A Pilot Randomized Trial of a Video Patient Decision Aid to Facilitate Early Intervention Referrals From Primary Care

Abstract

Many young children identified with developmental concerns in pediatric settings do not receive early intervention (EI). We assessed the impact of a video decision aid and text message reminder on knowledge and attitudes regarding developmental delay and EI as well as referral completion. We conducted a pilot randomized controlled trial in an urban setting and enrolled 64 parent-child dyads referred to EI. Compared with controls, participants who received the intervention demonstrated increased knowledge regarding developmental delay and EI as well as more favorable attitudes in certain topics. Although we did not find a significant difference between arms in EI intake and evaluation, we found a pattern suggestive of increased intake and evaluation among participants with low health literacy in the intervention arm. Additional study is needed to identify strategies that improve the EI referral process for families and to understand the potential targeted role for decision aids and text messages.

Beliefs Regarding Development and Early Intervention Among Low-Income African American and Hispanic Mothers

“…20,21 A recent randomized trial assessing the impact of a 3-minute video decision aid on parents' attitudes regarding DD and appraisals of EI demonstrated favorable changes in these areas. 22 The third theme, it's not that I don't trust the doctor, appeared consistently across all stages of the help-seeking pathway. Mothers in our study (as with parents across cultures) 23, 24 relied on social networks for advice about their child's care and help-seeking behaviors.…”

Addressing Health Literacy in Patient Decision Aids: An Update from the International Patient Decision Aid Standards

“…32,33,36 Studies that conducted separate analyses explored the moderating effects of literacy or health literacy ( n = 5), education ( n = 8), numeracy ( n = 1), poverty or socioeconomic status (e.g., income, n = 2), ethnicity or race ( n = 5), geographical location ( n = 2), insurance status ( n = 3), or language preference ( n = 1) by including interactions in their analyses. One study that conducted a separate analysis restricted their analysis only within the low-literacy group but did not compare with a high-literacy group, 26 and another study conducted a separate analysis to test the effect of their intervention among Latino participants only. 22…”

“…45 Often, interventions included a combination of formats such as print/video ( n = 3). 21,38,40 Four studies used print/video with another element such as text messages, 26 telephone, 30,34 or face-to-face counseling. 42 It was generally not specified whether a modality was chosen specifically to accommodate users with low literacy, with the exception of 2 studies that reported using a touch-screen PtDA format to this end.…”

“…21,23,38,44 Readability analysis software was used in 1 study to refine the PtDA text, 31 1 study reported the text was written at reduced readability, 30 and 1 study simply reported that the grade reading level was calculated; however, it is not clear whether it was specifically designed to be below grade 8. 33 Four studies stated that IPDAS criteria were followed; 3 attended to the original IPDAS quality criteria checklist, 21,26,35 whereas 1 attended to the IPDAS instrument (IPDASi v3.0) checklist. 38 An additional study reported that the IPDAS guidelines contributed to the conceptual framework that guided PtDA development, 24 and another updated their PtDA after the study was conducted to satisfy the original IPDAS quality criteria checklist.…”

A Systematic Review and Meta-Analysis of Patient Decision Aids for Socially Disadvantaged Populations: Update from the International Patient Decision Aid Standards (IPDAS)

“…Twenty-five PtDAs were included in the primary analysis. 36–60 An additional 13 studies of SDM interventions were included in the secondary analysis (Figure 1). 61–73…”