Computer-assisted health literacy intervention proposal

Health literacy is the ability to obtain, process, and understand health information needed to make informed health decisions. Low health literacy and limited English proficiency (LEP) are associated with poor health outcomes. Poor health outcomes from misunderstanding of prescription medications and reduced medication adherence results in frequent hospitalizations and higher health care costs. The burden disproportionately affects the Spanish-speaking population and exacerbates health consequences. Spanish dominant patients may not have the capacity to understand basic health information for appropriate health decisions and services. Poor communication between health care providers and English-limited patients may lead to impaired patient comprehension. Interventions are needed to build health literacy and address the barriers in communication. The public health significance of the study is the use of communication technologies to cost-effectively increase the availability of interpretation services in healthcare settings, ultimately impacting the health of Latino populations. This research proposes to implement a pilot study to evaluate a culturally and linguistically appropriate audio-visual language tool conducted in affiliation with the University of Pittsburgh. The project will involve partnerships with the Program for Health Care to the Underserved (PHCUP) at two free clinic sites, the Birmingham Free Clinic and the 9th St. Clinic. A mixed methods research study will explore the research question: “Are Spanish-speaking Latinos with language barriers more likely to understand and follow medication regimen using a culturally appropriate computer-assisted video instruction compared to using the usual paper instruction?” The proposed pilot study will demonstrate that computer-illustrated medication instructions improve medication understanding among Latino patients recruited from a safety-net clinic. Illustrated medication instructions can be a useful adjunct to traditional medication information and the teach-back method. Further research is needed to determine the effect of computer-assisted medication instructions on medication-taking behavior and clinical outcomes. Recommendations to develop a culturally appropriate and effective tool to improve medication management can address barriers to health literacy among Latinos, and may lead to improvements in care and a reduction in health disparities

Adaptation and Feasibility Study of a Digital Health Program to Prevent Diabetes among Low-Income Patients: Results from a Partnership between a Digital Health Company and an Academic Research Team.

Background. The feasibility of digital health programs to prevent and manage diabetes in low-income patients has not been adequately explored. Methods. Researchers collaborated with a digital health company to adapt a diabetes prevention program for low-income prediabetes patients at a large safety net clinic. We conducted focus groups to assess patient perspectives, revised lessons for improved readability and cultural relevance to low-income and Hispanic patients, conducted a feasibility study of the adapted program in English and Spanish speaking cohorts, and implemented real-time adaptations to the program for commercial use and for a larger trial of in multiple safety net clinics. Results. The majority of focus group participants were receptive to the program. We modified the curriculum to a 5th-grade reading level and adapted content based on patient feedback. In the feasibility study, 54% of eligible contacted patients expressed interest in enrolling (n = 23). Although some participants' computer access and literacy made registration challenging, they were highly satisfied and engaged (80% logged in at least once/week). Conclusions. Underserved prediabetic patients displayed high engagement and satisfaction with a digital diabetes prevention program despite lower digital literacy skills. The collaboration between researchers and a digital health company enabled iterative improvements in technology implementation to address challenges in low-income populations

Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED).

BackgroundRecurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population.Methods/designIn this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP <130 mmHg) at 1 year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care.DiscussionIf this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings.Trial registrationClinicalTrials.gov Identifier NCT01763203

Can mHealth Improve Risk Assessment in Underserved Populations? Acceptability of a Breast Health Questionnaire App in Ethnically Diverse, Older, Low-Income Women.

Background: Use of mobile health (mHealth) tools has expanded rapidly but little research has been done on its acceptability by low-income, diverse, older patient populations. Objective: To assess the attitudes of a diverse group of underserved women on the acceptability and usability of mHealth tools in a clinical setting using a breast health questionnaire application (app) at a public hospital mammography clinic. Methods: Semi-structured interviews were conducted in a breast-imaging center of an urban safety net institution from July-August 2012. Interviews included pre- and post-questions. Women completed the Athena breast health questionnaire app on an iPad and were asked about their experience and ways to improve the tool. Results: Fifteen women age 45-75 years from diverse ethnic and educational backgrounds were interviewed. The majority of women, 11 of 15, preferred the Athena app over a paper version and all the women thought the app was easy to use. Two Spanish-speaking Latinas preferred paper; and two women, with limited mobile phone use, did not have a preference. Many women indicated that it would be necessary to have staff available for instruction and assistance if the app were to be implemented. Conclusions: mHealth tools are an acceptable, if not preferred, method of collecting health information for diverse, older, low-income women. Further studies are required to evaluate the reliability and accuracy of data collection using mHealth tools in underserved populations. mHealth tools should be explored as a novel way to engage diverse populations to improve clinical care and bridge gaps in health disparities

Improving healthcare empowerment through breast cancer patient navigation: a mixed methods evaluation in a safety-net setting.

BackgroundBreast cancer mortality rates in the U.S. remain relatively high, particularly among ethnic minorities and low-income populations. Unequal access to quality care, lower follow up rates, and poor treatment adherence contribute to rising disparities among these groups. Healthcare empowerment (HCE) is theorized to improve patient outcomes through collaboration with providers and improving understanding of and compliance with treatment. Patient navigation is a health care organizational intervention that essentially improves healthcare empowerment by providing informational, emotional, and psychosocial support. Patient navigators address barriers to care through multilingual coordination of treatment and incorporation of access to community services, support, and education into the continuum of cancer care.MethodsUtilizing survey and qualitative methods, we evaluated the patient navigation program in a Northern California safety-net hospital Breast Clinic by assessing its impact on patients' experiences with cancer care and providers' perspectives on the program. We conducted qualitative interviews with 16 patients and 4 service providers, conducted approximately 66 hours of clinic observations, and received feedback through the self-administered survey from 66 patients.ResultsThe role of the patient navigator at the Breast Clinic included providing administrative assistance, psychosocial support, improved knowledge, better understanding of treatment process, and ensuring better communication between patients and providers. As such, patient navigators facilitated improved collaboration between patients and providers and understanding of interdisciplinary care processes. The survey results suggested that the majority of patients across all ethnic backgrounds and age groups were highly satisfied with the program and had a positive perception of their navigator. Interviews with patients and providers highlighted the roles of a navigator in ensuring continuity of care, improving treatment completion rates, and reducing providers' workload and waiting time. Uncertainty about the navigator's role among the patients was a weakness of the program.ConclusionsPatient navigation in the Breast Clinic had a positive impact on patients' experiences with care and healthcare empowerment. Clarifying uncertainties about the navigators' role would aid successful outcomes

Providing Language Services in Small Health Care Provider Settings: Examples From the Field

Assesses recent innovations in language service programs and activities at healthcare provider settings with ten or fewer clinicians. Includes an eight-step plan to help providers develop a strategy to meet the needs of their patients

Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes

Describes in detail eight change concepts as a guide to transforming a practice into a patient-centered medical home, including engaged leadership, quality improvement strategy, continuous and team-based healing relationships, and enhanced access

Beyond Infrastructure: Broadband for Development in Remote and Indigenous Regions

Recent telecommunications stimulus projects in the U.S. and Canada were intended to increase availability of broadband through funding infrastructure investments, largely in rural and remote regions. However, true access involves more than availability; it also includes affordability and adoption. This paper presents a framework for analyzing broadband adoption that takes into consideration geographical, economic and cultural environments in indigenous communities. It includes an overview of potential social and economic impacts of broadband in remote areas, using examples from the Alaska study and the Canadian North. It then reports on results of an evaluation of Internet use and potential adoption of broadband in remote indigenous communities of southwest Alaska. Finally, the paper provides a comparative analysis of U.S. and Canadian policies intended to achieve affordable access to broadband for rural users and sustainable business models for rural broadband providers.Ye

Implementation Of A Medication Adherence Protocol In A Large Urban Safety Net Hospital

Medication nonadherence has a deleterious effect on patients with chronic health conditions, as it contributes to poorer health outcomes and increased healthcare spending. This Doctor of Nursing Practice project sought to improve medication adherence in at-risk patients by enhancing patient-provider communication and improving health literacy in a large, urban, safety net hospital. Utilizing a multi-prong approach, patients were provided with a visual aid – a pill card, in conjunction with the teach-back method, to improve systolic blood pressure (SBP), diastolic blood pressure (DPB) and Hemoglobin A1c (HbA1c) over a 6-month period. Twenty-three patients participated in the project. Participant demographics, attitudes towards the intervention, and clinical indicators were analyzed. The project was well received by all who participated. Key findings included patients finding the pill card easy to use and the teach-back method helpful in learning more about their medications. All target clinical indices decreased: SBP; DBP; A1C, in keeping with current positive findings on the use of triangulated methods conducted with larger samples. This data demonstrates the need for future larger scale projects to evaluate outcomes using these methods. This protocol has the potential to be utilized as a foundational program for other safety net hospitals