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.
Highlights
The use of telemonitoring is a promising approach to optimizing outcomes in the treatment of heart failure (HF) for patients living in the community
Community needs assessment The focus group discussion began with a general discussion of the needs of Black and Hispanic HF disparity patients; multiple challenges were identified, including repeated hospitalization, medication management, and co-morbidities
Discussion previous studies have documented the clinical efficacy of remote monitoring of HF [11], and discussed the importance of adapting interventions to facilitate cultural relevance [20, 21], this 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
Summary
The use of telemonitoring is a promising approach to optimizing outcomes in the treatment of heart failure (HF) for patients living in the community. Hispanics with HF are diagnosed younger and die earlier than non-Hispanic Whites. Reasons for this greater disease burden in underserved populations are complex, resulting from the interaction of factors such as comorbidities, health access, socioeconomics and cultural factors [7, 9, 10]. Telemonitoring (TM) is a promising approach to optimize outcomes for HF patients living at home [11]. Using the audio/video component, TM involves the patient in self-monitoring and clinician feedback, allowing patients to stay in their homes while remaining connected to their support systems [12,13,14]. Riegel‘s group reported higher patient satisfaction among telemonitoring patients, compared with usual care [15]
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