Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes

Fredericksen, Rob J.; Harding, Barbara N; Ruderman, Stephanie A; McReynolds, Justin; Barnes, Greg; Lober, William B.; Fitzsimmons, Emma; Nance, Robin M.; Whitney, Bridget M; Delaney, Joseph A.; Mathews, William C; Willig, James H.; Crane, Paul K.; Crane, Heidi M.

doi:10.1080/09540121.2020.1845288

Cited by 11 publications

(9 citation statements)

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“…Undisclosed nicotine use would result in selection bias through inappropriately categorized participants; however, the use of self-administration through tablet has been shown to greatly reduce social desirability bias and increase the likelihood of accurate reporting of sensitive or potentially stigmatizing information. 55 The structure of our PROs did not allow a precise determination of days of use or amount of nicotine used, although our shift from categorical to continuous frequency of use is sufficiently robust to infer dose–response and is consistent with results considering the variable with an ordinal parameterization. In addition, although we assessed PWH by gender (and included transgender PWH), this analytic cohort lacked power to further differentiate analyses by transgender status.…”

Section: Discussionsupporting

confidence: 65%

Vaporized Nicotine (E-Cigarette) and Tobacco Smoking Among People With HIV: Use Patterns and Associations With Depression and Panic Symptoms

Hahn

Ruderman

Nance

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Vaporized nicotine (VN) use is increasing among people with HIV (PWH). We examined demographics, patterns of use, depression, and panic symptoms associated with VN and combustible cigarette (CC) use among PWH.Methods:We analyzed VN use among PWH in care at 7 US sites. PWH completed a set of patient-reported outcomes, including substance use and mental health. We categorized VN use as never vs. ever with the frequency of use (days/month) and CC use as never, former, or current. We used relative risk regression to associate VN and CC use, depression, and panic symptoms. Linear regression estimated each relationship with VN frequency. Models were adjusted for demographics.Results:Among 7431 PWH, 812 (11%) reported ever-using VN, and 264 (4%) reported daily use. Half (51%) of VN users concurrently used CC. VN users were more likely than those without use to be younger, to be White, and to report ever-using CC. PWH reporting former CC use reported ≥8.5 more days per month of VN use compared with never CC use [95% confidence interval (95% CI): 5.5 to 11.5 days/month] or current CC use (95% CI: 6.6 to 10.5 days/month). Depression (relative risk: 1.20 [95% CI: 1.02 to 1.42]) and panic disorder (1.71 [95% CI: 1.43 to 2.05]) were more common among PWH ever-using VN. Depression was common among PWH using VN (27%) and CC (22%), as was panic disorder (21% for VN and 16% for CC).Conclusion:Our study elucidated demographic associations with VN use among PWH, revealed the overlap of VN and CC use, and associations with depression/panic symptoms, suggesting roles of VN in self-medication and CC substitution, warranting further longitudinal/qualitative research.

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Section: Discussionsupporting

confidence: 65%

Vaporized Nicotine (E-Cigarette) and Tobacco Smoking Among People With HIV: Use Patterns and Associations With Depression and Panic Symptoms

Hahn

Ruderman

Nance

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Comparison of the chart reviews relating to phases when providers did and did not receive the PRO results used the Fisher exact test with a significance level of 0.05. Yes Depression (PHQ-9) [34,35] Yes Yes Anxiety (HIV symptoms inventory) [36] Yes Yes Adherence (VAS) Yes Yes Satisfaction with HIV medications (HATQoL) [37] Yes Yes Nicotine use Yes Yes Alcohol use (AUDIT-C) [38] Yes Yes Substance use (ASSIST) [39] Yes Yes Gender identity Yes Yes Sexual risk behavior (SRBI) [40] Yes Yes Sexual orientation Yes Yes Intimate partner violence (IPV-4) [41] Yes Yes Acceptability E-scale [18] Yes…”

Section: Discussionmentioning

confidence: 99%

“…Perspectives of participating PWH on the acceptability and usability of the PRO platform were evaluated by means of the Acceptability E-scale incorporated into the PRO (Supplementary Appendix 1), which measures 7 components of acceptability using Likert scales [ 18 ]. This was supplemented by 200 post-visit structured surveys carried out during the delivery phase to assess patient perception of the impact of PROs on care (100 per site; Supplementary Appendix 1).…”

Section: Methodsmentioning

confidence: 99%

“…In the field of HIV, a small number of studies have shown that the use of PROs in care enhances communication between patients and providers and improves providers’ ability to detect and monitor symptoms and health behaviors that might otherwise be missed, particularly mental health issues and substance use [ 6 , 15 , 16 ]. In a large US cohort of HIV clinics, tablet-based PROs have been well accepted and valued by providers [ 17 ] and reported as highly acceptable and easy to use by PWH [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Utility and Impact of the Implementation of Same-Day, Self-administered Electronic Patient-Reported Outcomes Assessments in Routine HIV Care in two North American Clinics

et al. 2022

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The PROgress study assessed the value and feasibility of implementing web-based patient-reported outcomes assessments (PROs) within routine HIV care at two North American outpatient clinics. People with HIV (PWH) completed PROs on a tablet computer in clinic before their routine care visit. Data collection included PROs from 1632 unique PWH, 596 chart reviews, 200 patient questionnaires, and 16 provider/staff questionnaires. During an initial setup phase involving 200 patients, PRO results were not delivered to providers; for all subsequent patients, providers received PRO results before the consultation. Chart review demonstrated that delivery of PRO results to providers improved patient-provider communication and increased the number of complex health and behavioral issues identified, recorded, and acted on, including suicidal ideation (88% with vs 38% without PRO feedback) and anxiety (54% with vs 24% without PRO feedback). In post-visit questionnaires, PWH (82%) and providers (82%) indicated that the PRO added value to the visit.

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“…These routine clinic visits present an important window of opportunity for healthcare providers to identify and address some of the problems that can contribute to poor HRQoL. However, PLHIV often encounter communication barriers with their healthcare providers and may not feel that providers are responsive to their healthcare priorities ( Antunes et al, 2020 ; Fredericksen et al, 2020a ; Okoli et al, 2020 ). Furthermore, providers may overlook important symptoms ( Edelman et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Development of a Clinic Screening Tool to Identify Burdensome Health-Related Issues Affecting People Living With HIV in Spain

et al. 2021

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BackgroundNumerous health-related issues continue to undermine the health and health-related quality of life (HRQoL) of people living with HIV (PLHIV). We developed a clinic screening tool (CST-HIV) for the purpose of identifying these issues in routine specialist clinical care in Spain.MethodsWe used the following established instrument development procedures: (1) a literature review; (2) four focus group discussions (FGDs), two that convened 16 expert HIV care providers, and two that convened 15 PLHIV; (3) prioritisation, selection and definition of constructs (health-related issues) to include in the CST-HIV and drafting of initial item pool; and (4) a pilot study to analyse psychometric properties and validity of items and to determine which to retain in the final CST-HIV. The FGD interview scripts incorporated an exercise to prioritise the health-related issues perceived to have the greatest negative effect on HRQoL. The online questionnaire used for the pilot study included the pool of CST-HIV items and validated measures of each construct.ResultsWe identified 68 articles that reported on factors associated with the HRQoL of PLHIV. The most burdensome health-related issues identified in the FGDs related to stigma, socioeconomic vulnerability, sleep/fatigue, pain, body changes, emotional distress, and sexuality. Based on the literature review and FGD findings, we selected and defined the following constructs to include in the initial CST-HIV: anticipated stigma, emotional distress, sexuality, social support, material deprivation, sleep/fatigue, cognitive problems, and physical symptoms. Two researchers wrote six to eight items for each construct. Next, 18 experts rated 47 items based on their clarity, relevance, and representativeness. Pilot testing was carried out with 226 PLHIV in Spain. We retained 24 items based on empirical criteria that showed adequate psychometric properties. Confirmatory factor analysis confirmed the eight-factor structure with a good fit to the data (RMSEA = 0.035, AGFI = 0.97, CFI = 0.99). We found strong positive correlations between the instrument’s eight dimensions and validated measures of the same constructs. Likewise, we found negative associations between the dimensions of the CST-HIV and HRQoL.ConclusionThe CST-HIV is a promising tool for use in routine clinical care to efficiently identify and address health-related issues undermining the HRQoL of PLHIV.

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Patient acceptability and usability of a self-administered electronic patient-reported outcome assessment in HIV care: relationship with health behaviors and outcomes

Cited by 11 publications

References 50 publications

Vaporized Nicotine (E-Cigarette) and Tobacco Smoking Among People With HIV: Use Patterns and Associations With Depression and Panic Symptoms

Vaporized Nicotine (E-Cigarette) and Tobacco Smoking Among People With HIV: Use Patterns and Associations With Depression and Panic Symptoms

Utility and Impact of the Implementation of Same-Day, Self-administered Electronic Patient-Reported Outcomes Assessments in Routine HIV Care in two North American Clinics

Development of a Clinic Screening Tool to Identify Burdensome Health-Related Issues Affecting People Living With HIV in Spain

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