Video as an Effective Method to Deliver Pretest Information for Rapid Human Immunodeficiency Testing

Abstract

Objectives: Video-based delivery of human immunodeficiency virus (HIV) pretest information might assist in streamlining HIV screening and testing efforts in the emergency department (ED). The objectives of this study were to determine if the video ''Do you know about rapid HIV testing?'' is an acceptable alternative to an in-person information session on rapid HIV pretest information, in regard to comprehension of rapid HIV pretest fundamentals, and to identify patients who might have difficulties in comprehending pretest information.Methods: This was a noninferiority trial of 574 participants in an ED opt-in rapid HIV screening program who were randomly assigned to receive identical pretest information from either an animated and live-action 9.5-minute video or an in-person information session. Pretest information comprehension was assessed using a questionnaire. The video would be accepted as not inferior to the in-person information session if the 95% confidence interval (CI) of the difference (D) in mean scores on the questionnaire between the two information groups was less than a 10% decrease in the in-person information session arm's mean score. Linear regression models were constructed to identify patients with lower mean scores based upon study arm assignment, demographic characteristics, and history of prior HIV testing. Results:The questionnaire mean scores were 20.1 (95% CI = 19.7 to 20.5) for the video arm and 20.8 (95% CI = 20.4 to 21.2) for the in-person information session arm. The difference in mean scores compared to the mean score for the in-person information session met the noninferiority criterion for this investigation (D = 0.68; 95% CI = 0.18 to 1.26). In a multivariable linear regression model, Blacks ⁄ African Americans, Hispanics, and those with Medicare and Medicaid insurance exhibited slightly lower mean scores, regardless of the pretest information delivery format. There was a strong relationship between fewer years of formal education and lower mean scores on the questionnaire. Age, gender, type of insurance, partner ⁄ marital status, and history of prior HIV testing were not predictive of scores on the questionnaire. Conclusions:In terms of patient comprehension of rapid HIV pretest information fundamentals, the video was an acceptable substitute to pretest information delivered by an HIV test counselor. Both the video and the in-person information session were less effective in providing pretest information for patients with fewer years of formal education.ACADEMIC EMERGENCY MEDICINE 2009; 16:124-135 ª

Emergency Medicine Resident Attitudes and Perceptions of HIV Testing Before and After a Focused Training Program and Testing Implementation

“…Such findings are informative for HIV testing initiatives, and alternative means of minimizing these barriers have been explored both in our program 33,34 and others. 10,[35][36][37][38] Alternative models for delivering HIV testing in EDs that have been explored recently include provision of dedicated HIV testing facilitators, which would essentially eliminate ED providers' concern over time, paper work, manpower, and testing procedures. [13][14][15][16]39 Drawbacks of that approach, however, are the requirement for dedicated sustainable funding from the public or private sector to hire additional staff and the need for a separate parallel operational program.…”

Race and Emotion in Computer-Based HIV Prevention Videos for Emergency Department Patients

“…Although the effectiveness of video-based HIV testing and prevention programs has been clearly established (Carey, Coury-Doniger, Senn, Vanable, & Urban 2008; Gilbert et al, 2008; Merchant et al, 2007, 2009) systematic examinations of how educational video segments can be optimized for greater impact have largely been overlooked. For example, studies generally do not compare multiple video segments to examine how the physical characteristics of people who appear onscreen in a public health message can shape a video’s effectiveness among particular groups of viewers.…”

“…Merchant et al, (2009) used a 9.5 minute video to provide HIV pretest information to patients recruited from the ambulatory care and urgent care areas of a hospital ED and found the video “was an acceptable substitute for an in-person information session” (p. 132). Carey et al, (2008) used a video to promote HIV testing among patients at an STD (sexually transmitted disease) clinic who were at risk for HIV and had declined multiple offers of an HIV test.…”

“…The Gilbert et al, (2008) intervention, in contrast, required multiple sessions of roughly 1 hour each and therefore would have been impractical in an ED. Second, this study’s intervention was implemented in the main treatment area of a hospital ED, in contrast to that of Merchant et al’s (2009), which was implemented in an ED but may not have recruited patients in all parts of the ED, such as the critical care area. Unlike Carey et al, (2008) or Gilbert et al, which brought participants to a private room to deliver the intervention, the video segments used in this study were delivered on a handheld computer where the patient was receiving treatment.…”

“…Third, and perhaps most notable, the above studies did not compare multiple video segments to determine the most effective implementation of educational theory. Merchant et al (2009) and Carey et al (2008) showed participants a single video and then evaluated the video’s success. Gilbert et al (2008) targeted specific video segments to individual participants, but all the videos depicted the same actor in the role of physician.…”