A qualitative analysis to optimize a telemonitoring intervention for heart failure patients from disparity communities

Abstract

BackgroundThe use of telemonitoring is a promising approach to optimizing outcomes in the treatment of heart failure (HF) for patients living in the community. HF telemonitoring interventions, however, have not been tested for use with individuals residing in disparity communities.MethodsThe current study describes the results of a community based participatory research approach to adapting a telemonitoring HF intervention so that it is acceptable and feasible for use with a lower-income, Black and Hispanic patient population. The study uses the ADAPT-ITT framework to engage key community stakeholders in the process of adapting the intervention in the context of two consecutive focus groups. In addition, data from a third focus group involving HF telemonitoring patient participants was also conducted. All three focus group discussions were audio recorded and professionally transcribed and lasted approximately two hours each. Structural coding was used to mark responses to topical questions in the interview guide.ResultsThis is the first study to describe the formative process of a community-based participatory research study aimed at optimizing telehealth utilization among African-American and Latino patients from disparity communities. Two major themes emerged from qualitative analyses of the focus group data. The first theme that arose involved suggested changes to the equipment that would maximize usability. Subthemes identified included issues that reflect the patient populations targeted, such as Spanish translation, font size and medical jargon. The second theme that arose involved suggested changes to the RCT study structure in order to maximize participant engagement. Subthemes also identified issues that reflect concerns of the targeted patient populations, such as the provision of reassurances regarding identity protection to undocumented patients in implementing an intervention that utilizes a camera, and that their involvement in telehealth monitoring would not replace their clinic care, which for many disparity patients is their only connection to medical care.ConclusionsThe adaptation, based on the analysis of the data from the three focus groups, resulted in an intervention that is acceptable and feasible for HF patients residing in disparity communities.Trial registrationNCT02196922; ClinicalTrials.gov (US National Institutes of Health).Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0300-9) contains supplementary material, which is available to authorized users.

mHealth and Engagement Concerning Persons With Chronic Somatic Health Conditions: Integrative Literature Review

“…The learning process as a form of engagement was expressed in various ways. For example, mHealth solutions with coaching and educational components, such as animated scenarios, combined audio and text instructions and quizzes, supported learning [ 16 , 28 , 29 ].…”

“…Several factors were described as influencing the engagement process. Lack of time and busy lifestyles, with constraints due to home obligations, childcare, work, and travel leading to difficulties in integrating the solution into daily life, often resulted in disengagement [ 18 , 23 , 28 , 34 ]. Technological problems such as glitches, errors, connectivity problems, and battery attrition were other factors described as influencing engagement [ 23 , 28 , 31 , 34 ].…”

“…Lack of time and busy lifestyles, with constraints due to home obligations, childcare, work, and travel leading to difficulties in integrating the solution into daily life, often resulted in disengagement [ 18 , 23 , 28 , 34 ]. Technological problems such as glitches, errors, connectivity problems, and battery attrition were other factors described as influencing engagement [ 23 , 28 , 31 , 34 ]. Concerns about trust, privacy, and security were also reported to influence engagement and usage negatively [ 18 , 19 , 34 , 43 ].…”

Impact of telemonitoring approaches on integrated HIV and TB diagnosis and treatment interventions in sub-Saharan Africa: a scoping review

“…11,12 The local socio-cultural ecological cascades in this context are trusted community delivery platforms that are policy-driven and ensure HIV and TB prevention and treatment interventions in reaching the target populations. These may include the access and uptake coverage to quality programs and strategies coupled with ownership, shared accountability and transparency.…”

A Randomized Controlled Trial Comparing Telehealth Self-Management to Standard Outpatient Management in Underserved Black and Hispanic Patients Living with Heart Failure

“…The TSM intervention was tailored to the needs of the targeted community using a community-based participatory research (CBPR) approach, the ADAPT-ITT (Assessment Decision Administration Production Topical Experts—Integration Training Testing) model to facilitate usability and feasibility. 28,29 Spanish and/or English-speaking patients 18 years and older and recently discharged from the hospital were followed for 90 days. Patients were excluded if they were already receiving telehealth monitoring.…”