory of Planned Behavior. JMIR Form Res 2023; 7:e47666. [PMID: 37707942 PMCID: PMC10540011 DOI: 10.2196/47666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND People living with HIV have long life expectancy and are experiencing more comorbid conditions, being at an increased risk for developing cardiovascular disease (CVD) and diabetes, further exacerbated due to the HIV or inflammatory process. One effective intervention shown to decrease mortality and improve health outcomes related to CVD and diabetes in people living with HIV is increased regular physical activity. However, people living with HIV often fall short of the daily recommended physical activity levels. While studies show that mobile health (mHealth) can potentially help improve people's daily activity levels and reduce mortality rates due to comorbid conditions, these studies do not specifically focus on people living with HIV. As such, it is essential to understand how mHealth interventions, such as wearables, can improve the physical activity of people living with HIV. OBJECTIVE This study aimed to understand participants' experiences wearing a fitness tracker and an app to improve their physical activity. METHODS In total, 6 focus groups were conducted with participants who completed the control arm of a 6-month randomized controlled trial (ClinicalTrials.gov NCT03205982). The control arm received daily walk step reminders to walk at least 5000 steps per day and focused on the overall wellness of the individual. The analysis of the qualitative focus groups used inductive content analysis using the theory of planned behavior as a framework to guide and organize the analysis. RESULTS In total, 41 people living with HIV participated in the focus groups. The majority (n=26, 63%) of participants reported their race as Black or African American, and 32% (n=13) of them identified their ethnicity as Hispanic or Latino. In total, 9 major themes were identified and organized following the theory of planned behavior constructs. Overall, 2 major themes (positive attitude toward tracking steps and tracking steps is motivating) related to attitudes toward the behavior, 2 major themes (social support or motivation from the fitness tracker and app and encouragement from family and friends) related to participant's subjective norms, 1 theme (you can adjust your daily habits with time) related to perceived behavioral control, 2 themes (reach their step goal and have a healthier lifestyle) related to participant's intention, and 2 themes (continuing to walk actively and regularly wearing the fitness tracker) related to participant's changed behavior. Participants highlighted how the mHealth interface with the avatar and daily step tracking motivated them to both begin and continue to engage in physical activity by adjusting their daily routines. CONCLUSIONS Findings from this study illustrate how features of mHealth apps may motivate people living with HIV to start and continue sustained engagement in physical activities. This sustained increase in physical activity is crucial for reducing the risk of comorbid conditions such as diabetes or CVD. TRIAL REGISTRATION ClinicalTrials.gov NCT03205982; https://classic.clinicaltrials.gov/ct2/show/NCT03205982.
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Affiliation(s)
- Gabriella Sanabria
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Brady Bushover
- Columbia University Mailman School of Public Health, New York, NY, United States
| | - Sarah Ashrafnia
- Division of Scholarship and Research, Columbia University School of Nursing, New York, NY, United States
| | - Evette Cordoba
- Division of Scholarship and Research, Columbia University School of Nursing, New York, NY, United States
| | - Rebecca Schnall
- Columbia University Mailman School of Public Health, New York, NY, United States
- Division of Scholarship and Research, Columbia University School of Nursing, New York, NY, United States
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Torres-Blasco N, Castro-Figueroa EM, Zamore C, Claros M, Peña-Vargas C, Rosario L, Sanabria G, Breitbart W, Costas-Muñiz R. Family functioning and psychosocial symptoms among Latinx patients coping with advanced cancer. Palliat Support Care 2023; 21:461-464. [PMID: 36098498 PMCID: PMC10008749 DOI: 10.1017/s1478951522001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This brief report aims to describe and determine the association of family functioning (e.g., cohesion and expressiveness) with psychosocial needs among Spanish Latinx patients coping with advanced cancers. METHODS Descriptive and correlation analyses were performed on data from 103 patients coping with advanced cancer (Stages III and IV). The measures used were the Family Relationships Index, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy: General. RESULTS Results indicated that most of the participants had low family function (65%). Participants with higher family functioning (35%) had high levels of quality of life [r(103) .318, p < .002]. A higher level of quality of life was also strongly associated with lower levels of anxiety [r(95) -.653, p < .000], lower levels of depression [r(95) -.733, p < .000], and lower levels of hopelessness [r(95) -.585, p = .000]. A total of 22.3% of Latinx advanced cancer patients reported poor cohesiveness; those with low cohesiveness also had higher levels of depression [r(103) -.28, p = .004] and anxiety [r(103) -.27, p = .005]. Correlations between expressiveness and hopelessness were significant; namely, those with higher expressiveness had lower hopelessness [r(103) -.274, p = .005]. SIGNIFICANCE OF RESULTS Findings present a high correlation between family functioning and psychosocial symptoms.
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Affiliation(s)
- Normarie Torres-Blasco
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | - Eida M Castro-Figueroa
- Department of Psychiatry and Human Behavior, School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, New York, NY, USA
| | - Carolina Zamore
- Immigrant Health and Cancer Disparities, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Maria Claros
- Immigrant Health and Cancer Disparities, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Cristina Peña-Vargas
- Department of Psychiatry and Human Behavior, Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, USA
| | - Lianel Rosario
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, PR, USA
| | - Gabriella Sanabria
- Community and Family Health, College of Public Health, University of South Florida
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Rosario Costas-Muñiz
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Sanabria G, Greene KY, Tran JT, Gilyard S, DiGiovanni L, Emmanuel PJ, Sanders LJ, Kosyluk K, Galea JT. "A Great Way to Start the Conversation": Evidence for the Use of an Adolescent Mental Health Chatbot Navigator for Youth at Risk of HIV and Other STIs. J Technol Behav Sci 2023:1-10. [PMID: 37362063 PMCID: PMC10172071 DOI: 10.1007/s41347-023-00315-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 06/28/2023]
Abstract
Chatbot use is increasing for mobile health interventions on sensitive and stigmatized topics like mental health because of their anonymity and privacy. This anonymity provides acceptability to sexual and gendered minority youth (ages 16-24) at increased risk of HIV and other STIs with poor mental health due to higher levels of stigma, discrimination, and social isolation. This study evaluates the usability of Tabatha-YYC, a pilot chatbot navigator created to link these youth to mental health resources. Tabatha-YYC was developed using a Youth Advisory Board (n = 7). The final design underwent user testing (n = 20) through a think-aloud protocol, semi-structured interview, and a brief survey post-exposure which included the Health Information Technology Usability Evaluation Scale. The chatbot was found to be an acceptable mental health navigator by participants. This study provides important design methodology considerations and key insights into chatbot design preferences of youth at risk of STIs seeking mental health resources.
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Affiliation(s)
| | - Karah Y. Greene
- College of Behavioral and Community Sciences, School of Social Work, University of South Florida, Tampa, FL USA
| | - Jennifer T. Tran
- College of Behavioral and Community Sciences, Department of Mental Health Law and Policy, University of South Florida, Tampa, FL USA
- School of Nursing, Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA USA
| | - Shelton Gilyard
- College of Behavioral and Community Sciences, School of Social Work, University of South Florida, Tampa, FL USA
| | - Lauren DiGiovanni
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Patricia J. Emmanuel
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Lisa J. Sanders
- Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Kristin Kosyluk
- College of Behavioral and Community Sciences, Department of Mental Health Law and Policy, University of South Florida, Tampa, FL USA
| | - Jerome T. Galea
- College of Behavioral and Community Sciences, School of Social Work, University of South Florida, Tampa, FL USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
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Schnall R, Sanabria G, Jia H, Cho H, Bushover B, Reynolds NR, Gradilla M, Mohr DC, Ganzhorn S, Olender S. Efficacy of an mHealth self-management intervention for persons living with HIV: the WiseApp randomized clinical trial. J Am Med Inform Assoc 2023; 30:418-426. [PMID: 36469808 PMCID: PMC9933073 DOI: 10.1093/jamia/ocac233] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Progression of HIV disease, the transmission of the disease, and premature deaths among persons living with HIV (PLWH) have been attributed foremost to poor adherence to HIV medications. mHealth tools can be used to improve antiretroviral therapy (ART) adherence in PLWH and have the potential to improve therapeutic success. OBJECTIVE To determine the efficacy of WiseApp, a user-centered design mHealth intervention to improve ART adherence and viral suppression in PLWH. DESIGN, SETTING, AND PARTICIPANTS A randomized (1:1) controlled efficacy trial of the WiseApp intervention arm (n = 99) versus an attention control intervention arm (n = 101) among persons living with HIV who reported poor adherence to their treatment regimen and living in New York City. INTERVENTIONS The WiseApp intervention includes the following components: testimonials of lived experiences, push-notification reminders, medication trackers, health surveys, chat rooms, and a "To-Do" list outlining tasks for the day. Both study arms also received the CleverCap pill bottle, with only the intervention group linking the pill bottle to WiseApp. RESULTS We found a significant improvement in ART adherence in the intervention arm compared to the attention control arm from day 1 (69.7% vs 48.3%, OR = 2.5, 95% CI 1.4-3.5, P = .002) to day 59 (51.2% vs 37.2%, OR = 1.77, 95% CI 1.0-1.6, P = .05) of the study period. From day 60 to 120, the intervention arm had higher adherence rates, but the difference was not significant. In the secondary analyses, no difference in change from baseline to 3 or 6 months between the 2 arms was observed for all secondary outcomes. CONCLUSIONS The WiseApp intervention initially improved ART adherence but did not have a sustained effect on outcomes.
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Affiliation(s)
- Rebecca Schnall
- School of Nursing, Columbia University, New York, New York, USA
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Gabriella Sanabria
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Haomiao Jia
- School of Nursing, Columbia University, New York, New York, USA
| | - Hwayoung Cho
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Brady Bushover
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Nancy R Reynolds
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sarah Ganzhorn
- School of Nursing, Columbia University, New York, New York, USA
| | - Susan Olender
- Division of Infectious Disease, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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Galea JT, Sanabria G, Greene KY, Thompson M, Doering T, Fuchs D, Grey A, Saucedo A, Rosler M, Simmons C. MSW Students' Perspectives on Learning and Delivering a Protocolized, Low-Intensity Transdiagnostic Psychological Intervention: Implications for Experiential Learning. Community Ment Health J 2022; 59:812-817. [PMID: 36374380 DOI: 10.1007/s10597-022-01053-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
Problem Management Plus (PM+) is a protocolized, low-intensity, transdiagnostic psychological intervention designed to be delivered by lay individuals. Faculty at the University of South Florida School of Social Work recognized PM + as a potential psychological intervention for master's students to learn to complement their clinical coursework and simultaneously provide an experiential learning experience to support their clinical skills. Before this pilot, the feasibility and acceptability of integrating PM + into a Master of Social Work (MSW) setting were unknown. Upon analyzing the students' feedback using inductive content analysis, it is evident that experiential learning using interventions is crucial to building the self-efficacy of MSW students. Students reported that PM + helped their personal mental health and client interactions, using the tools they learned even a year after the pilot. Future research should focus on integrating PM + into experiential learning experiences within social work and allied academic settings and professions.
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Affiliation(s)
- Jerome T Galea
- School of Social Work, University of South Florida, Tampa, USA. .,College of Public Health, University of South Florida, Tampa, USA. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
| | | | - Karah Y Greene
- School of Social Work, University of South Florida, Tampa, USA
| | | | - Tracy Doering
- School of Social Work, University of South Florida, Tampa, USA
| | - Doriangel Fuchs
- School of Social Work, University of South Florida, Tampa, USA
| | - Amanda Grey
- School of Social Work, University of South Florida, Tampa, USA
| | - Adilene Saucedo
- School of Social Work, University of South Florida, Tampa, USA
| | - Melanie Rosler
- School of Social Work, University of South Florida, Tampa, USA
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Poh Loh K, Liu J, Ganzhorn S, Sanabria G, Schnall R. Establishing a usability cut-point for the Health Information Technology Usability Evaluation Scale (Health-ITUES). Int J Med Inform 2022; 160:104713. [PMID: 35144102 PMCID: PMC8903058 DOI: 10.1016/j.ijmedinf.2022.104713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Health Information Technology Usability Evaluation Scale (Health-ITUES) is a validated and reliable instrument to evaluate usability of information technology (IT) tools. In this study, we aimed to establish the optimal cut-point of the Health-ITUES to identify usability of IT tools. METHODS Adult participants were recruited to a trial evaluating a mobile app for self-managing HIV. Participants completed the Health-ITUES at the 3- and 6-month follow-up. Health-ITUES is a 20-item questionnaire that assesses four subscales: impact, perceived usefulness, perceived ease of use, and user control. The total score ranged from 1 to 5 and a higher score indicates greater usability. App use was defined as the proportion of activities completed by participants in both study arms. The selection of an optimal cut-point involved a series of multiple linear regression models with 500 bootstrap replications to examine the relationship between the Health-ITUES total score and app use, controlling for potential covariates. RESULTS We included 158 participants; mean age was 49.7 years (SD 10.3), 71% were African American/Black, and 72% were non-Hispanic. Mean Health-ITUES total scores at 3 and 6 months were 4.39 (SD 0.75) and 4.43 (SD 0.75), respectively. App use completedby participants from baseline to the 3-month follow-up visits was 0.61 (SD 0.36, range 0-1.72) and from 3-month to the 6-month follow-up visits was 0.51 (SD 0.37). Participants who reported greater Health-ITUES total score completed more activities [β = 0.18, 95% Confidence Interval (CI) 0.10-0.27]. The optimal cut-point of 4.32 (95% CI: 4.25-4.56) yielded the lowest p-value to identify usability of IT tools. CONCLUSIONS In this study of adults with HIV, we identified an optimal cut-point of 4.32 on the Health-ITUES total score to define usability. Further studies are needed to validate this cut-point.
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Stonbraker S, Sanabria G, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Rowell-Cunsolo T, Halpern M, Bakken S, Schnall R, George M. "If They Give Their Mind to HIV, They Don't Last as Long": An Explanatory Model of HIV Infection in a Limited-Resource Setting Informs Person-Centered Care. Glob Qual Nurs Res 2022; 9:23333936221097112. [PMID: 35719278 PMCID: PMC9203948 DOI: 10.1177/23333936221097112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/04/2022] [Accepted: 03/19/2022] [Indexed: 11/18/2022] Open
Abstract
Explanatory models describe individuals’ perceptions of their illness experiences, which can guide culturally relevant care. We constructed an explanatory model of the experience of living with human immunodeficiency virus (HIV) in the Dominican Republic. Following qualitative descriptive methodology, we conducted interviews in Spanish using a semi-structured interview guide developed using Kleinman’s explanatory model framework. Two bilingual researchers coded interview transcripts following conventional content analysis. We used deductive codes from Kleinman’s framework and inductive codes external to the framework to construct the codebook. We arranged codes by shared meaning into categories and constructed themes that reflected shared findings from inductive categories and deductive codes. Twenty-six persons living with HIV participated. They provided rich descriptions of their experiences represented by four cross-cutting themes, which informed the explanatory model. By incorporating this in-depth understanding of patients’ illness experiences into care delivery, nurses can cultivate culturally meaningful and trusting patient-centered partnerships that improve health.
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Affiliation(s)
- Samantha Stonbraker
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, USA
| | | | | | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
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Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
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Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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Pupello DF, Bessone LN, Lopez E, Brock JC, Alkire MJ, Izzo EG, Sanabria G, Sims DP, Ebra G. Long-term results of the bioprosthesis in elderly patients: impact on quality of life. Ann Thorac Surg 2001; 71:S244-8. [PMID: 11388196 DOI: 10.1016/s0003-4975(01)02515-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A wealth of data exists on acceptable mortality and morbidity for valve operations in older patients, yet information documenting quality of life is lacking. METHODS From October 1974 to May 1998, 2,075 patients aged 65 years and older underwent valve replacement using a porcine bioprosthesis. There were 1,126 men (54.3%) and 949 women (45.7%) with a mean age of 73.9 years (range 65 to 104 years). RESULTS The elective hospital mortality was 8.5% (158 patients), and urgent/emergent/salvage mortality was 25.8% (54 patients). Follow-up was completed for 1,863 patients (98.2%) and extended from 1 month to 23.0 years (mean 60.8 months) with a cumulative follow-up of 9,442.1 patient-years. At follow-up, surviving patients (n = 849) completed the Short Form-36 Quality of Life Survey. Results showed patients had a more favorable quality of life compared with control subjects matched for age and sex. Functional improvement was significant with 96.3% in New York Heart Association functional class I or II at follow-up. There were 74 valves that failed from all causes (33 aortic and 41 mitral valves). Actuarial freedom from valve failure at 9 years was 94.4%+/-1.1% and at 18 years was 83.7%+/-2.4%. CONCLUSIONS Valve replacement in older patients provides excellent functional improvement, reduces late cardiac events, and enhances quality of life.
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Pupello DF, Bessone LN, Hiro SP, Lopez-Cuenca E, Glatterer MS, Angell WW, Brock JC, Alkire MJ, Izzo EG, Sanabria G. Bioprosthetic valve longevity in the elderly: an 18-year longitudinal study. Ann Thorac Surg 1995; 60:S270-4; discussion S275. [PMID: 7646171 DOI: 10.1016/0003-4975(95)00298-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The issue of bioprosthetic valve durability has become of critical importance as the number of elderly patients requiring valve operation has continued to increase. Our previous study showed bioprosthetic valve durability to be in excess of 83% at 13 years for patients 70 years of age and older at the time of implantation. There is limited follow-up data in the literature beyond this time point, however. Accordingly a retrospective analysis was conducted of all patients with bioprosthetic valves who were 70 years of age and over at the time of implantation. From September 1974 to April 1994, 1007 patients 70 years of age and over underwent valve replacement using a porcine bioprosthesis. The patients ranged in age from 70 to 104 years (mean, 75.6 +/- 4.3 years). There were 549 men (54.5%) and 458 women (45.5%). Preoperatively 98.8% of the patients were in New York Heart Association functional class III or IV. Operation was performed as an emergency in 66 patients (6.6%). The hospital mortality was 10.9% (110 patients), with 897 hospital survivors. There were 961 valves at risk. Follow-up extended from 1 month to 18.8 years (mean, 56.6 months). The cumulative follow-up is 4232.3 patient-years. A total of 31 valves failed, 12 in the aortic position and 19 in the mitral position (p < 0.0024). The causes of valve failure have included structural deterioration (16 valves), prosthetic endocarditis (7 valves), nonstructural dysfunction (5 valves), prosthetic thrombosis (1 valve), and other (2 valves).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D F Pupello
- St. Joseph's Heart Institute, Tampa, Florida, USA
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Sanabria G, Ozaki K. [Comparative study of various heath indicators in Japan and Cuba]. Tokai J Exp Clin Med 1984; 9:263-73. [PMID: 6537040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The medical systems in Cuba and Japan are described by using specific indicators and considering geographical, demographic and economical situations of the two countries. Objective data were tabulated to compare the present situation. An attempt was made to predict the future prospects of the medical system in both countries. The following difference between the two countries was noted. Japan is a highly industrialized country with a high standard of living and a mature economy that can tolerate unfavourable international economy. In recent years, the growth of the economy in Cuba has been made stable due to government planning at a rate of 5 percent in 1983. However, Cuba is still in the midst of industrialization and highly susceptible to the bad condition of the international economy.
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