Incorporating African American Veterans' Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol

Background

Peer narratives engage listeners through personally relevant content and have been shown to promote lifestyle change and effective self-management among patients with hypertension. Incorporating key quotations from these stories into follow-up text messages is a novel way to continue the conversation, providing reinforcement of health behaviors in the patients’ daily lives.

Objective

In our previous work, we developed and tested videos in which African American Veterans shared stories of challenges and success strategies related to hypertension self-management. This study aims to describe our process for developing a text-messaging protocol intended for use after viewing videos that incorporate the voices of these Veterans.

Methods

We used a multistep process, transforming video-recorded story excerpts from 5 Veterans into 160-character texts. We then integrated these into comprehensive 6-month texting protocols. We began with an iterative review of story transcripts to identify vernacular features and key self-management concepts emphasized by each storyteller. We worked with 2 Veteran consultants who guided our narrative text message development in substantive ways, as we sought to craft culturally sensitive content for texts. Informed by Veteran input on timing and integration, supplementary educational and 2-way interactive assessment text messages were also developed.

Results

Within the Veterans Affairs texting system Annie, we programmed five 6-month text-messaging protocols that included cycles of 3 text message types: narrative messages, nonnarrative educational messages, and 2-way interactive messages assessing self-efficacy and behavior related to hypertension self-management. Each protocol corresponds to a single Veteran storyteller, allowing Veterans to choose the story that most resonates with their own life experiences.

Conclusions

We crafted a culturally sensitive text-messaging protocol using narrative content referenced in Veteran stories to support effective hypertension self-management. Integrating narrative content into a mobile health texting intervention provides a low-cost way to support longitudinal behavior change. A randomized trial is underway to test its impact on the lifestyle changes and blood pressure of African American Veterans.

Trial Registration

ClinicalTrials.gov NCT03970590; https://clinicaltrials.gov/ct2/show/NCT03970590

International Registered Report Identifier (IRRID)

DERR1-10.2196/29423

Assessing Patients' Perceptions of Clinician Communication: Acceptability of Brief Point-of-Care Surveys in Primary Care

BACKGROUND

Improving patient-centered (PC) communication is a priority in many healthcare organizations. Most PC communication metrics are distal to the care encounter and lack clear attribution, thereby reducing relevance for leaders and clinicians.

OBJECTIVE

We assessed the acceptability of measuring PC communication at the point-of-care.

DESIGN

A brief patient survey was conducted immediately post-primary care appointments at one Veterans Affairs Medical Center. Audit-feedback reports were created for clinicians and discussed in qualitative interviews.

PARTICIPANTS

A total of 485 patients completed the survey. Thirteen interviews were conducted with clinicians and hospital leaders.

MAIN MEASURE(S)

Measures included collaboRATE (a 3-item tool measuring PC communication), a question about how well needs were met, and overall visit satisfaction. Data were analyzed using descriptive statistics to characterize the mean and distribution of collaboRATE scores and determine the proportion of patients giving clinicians a "top score" on each item. Associations among responses were examined. Interviews focused on the value of measuring PC communication and were analyzed using a framework approach.

KEY RESULTS

The proportion of patients giving PC communication "top scores" ranged from 41 to 92% for 16 clinicians who had ≥ 25 completed surveys. Among patients who gave "top scores" for PC communication, the odds of reporting that needs were "completely met" were 10.8 times higher (p < .001) and the odds of reporting being "very satisfied" with their care were 13.3 times higher (p < .001) compared with patients who did not give "top scores." Interviewees found clinician-specific feedback useful; concerns included prioritizing this data when other measures are used to evaluate clinicians' performance. Difficulties improving PC communication given organizational structures were noted. Recommendations for interventions included peer-to-peer education and mentoring by top-scoring clinicians.

CONCLUSIONS

Assessing provider communication at the point-of-care is acceptable and useful to clinicians. Challenges remain to properly incentivize and support the use of this data for improving PC communication.

Overview of the space environmental effects observed on the retrieved Long Duration Exposure Facility (LDEF)

The Long Duration Exposure Facility (LDEF), which encompassed 57 experiments with more than 10,000 test specimens, spent 69 months in low Earth orbit (LEO) before it was retrieved by the Space Shuttle in January 1990. Hundreds of LDEF investigators, after studying for over two years these retrieved test specimens and the onboard recorded data and systems hardware, have generated a unique first-hand view of the long term synergistic effects that the LEO environment can have on spacecraft. These studies have also contributed significantly toward more accurate models of the LEO radiation, meteoroid, manmade debris and atomic oxygen environments. This paper provides an overview of some of the many LDEF observations and the implications these can have on future spacecraft such as Space Station Freedom.