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Abstract
BackgroundAlthough home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities.ObjectiveThis study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention.MethodsWe utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides.ResultsWe describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities.ConclusionsThese findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients.Trial RegistrationClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485
Highlights
BackgroundChronic obstructive pulmonary disease (COPD) is the leading cause of hospitalization for older adults in the United States
Consumer perspectives mainly focused on cultural tailoring, whereas provider perspectives focused on equipment functionality
The equipment demonstration illustrated that the equipment initially overwhelms some patient stakeholders; the hands-on aspect of the demonstration helped them feel more at ease, the community advisory board (CAB) felt that important adaptations were needed to ensure safety and improve the usability of the intervention
Summary
BackgroundChronic obstructive pulmonary disease (COPD) is the leading cause of hospitalization for older adults in the United States. African Americans and Hispanics are disproportionately affected by social and economic inequalities that impact access to care, including language, acculturation, and immigration status [3] Both groups bear a high burden of illness and death due to COPD and asthma and are twice as likely to visit the emergency room for COPD-associated conditions as compared with non-Hispanic whites [4,5]. COPD patients admitted for COPD exacerbation have a 23% and 50% risk of 30-day and 12-month readmission [8], respectively, and African American and Hispanic race or ethnicity is associated with an almost twofold increase in hospitalization risk [9] Patients and their caregivers suffer from discontinuity of care and decreased quality of life with each of these transitions into and out of the hospital.
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