Feasibility of using audio computer-assisted self-interview (ACASI) screening in routine HIV care.
ABSTRACT We evaluated the feasibility of implementing audio computer-assisted self-interviews (ACASI) as part of routine clinical care at two community hospital-based HIV clinics in New York City. Between June 2003 and August 2006, 215 patients completed 1001 ACASI sessions in English or Spanish prior to their scheduled clinical appointments. Topics covered included antiretroviral therapy adherence, depression symptoms, alcohol and drug use, and condom use. Patients and providers received feedback reports immediately after each session. Feasibility was evaluated by quantitative analysis of ACASI responses, medical chart reviews, a brief patient questionnaire administered at the conclusion of each computer session, patient focus groups, and semi-structured provider interviews. ACASI interviews frequently identified inadequate medication adherence and depression symptoms: at baseline, 31% of patients reported < or =95% adherence over the past three days and 52% had symptoms of depression (CES-D score > or =16). Substance abuse problems were identified less frequently. Patients were comfortable with the ACASI and appreciated it as an additional communication route with their providers; however, expectations about the level of communication achieved were sometimes higher than actual practice. Providers felt the summary feedback information was useful when received in a timely fashion and when they were familiar with the clinical indicators reported. Repeated ACASI sessions did not have a favorable impact on adherence, depression, or substance use outcomes. No improvements in HIV RNA suppression were observed in comparison to patients who did not participate in the study. We conclude that it is feasible to integrate an ACASI screening tool into routine HIV clinical care to identify patients with inadequate medication adherence and depression symptoms. Repeated screening was not associated with improved clinical outcomes. ACASI screening should be considered in HIV clinical care settings to assist providers in identifying patients with the greatest need for targeted psychosocial services including adherence support and depression care.
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ABSTRACT: Efficacious behavioral interventions and practices have not been universally accepted, adopted, or diffused by policy makers, administrators, providers, advocates, or consumers. Biomedical innovations for sexually transmitted disease (STD) and HIV prevention have been embraced but their effectiveness is hindered by behavioral factors. Behavioral interventions are required to support providers and consumers for adoption and diffusion of biomedical innovations, protocol adherence, and sustained prevention for other STDs. Information and communication technology such as the Internet and mobile phones can deliver behavioral components for STD/HIV prevention and care to more people at less cost. Recent innovations in STD/HIV prevention with information and communication technology-mediated behavioral supports include STD/HIV testing and partner interventions, behavioral interventions, self-management, and provider care. Computer-based and Internet-based behavioral STD/HIV interventions have demonstrated efficacy comparable to face-to-face interventions. Mobile phone STD/HIV interventions using text-messaging are being broadly utilized but more work is needed to demonstrate efficacy. Electronic health records and care management systems can improve care, but interventions are needed to support adoption. Information and communication technology is rapidly diffusing globally. Over the next 5-10 years smart-phones will be broadly disseminated, connecting billions of people to the Internet and enabling lower cost, highly engaging, and ubiquitous STD/HIV prevention and treatment support interventions.Current opinion in psychiatry 03/2010; 23(2):139-44. DOI:10.1097/YCO.0b013e328336656a · 3.55 Impact Factor
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ABSTRACT: It is widely acknowledged that compliance and persistence with oral osteoporosis medications, particularly with bisphosphonates, is poor. Several excellent reviews have been written on compliance and persistence with osteoporosis medications and have discussed improvements seen with extended dosing intervals. This review begins with studies on extended dosing intervals to examine the limitations of administrative claims data. It also looks at compliance and persistence across multiple medical conditions, examining the importance of prescription fulfillment, intentional choice, causation and possible interventions.Reviews in Endocrine and Metabolic Disorders 05/2010; 11(4):275-80. DOI:10.1007/s11154-010-9138-0 · 3.81 Impact Factor
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ABSTRACT: A self-report (a.k.a. survey) is a measure where the respondent supplies information about him or herself. Self-reports are important in medical research because some variables (e.g., attitudes, beliefs, self-judged ability) only can be assessed from information directly furnished by the patient or other subject. A self-report is obtained by questionnaire, interview, or related methods. Questionnaires are written documents that can be self-completed without interviewer involvement or read aloud as part of an interview; interviews usually (but not always) are administered orally; both can be structured (comprise closed-ended questions), unstructured (comprise open-ended questions), or semistructured (comprise a mix of both question types). If answers to a research question can be obtained only via self-report, the investigator should first determine whether an instrument already exists that is reliable, valid, and otherwise suitable for the population of interest. In situations where a new instrument must be developed, the investigator must clearly define the question(s) of interest; identify the population to be surveyed; select the preferred type of self-report/format of measurement; consider inclusion of validation questions, pretest, and pilot test and edit the measure; and test the final battery of questions for reliability and validity. When developing or implementing a survey, the investigator must be certain to observe all ethical and legal aspects of survey methodology.Principles of Research Methodology, 01/2012: pages 147-175; , ISBN: 978-1-4614-3359-0