Conducting Internet-Based Visits for Onboarding Populations With Limited Digital Literacy to an mHealth Intervention: Development of a Patient-Centered Approach.
Conducting Internet-Based Visits for Onboarding Populations With Limited Digital Literacy to an mHealth Intervention: Development of a Patient-Centered Approach.
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DOI：
10.2196/25299
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发表时间：
2021-04-29
影响因子：
2.2
通讯作者：
Lyles CR
中科院分区：
文献类型：
--
作者：
Hernandez-Ramos R;Aguilera A;Garcia F;Miramontes-Gomez J;Pathak LE;Figueroa CA;Lyles CR
COVID-19大流行促使面向患者的研究转向数字和远程医疗战略。如果这些战略不适用于社会经济地位较低的少数群体患者，健康不平等将进一步加剧。以患者为中心的护理模式可以成功地改善少数群体患者的访问和体验。本研究的目的是提出的发展过程和初步接受改变在人的入职程序到基于互联网的，远程程序的移动的健康（mHealth）干预的数字素养有限的人群。我们积极招募安全网患者（在美国旧金山弗朗西斯科的公共卫生保健提供系统接受治疗的糖尿病和抑郁症的英语和西班牙语成年人）参加一项关于短信支持体力活动的随机对照试验。由于COVID-19疫情，我们将亲自招聘和入职程序改为基于互联网的远程流程，并提供人力支持。我们对招募队列的组成从COVID-19前时期到COVID-19招募时期可能发生的变化进行了初步评估。首先，我们分析了在2019冠状病毒病大流行之前曾参加过面对面入职培训的患者（n=32）的数字档案。接下来，我们记录了对我们的入职流程所做的所有更改，以说明远程招募，特别是那些需要支持不太熟悉自己将应用程序下载到移动的手机上的患者。最后，我们使用新的研究程序招募了COVID-19社交距离期间的患者（n=11）。这些患者还被问及他们参加完全数字化的mHealth干预的经历。在COVID-19之前和COVID-19期间的招募（N=43）显示智能手机拥有率相对较高，但自我报告的数字素养较低，所有患者中有32.6%（14/43）报告他们需要帮助使用智能手机和安装应用程序。对入职程序进行了重大更改，包括通过Zoom视频通话和/或标准电话促进应用程序下载，并实施简短的一对一工作人员-患者互动，以提供针对每位患者数字素养技能的个性化技术援助。比较COVID-19前和COVID-19期间的招募，有数字素养障碍的患者比例从COVID-19前队列的34. 4%（11/32）降至COVID-19队列的27. 3%（3/11）。两个队列之间的数字素养得分差异不显著（P= 0.49）。社会经济地位较低的患者对使用数字平台管理其健康有很高的兴趣，但他们可能需要额外的前期人力支持才能获得访问。一对一的工作人员与患者的合作关系使我们能够提供针对每位患者数字素养技能的个性化技术援助，并采用简单的策略来解决患者的障碍。这些额外的远程入职策略可以减轻但不能消除没有丰富技术经验的患者的数字障碍。Clinicaltrials.gov NCT 0349025，https://clinicaltrials.gov/ct2/show/NCT03490253
The COVID-19 pandemic has propelled patient-facing research to shift to digital and telehealth strategies. If these strategies are not adapted for minority patients of lower socioeconomic status, health inequality will further increase. Patient-centered models of care can successfully improve access and experience for minority patients. This study aims to present the development process and preliminary acceptability of altering in-person onboarding procedures into internet-based, remote procedures for a mobile health (mHealth) intervention in a population with limited digital literacy. We actively recruited safety-net patients (English- and Spanish-speaking adults with diabetes and depression who were receiving care at a public health care delivery system in San Francisco, United States) into a randomized controlled trial of text messaging support for physical activity. Because of the COVID-19 pandemic, we modified the in-person recruitment and onboarding procedures to internet-based, remote processes with human support. We conducted a preliminary evaluation of how the composition of the recruited cohort might have changed from the pre–COVID-19 period to the COVID-19 enrollment period. First, we analyzed the digital profiles of patients (n=32) who had participated in previous in-person onboarding sessions prior to the COVID-19 pandemic. Next, we documented all changes made to our onboarding processes to account for remote recruitment, especially those needed to support patients who were not very familiar with downloading apps onto their mobile phones on their own. Finally, we used the new study procedures to recruit patients (n=11) during the COVID-19 social distancing period. These patients were also asked about their experience enrolling into a fully digitized mHealth intervention. Recruitment across both pre–COVID-19 and COVID-19 periods (N=43) demonstrated relatively high rates of smartphone ownership but lower self-reported digital literacy, with 32.6% (14/43) of all patients reporting they needed help with using their smartphone and installing apps. Significant changes were made to the onboarding procedures, including facilitating app download via Zoom video call and/or a standard phone call and implementing brief, one-on-one staff-patient interactions to provide technical assistance personalized to each patient’s digital literacy skills. Comparing recruitment during pre–COVID-19 and COVID-19 periods, the proportion of patients with digital literacy barriers reduced from 34.4% (11/32) in the pre–COVID-19 cohort to 27.3% (3/11) in the COVID-19 cohort. Differences in digital literacy scores between both cohorts were not significant (P=.49). Patients of lower socioeconomic status have high interest in using digital platforms to manage their health, but they may require additional upfront human support to gain access. One-on-one staff-patient partnerships allowed us to provide unique technical assistance personalized to each patient’s digital literacy skills, with simple strategies to troubleshoot patient barriers upfront. These additional remote onboarding strategies can mitigate but not eliminate digital barriers for patients without extensive technology experience. Clinicaltrials.gov NCT0349025, https://clinicaltrials.gov/ct2/show/NCT03490253