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

描述（由申请人提供）：在这个项目中，我们建议开发并对一种基于计算机的视频干预进行初步评估，该干预旨在提高美国医院急诊科（ed）的HIV检测接受度。最需要艾滋病毒检测和预防教育的人，包括吸毒者和其他不知道自己感染状况的艾滋病毒感染者，往往很少或根本没有机会在急诊科以外的地方获得医疗保健。目前在急诊科提供常规艾滋病毒检测的努力，往往错过了最有可能受益的病人。由于急诊科工作人员的限制，特别是时间和已经繁重的工作量，许多急诊科无法为所有患者提供检查或充分提供必要的预检查信息。此外，由于艾滋病毒检测是自愿的，风险最高的患者可能会减少。未确诊的艾滋病毒病例构成了一个重大的公共卫生问题，因为不知道自己被感染的人无法接受治疗，并可能在不知不觉中将艾滋病毒传染给他人。本研究开发的干预措施不仅可以为更多的患者提供艾滋病毒检测，而且可以增加同意接受检测的患者数量。拟议的干预措施将采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。一个视频描绘了一个熟练的提供者引人入胜地解释艾滋病毒检测的重要性，可以在掌上电脑上单独传送给急诊科的所有患者，而只需要很少的人员。由于观看视频不需要阅读，视频特别适合在急诊科寻求治疗的文化水平较低的人群。拟议的研究将涉及一项随机对照试验，在急诊科分诊时最初拒绝接受艾滋病毒检测的急诊科患者中进行试验，以确定哪种类型的视频内容会增加艾滋病毒检测的接受程度和相关知识。我们还将收集有关患者接受程度和干预措施可行性的数据，为进一步研究提供信息，以完善干预措施，并将其扩展到一系列临床环境中。这项研究也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的影响。参与者将被随机分组，使用掌上电脑观看不同的教育视频片段，并对干预前后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检测。目的1：开发一种基于计算机的视频干预，以提高最初拒绝分诊时提供的艾滋病毒检测的ED患者对艾滋病毒检测的接受程度和知识。目标2：通过早期随机对照试验评估视频内容的关键维度，检查可接受性、可行性和有效性。这项研究将开启一条有价值的研究路线，测试如何优化视频以达到最大效果，同时教育那些可能无法接触到的高风险患者。

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.