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

Provider Perspectives on Language Barriers in MyChart Enrollment for Patients with Limited English Proficiency

Background: There are 25 million people in the United States with limited English proficiency (LEP). Patients with LEP are a vulnerable population who may have worse health outcomes compared to English-proficient patients, as they face barriers to safe, effective, and high-quality care. Previous studies show this population is likely to benefit from utilization of patient portals, which allow users to access personal health information and communicate with healthcare providers. Current literature reports that patients with LEP and their families have a strong interest in using the patient portal as it can help them understand their providers and health, remember their care plan, and have more control over their health. However, there is less portal access and utilization among patients with LEP. This study was conducted to obtain provider perspectives surrounding MyChart engagement of patients with LEP to identify potential barriers to MyChart enrollment at the University of Vermont Health Network (UVMHN). Methods: EPIC’s Slicer Dicer tool was utilized to obtain UVMHN patient counts organized by reported language and MyChart activation. Data was collected from an anonymous REDCap survey sent to 211 providers within UVMHN Departments of General Internal Medicine, Family Medicine, and Pediatrics, and analyzed utilizing Excel. Results: 67.9% of UVMHN Primary Care English speakers have MyChart activated compared to 46.9% of patients with LEP. Providers strongly believe that MyChart is beneficial to patients and families with 72.1% of providers agreeing that it improves the patient-provider relationship. When asked specifically about patients with LEP, 36% of providers agree that MyChart access is beneficial to care. 49% report they are likely to encourage MyChart enrollment to their patients with LEP; however, only 14% know how to assist in enrollment. Differences in knowledge of language services are seen in different visit modalities: 78.1% of providers report ability to provide language services during in-person visits compared to 48.8% for video visits and 46.3% for telephone visits. Once made aware of the differences in MyChart activation status between English proficient patients and patients with LEP, providers frequently requested more education around language assistance, MyChart activation instructions to provide patients in their dominant language, translation tools within EPIC, and training for support staff to also encourage patients with LEP to enroll in MyChart. Conclusions: While providers overwhelmingly believe MyChart is useful to patient care and are likely to recommend it to their patients with LEP, they lack the tools and education necessary to aid in equitable enrollment. Educational materials and translated resources should be created for providers to utilize in assisting their patients with LEP. A follow-up study with patients would provide an opportunity to compare patient and provider responses and gain additional perspectives on MyChart access and utilization

Increasing Colorectal Cancer Screening Uptake Among Hispanic/Latino Patients: A Quality Improvement Initiative

Background: In 2021, cancer (CRC) screening rates for Latino men (42%) and women (47.5%) remain well below the Health People 2020 target (70.5%). Extensive documentation of barriers for screening include language, insurance status, and other sociocultural barriers which contribute to delays in diagnosis and/or diagnosis at advanced stages of the disease, and worse health outcomes. Latinos need culturally and linguistically appropriate health promotion interventions aimed to increase CRC screening rates with any modality (FIT, Cologuard, or Colonoscopy). Methods: The Donabedian Structure-Process-Outcome (S-P-O) Model for quality improvement was used to develop and target a provider-driven, language-concordant communication interventions for Hispanic patients who were eligible for CRC screening according to the USPS Task Force Guidelines in a primary care practice in Nashville, TN. Results: Out of the 458 Latino patients who were eligible for screening between August 2021-November 2022, only 124 were seen for an annual preventative visit in which screening was ordered. Out of the 124 patients who had orders for CRC screening and received the targeted communication intervention, 85 (68.5%) completed the screening and 39 (31.5%) did not complete the screening. Of those who completed the screening, 47 were insured (55.3%) and 38 were uninsured (44.7%). Conclusion: This study shows that with targeted, linguistically appropriate provider recommendation, Latino patients agree to recommended screening at rates that approach the national benchmark. However most eligible Latino patients are not receiving the recommended screening because they underutilize annual wellness visits during which this counseling/awareness typically takes place. This highlights the need for providers to provide counseling and recommendation for routine cancer screening during any follow-up visits to increase screening uptake in this population. Keywords: Hispanic/Latinos, insured/uninsured, self-pay, colorectal cancer screening, quality improvement, provider-driven interventions, language and cultural barriers

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 ( = 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

Towards Multi-Lingual Pneumonia Research Data Collection Using the Community-Acquired Pneumonia International Cohort Study Database

Background: Although multilingual interfaces are preferred by most users when they have a choice, organizations are often unable to support and troubleshoot problems involving multiple user languages. Software that has been structured with multiple languages and data interlinking considerations early in its development is more likely to be easily maintained. We describe the process of adding multilingual support to the CAPO international Cohort study database using REDCap. Methods: Using Google Translate API we extend the supported Spanish language version of REDCap to the most recent version used by CAPO, 8.1.4. We then translate the English data dictionary for CAPO to Spanish and link the two projects together using REDCap’s hook feature. Results: The Community Acquired Pneumonia Organization database now supports data collection in Spanish for its international collaborators. REDCap’s program hook functionality facilitates both databases staying up to date. When a new case is added to the Spanish project, the case is also added to the English project and vice versa. Conclusions: We describe the implementation of multilingual functionality in a data repository for community-acquired pneumonia and describe how similar projects could be structured using REDCap as an example software environment

Women, Health and Aging: Building a Statewide Movement

Provides an overview of current policy and program environments that affect the state's most vulnerable elder population, and considers some effective strategies to address the growing needs of older persons in California

Optimizing Screening Mammography: Educating Underserved Individuals with Limited English Proficiency

Problems: Culture and language may create huge barriers to the delivery of high-quality care for patients with Limited English Proficiency (LEP) who are seeking breast cancer care, especially in a population that consists of a large proportion of disadvantaged, low income, low English literacy, and high-risk women over 45 years of age. Context: LEP patients’ inability to effectively communicate and inadequate knowledge about screening mammography have put them at great risk of receiving additional images during the exam, as well as brought a huge burden to technologists regarding breast positioning. Interventions: A Doctor of Nursing Practice project was implemented to create culturally sensitive and language appropriate patient education materials on screening mammography. This material will benefit LEP patients by teaching enhanced breast positioning skills, body relaxation techniques, and general knowledge on screening mammography. Measures: The metric included a pre-post online interventional participant survey that evaluated knowledge, confidence, readiness, and likelihood to participate in screening mammography in the future. Results: A total of 60 Chinese women (aged 40-65) participated in the online survey. Data analysis demonstrated a 24.82% gain in their knowledge on screening mammography and a 46.82% gain in their understanding of breast positioning skills and body relaxation techniques. Forty-eight (80%) participants indicated the education material has enhanced their knowledge and they would like to use those tips in the future. Fifty-two participants (86.7%) suggested they would recommend the material to other patients. Conclusion: A culturally and linguistically appropriate patient education material is imperative in increasing the LEP population’s knowledge of screening mammography and may promote their willingness to participate in screening programs

Achieving Equity in Health for Children and Families in New Mexico Through the Affordable Care Act (ACA)

The 2010 Patient Protection and Affordable Care Act (ACA) can help New Mexico achieve health equity by expanding access to care, bolstering public health and prevention programs, and improving the health-care safety net. A number of provisions under the ACA focus on reducing health disparities, particularly among racial and ethnic populations. This study provides a point-in-time snapshot of the progress in implementing ACA provisions aimed at advancing health equity for children and families living in New Mexico.Drawing from multiple sources of evidence — census data, geo-mapping, 55 stakeholder interviews, and a comprehensive review of the literature and policy documents — this study:(1) provides a baseline of children's insurance coverage needed for ongoing monitoring and tracking of progress toward health equity;(2) reviews the health equity provisions in the ACA and highlights those New Mexico is implementing;(3) researches and gathers information about the challenges of implementing specific provisions of the ACA focusing on health equity;(4) summarizes implementation benchmarks and timelines; and(5) provides solutions for moving forward to achieving health equity for children and their families.