Tailoring Interface for Spanish Language: A Case Study with CHICA System.
ABSTRACT We developed a clinical decision support system (CDSS) – Child Health Improvement through Computer Automation (CHICA) - to
deliver patient specific guidance at the point of clinical care. CHICA captures structured data from families, physicians,
and nursing, staff using a scannable paper user interface - Adaptive Turnaround Documents (ATD) while remaining sensitive
to the workflow constraints of a busy outpatient pediatric practice. The system was deployed in November 2004 with an English
language only user interface. In July 2005, we enhanced the user interface with a Spanish version of the pre-screening questionnaire
to capture information from Spanish speaking families in our clinic. Subsequently, our results show an increase in rate of
family responses to the pre-screening questionnaire by 36% (51% vs. 87%) in a four month time period before and after the
Spanish interface deployment and up to 32% (51% vs. 83%) since November 2004. Furthermore, our results show that Spanish speaking
families, on average, respond to the questionnaire more than English speaking families (85% vs. 49%). This paper describes
the design, implementation challenges and our measure of success when trying to adapt a computer scannable paper interface
to another language.
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ABSTRACT: Race and ethnicity affect children's risk of secondhand smoke exposure. However, little is known about how race and language preference impact parents' self-reported smoking and stopping smoking rates. We analyzed data for 16,523 children aged 0-11 years from a pediatric computer decision support system (Child Health Improvement through Computer Automation [CHICA]). CHICA asks families in the waiting room about household smokers. We examined associations between race, insurance, language preference, and household smoking and reported stopping smoking rates using logistic regression. Almost a quarter (23%) of the children's families reported a smoker at home. Hispanic children are least likely (odds ratio [OR]: 0.17, confidence interval [CI]: 0.12-0.24) to have secondhand smoke exposure when compared to African American and white children, as were those with private insurance (OR: 0.52, CI: 0.43-0.64) or no insurance (OR: 0.79, CI: 0.71-0.88) compared to publicly insured. Children from English speaking families were more likely (OR: 1.55, CI: 1.24-1.95) to have secondhand smoke exposure compared to Spanish speaking families. Among smoking families, 30% reported stopping smoking subsequently. Stopping rates were higher in Hispanic (OR: 3.25, CI: 2.06-5.13) and African American (OR: 1.39, CI: 1.01-1.91) families compared to white children's families. Uninsured families were less likely than publicly insured families to report stopping smoking (OR: 0.76, CI: 0.63-0.92). English speaking families were less likely (OR: 0.56, CI: 0.41-0.75) to report stopping smoking compared to Spanish speaking even in a subgroup analyses of Hispanic families (OR: 0.55, CI: 0.39-0.76). In our safety net practices serving children predominantly on public insurance, Spanish speaking families reported the lowest risk of secondhand smoke exposure in children and the highest rate of stopping smoking in the household. Hispanic families may have increasing secondhand exposure and decreasing rates of stopping smoking as they acculturate.Pediatric Allergy, Immunology, and Pulmonology 09/2013; 26(3):144-151. DOI:10.1089/ped.2013.0257 · 0.56 Impact Factor
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ABSTRACT: Early television (TV) viewing has been linked with maternal depression and has adverse health effects in children. However, it is not known how early TV viewing occurs. This study evaluated the prevalence at which parents report TV viewing for their children if asked in the first 2 years of life and whether TV viewing is associated with maternal depression symptoms. Using a cross-sectional design, TV viewing was evaluated in children 0 to 2 years of age in 4 pediatric clinics in Indianapolis, IN, between January 2011 and April 2012. Families were screened for any parental report of depression symptoms (0-15 months) and for parental report of TV viewing (before 2 years of age) using a computerized clinical decision support system linked to the patient's electronic health record. There were 3254 children in the study. By parent report, 50% of children view TV by 2 months of age, 75% by 4 months of age, and 90% by 2 years of age. Complete data for both TV viewing and maternal depression symptoms were available for 2397 (74%) of children. In regression models, the odds of parental report of TV viewing increased by 27% for each additional month of child's age (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.25-1.30; p < .001). The odds of TV viewing increased by almost half with parental report of depression symptoms (OR, 1.47; CI, 1.07-2.00, p = .016). Publicly insured children had 3 times the odds of TV viewing compared to children with private insurance (OR, 3.00; CI, 1.60-5.63; p = .001). Black children had almost 4 times the odds (OR, 3.75; CI, 2.70-5.21; p < .001), and white children had one-and-a-half times the odds (OR, 1.55; CI, 1.04-2.30; p = .032) of TV viewing when compared to Latino children. By parental report, TV viewing occurs at a very young age in infancy, usually between 0 and 3 months and varies by insurance and race/ethnicity. Children whose parents report depression symptoms are especially at risk for early TV viewing. Like maternal depression, TV viewing poses added risks for reduced interpersonal interactions to stimulate infant development. This work suggests the need to develop early targeted developmental interventions. Children as young as 0 to 3 months are viewing TV on most days. In the study sample of 0 to 2 year olds, the odds of TV viewing increased by more than a quarter for each additional month of child's age and by as much as half when the mother screened positive for depression symptoms.Journal of developmental and behavioral pediatrics: JDBP 03/2014; DOI:10.1097/DBP.0000000000000035 · 2.12 Impact Factor