Optimizing Computer-Based Video to Increase HIV Testing in Emergency Departments

优化基于计算机的视频以增加急诊科的艾滋病毒检测

• 批准号: 8140952
• 负责人: Ian David Aronson
• 金额: $ 15.03万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-15 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8140952
• 关键词: AIDS prevention; Accident and Emergency department; Affect; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Computers; Country; Data; Data Collection; Diagnosis; Dimensions; Drug user; Effectiveness; Environment; Evaluation; Female; Future; Gender; HIV; Handheld Computers; Health Services Accessibility; Healthcare; Hospitals; Hour; Human Resources; Human immunodeficiency virus test; Individual; Infection; Intervention; Knowledge; Law Enforcement; Lead; Learning; Low Literacy Population; Methodology; Modeling; Participant; Patients; Population; Prevalence; Prevention education; Prevention program; Professional counselor; Provider; Public Health; Randomized; Randomized Controlled Trials; Reading; Reporting; Research; Research Personnel; Risk; Services; Solutions; Staging; Stigmata; Testing; Time; Training; Triage; United States; Visit; Work; Workload; base; care seeking; comparative; design; disorder prevention; experience; high risk; high risk behavior; instrument; male; post intervention; public health priorities; social stigma; theories; therapy design; tool; uptake

DESCRIPTION (provided by applicant): In this project, we propose to develop and conduct a preliminary evaluation of a computer-based video intervention designed to increase HIV test acceptance in hospital emergency departments (EDs) across the United States. People most in need of HIV testing and prevention education, including drug users and other HIV-infected individuals who are unaware of their infection status, often have little or no access to healthcare outside the ED. Current efforts to offer routine HIV testing in the ED often miss patients who would benefit most. Due to ED staff limitations, most notably time and an already heavy workload, many EDs are not able to offer all patients a test or adequately provide necessary pre-test information. Further, because HIV testing is voluntary, patients at highest risk may decline. Undiagnosed cases of HIV present a significant public health problem, as people who do not know they are infected cannot receive treatment, and may unknowingly spread HIV to others. The intervention developed in this study can be used not only to offer HIV testing to more patients, but to increase the number of patients who agree to be tested. The proposed intervention will employ computer-based video that communicates standardized public health messages in ways patients understand. A video portraying a skilled provider engagingly explaining the importance of HIV testing can be individually delivered on handheld computers to all patients in an ED, while making only minimal personnel demands. Because viewing a video does not require reading, videos are especially suited to lower-literacy populations that seek care in an ED. The proposed research will involve a randomized controlled trial among ED patients who initially decline an HIV test at ED triage to determine what types of video content lead to increases in HIV test uptake and related knowledge. We will also gather data on patient acceptance and the feasibility of the intervention to inform further research to refine the intervention and expand it for use in an array of clinical environments. This study will also provide a new methodology to comparatively evaluate how video content can be optimized for greatest impact. Participants will be randomized into groups that use handheld computers to view different educational video segments and respond to pre- post-intervention data collection instruments. At the end of the intervention, the computers will ask participants if they would like an HIV test. AIM 1 Develop a computer-based video intervention to increase HIV test acceptance and knowledge among ED patients who initially decline an HIV test offered at triage. AIM 2 Evaluate critical dimensions of video content through an early stage randomized controlled trial examining acceptability, feasibility, and effectiveness. This study will begin a valuable line of research testing how video can be optimized for greatest effectiveness while simultaneously educating high-risk patients who might otherwise not be reached. PUBLIC HEALTH RELEVANCE: The Centers for Disease Control and Prevention recommends routine HIV testing in emergency departments (EDs) because people who visit an ED may lack access to other forms of healthcare, and if they are not tested for HIV, may be infected for years before receiving a diagnosis. Unfortunately, current testing efforts often fail to reach those most at risk. This study will develop and evaluate the acceptability, feasibility and preliminary effectiveness of an automated, computer-based video intervention, which offers considerable promise for increasing HIV test acceptance in EDs across the United States, thus having a marked public health impact.

描述(由申请人提供)：在这个项目中，我们建议开发并进行一项基于计算机的视频干预的初步评估，旨在提高全美医院急诊科(ED)对艾滋病毒检测的接受度。最需要艾滋病毒检测和预防教育的人，包括吸毒者和其他感染艾滋病毒的人，他们不知道自己的感染状况，通常很少或根本没有机会获得急诊科以外的医疗保健。目前在急诊室提供艾滋病毒常规检测的努力往往会遗漏那些受益最大的患者。由于急诊科工作人员的限制，最明显的是时间和已经很重的工作量，许多急诊科无法为所有患者提供测试或充分提供必要的测试前信息。此外，由于艾滋病毒检测是自愿的，最高风险的患者可能会减少。未确诊的艾滋病毒病例是一个重大的公共卫生问题，因为不知道自己感染了艾滋病毒的人无法接受治疗，并可能在不知不觉中将艾滋病毒传播给其他人。这项研究中开发的干预措施不仅可以用来为更多的患者提供艾滋病毒检测，还可以用来增加同意接受检测的患者数量。拟议的干预措施将使用基于计算机的视频，以患者理解的方式传达标准化的公共卫生信息。一段描述熟练提供者的视频可以在手持计算机上单独发送给急诊室的所有患者，同时只需最低限度的人员要求。因为观看视频不需要阅读，所以视频特别适合在急诊室寻求护理的低识字率人群。这项拟议的研究将在最初拒绝在ED分流时接受HIV检测的ED患者中进行随机对照试验，以确定哪些类型的视频内容会导致HIV检测摄取和相关知识的增加。我们还将收集有关患者接受度和干预可行性的数据，为进一步的研究提供信息，以完善干预并将其扩展到一系列临床环境中使用。这项研究还将提供一种新的方法来比较评估如何优化视频内容以获得最大影响。参与者将被随机分成几组，使用掌上电脑观看不同的教育视频片段，并对干预前的数据收集工具做出反应。在干预结束时，计算机将询问参与者是否愿意进行艾滋病毒测试。目的1开发一种基于计算机的视频干预，以提高最初拒绝在分诊时提供艾滋病毒检测的ED患者对HIV检测的接受度和知识。目的2通过对视频内容的可接受性、可行性和有效性进行早期随机对照试验，评估视频内容的关键维度。这项研究将开始一系列有价值的研究，测试如何优化视频以实现最大效率，同时教育那些原本可能无法接触到的高危患者。 与公共卫生相关：疾病控制和预防中心建议在急诊科进行常规艾滋病毒检测，因为去急诊室就诊的人可能无法获得其他形式的医疗保健，如果他们没有接受艾滋病毒检测，可能会在得到诊断之前感染多年。不幸的是，目前的检测工作往往无法触及风险最高的人群。这项研究将开发和评估基于计算机的自动化视频干预的可接受性、可行性和初步有效性，这将为提高全美急诊室对艾滋病毒检测的接受度提供相当大的希望，从而对公共健康产生显著影响。