Phone Reminders Research Articles

Abstract A122: Predictors of mailed fecal immunochemical test return for Hispanic patients receiving care at community health centers

Abstract Background and Purpose: Mailed fecal immunochemical testing (FIT) is an evidence-based strategy to increase colorectal cancer (CRC) screening. We have previously reported that a multi-level mailed FIT intervention resulted in higher CRC screening rates compared to usual care among Hispanic patients receiving care at Community Health Centers (CHCs). The objective of this study was to assess predictors of mailed FIT completion among Hispanic individuals. Methods: The San Diego Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) project tested a multi-level mailed FIT intervention in 3 CHC systems in Southern California. Using a cluster-randomized trial design, 9 clinics were randomized to mailed FIT and 16 to usual care. The intervention was delivered in Spanish and English and included an invitation letter, a mailed FIT kit with completion instructions, and phone and text-based reminders. Multi-level implementation strategies (i.e., training, centralized facilitation, etc.) were utilized to increase uptake. For this analysis, we assessed mailed FIT completion at 1 year among Hispanic participants ages 50-75 years not up-to-date with CRC screening at baseline and who were randomized to clinics in the mailed FIT intervention. We conducted logistic regression to assess relationships between sex, language preference, health insurance and mailed FIT return. Results: Among the 9 intervention clinics, 2,199 Hispanic patients who were age-eligible and not up-to-date with CRC screening at baseline were included in the present analysis. In this group, 1,457 (66.3%) were female, 1,449 (65.9%) were Spanish-speaking, and 769 (35.0%) returned the FIT kit. Variation in FIT return for Hispanic individuals was shown across CHC systems: 53.2% in CHC1, 31.4% in CHC2, and 24.7% in CHC3. The percentage of individuals who returned the mailed FIT was highest among 55 to 59-year-olds (39.4%) and lowest among 50 to 54-year-olds (30.6%). Results from univariate logistic regression showed that individuals who preferred Spanish language had higher return rate than those who preferred English (OR=1.44; 95% CI: 1.17-1.77). FIT return was higher among participants who were privately insured compared with Medicaid-insured individuals (OR=1.57; 95% CI: 1.20-2.06). Return rate was higher among females compared to males, but the difference was not statistically significant (OR=1.13, 95% CI: 0.98-1.29). Conclusions: Among Hispanic patients who receive care at CHCs, a regional mailed FIT intervention was effective at increasing screening rates. Mailed FIT completion among participants randomized to clinics in the intervention group varied by language preference and health insurance status. These results suggest that future efforts could be tailored to increase FIT return rates among English-speaking Hispanics and those with Medicaid insurance. Citation Format: Joshua Demb, Maria Elena Martinez, Scott Roesch, Samir Gupta, Valesca Largaespada, Sheila F. Castañeda, Borsika A. Rabin, Jennifer Covin, Kristine Ortwine, Yesenia Preciado-Hidalgo, Nicole Howard, James Schultz, Nannette Stamm, Daniel Ramirez, Michael T. Halpern, Jesse Nodora. Predictors of mailed fecal immunochemical test return for Hispanic patients receiving care at community health centers [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A122.

Impact of Multi-Component Outreach on Colorectal Cancer Screening and Genetic Testing Preferences

Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide, with early detection through screening significantly reducing mortality rates. However, disparities in access to screening persist, particularly in disadvantaged communities. Fecal Immunochemical Testing (FIT) offers a cost-effective, non-invasive method that increases screening participation by eliminating the need for in-person visits. Multicomponent outreach strategies are crucial to improving participation rates, particularly in populations with limited healthcare access. Methods: This study employed a mixed-method, sequential explanatory design to assess the impact of a population-based, centralized outreach program on CRC screening rates. Quantitative data from Kaiser Permanente Northern California's (KPNC) screening program were analyzed alongside qualitative ethnographic data to explore the implementation of the FIT-based outreach system. A cohort of individuals aged 51 to 75 years was included, with screening completion rates and follow-up processes examined. Results: Among the community initially screened, 40% participated in CRC screening before intervention. The implementation of a centralized, computerized outreach system led to a significant increase in participation, with screening rates rising by 30 percentage points within eight weeks. A combination of automated phone calls, text messages, and reminders during clinic visits further increased coverage by 12 percentage points, resulting in a total screening participation rate of 80%. The study also found that mailed FIT kits significantly improved participation rates, with FIT mailers leading to a 28-percentage point increase in screening compared to opportunistic testing. Various forms of patient guidance resulted in a 17-percentage point rise in screening, while recall interventions led to a modest 3-percentage point increase. Conclusion: The study demonstrates the effectiveness of a multicomponent, centralized outreach approach in increasing CRC screening participation in a large and diverse population.

The impact of coronavirus pandemic shutdowns on immunization completion in Hadeetha, Anbar, Iraq: A case-study of vaccine completion in a recovering healthcare system

The SARS-COV2 pandemic caused significant disruptions in immunization delivery. Baseline deficit gaps in immunization completion exacerbated ongoing disparities in immunization coverage in low- and middle-income. Emerging reports focused on global strategies for return to routine immunization schedules. Currently, there are no studies that examined the dual challenge of returning to normal immunization in a conflict-recovery setting, such as the ISIS (Islamic State of Iraq and Syria) occupation of Iraq post-COVID-19 pandemic.The objective of this study was to estimate the number of children in Hadeetha, Iraq from 12 to 24 months of age who continued to be lost to the routine immunization schedule due to the COVID-19 pandemic shutdowns. Random sampling occurred from a compiled district health facility registrar of all children in the target birth cohort who had a 12-month immunization scheduled during the 2020 lockdown and were lost to the immunization schedule. A total of 171 households from the sampling frame were included in the final sample. In this cross-sectional study, survey data was collected on the head of the household, the caregiver and the child. Additional questions assessed vaccine hesitancy, vaccine information trusted sources and COVID-19 impact on healthcare access. A risk factor analysis was applied to assess using Chi-square (Χ2) for predictors of lack of DTP3 (Diphtheria, Tetanus and Polio) third dose completion. Of children in the study, 67.3 % did not complete the 6-antigen series at 12-months of age and 46.2 % were missing DTP3 for vaccines to be completed during the pandemic shutdown. Specific risk factors for lack of immunization for the DTP3 vaccine included area of residence, age and caregiver knowledge of vaccines. Respondents indicated a dependence on mass vaccination campaigns but also indicated a willingness to receive phone reminders and television campaigns about vaccination schedules.

Facilitators and barriers to initiating and completing tuberculosis preventive treatment among children and adolescents living with HIV in Uganda: a qualitative study of adolescents, caretakers and health workers

IntroductionPeople living with HIV (PLHIV) have a 20-fold risk of tuberculosis (TB) disease compared to HIV-negative people. In 2021, the uptake of TB preventive treatment among the children and adolescents living with HIV at the Baylor-Uganda HIV clinic was 45%, which was below the national target of 90%. Minimal evidence documents the enablers and barriers to TB preventive treatment (TPT) initiation and completion among children and adolescents living with HIV(CALHIV). We explored the facilitators and barriers to TPT initiation and completion among CALHIV among adolescents aged 10-19years and caretakers of children below 18years.MethodsWe conducted a qualitative study from February 2022 to March 2023, at three paediatric and adolescent HIV treatment centers in Uganda. In-depth interviews were conducted at TPT initiation and after completion for purposively selected health workers, adolescents aged 10–19 years living with HIV, and caretakers of children aged below 18years.ResultsThe desire to avoid TB disease, previous TB treatment, encouragement from family members, and ministry of health policies emerged as key facilitators for the children and adolescents to initiate TPT. Barriers to TPT initiation included; TB and HIV-related stigma, busy carer and adolescent work schedules, reduced social support from parents and family, history of drug side effects, high pill burden and fatigue, and perception of not being ill. TPT completion was enabled by combined TPT and ART refill visits, delivery of ART and TPT within the community, and continuous education and counseling from health workers. Reported barriers to TPT completion included TB and HIV-related stigma, long waiting time. Non-disclosure of HIV status by caretakers to CALHIV and fear of side effects was cited by health workers as a barrier to starting TPT. Facilitators of TPT initiation and completion reported by healthcare workers included patient and caretaker health education, counselling about benefits of TPT and risk of TB disease, having same appointment for TPT and ART refill to reduce patient waiting time, adolescent-friendly services, and appointment reminder phone calls.ConclusionThe facilitators and barriers of TPT initiation and completion among CALHIV span from individual, to health system and structural factors. Health education about benefits of TPT and risk of TB, social support, adolescent-friendly services, and joint appointments for TPT and ART refill are major facilitators of TPT initiation and completion among CALHIV in Uganda.

Factors influencing adherence to antiretroviral therapy among young adults in Limpopo province.

South Africa is among the countries with the greatest burden of human immunodeficiency virus (HIV) in the world. The introduction of antiretroviral therapy (ART) has made HIV a manageable chronic health condition with a return to normal life expectancy. Adherence to ART is a prerequisite to realising these benefits. A qualitative study was conducted using individual semi-structured interviews to understand factors influencing adherence to ART among young adults. The study was conducted at three busy primary care clinics around Mankweng Hospital. Participants aged 18-35 years who had been on ART for more than a year were purposefully selected. Open-ended questions were used to explore factors that influence ART. Recorded interviews were transcribed verbatim and translated. The coded transcripts were thematically analysed. Eight major themes were identified to influence ART adherence among young adults: medication-related factors, healthcare system factors, attitudes of healthcare workers, economic factors, disclosure, acceptance, mobile phone reminders and family support. Adherence to ART is a major problem in our communities, and people living with HIV are still finding it challenging to optimally adhere to their ART medication because of the identified factors that influence ART adherence. Family support is a significant factor that was identified to positively influence ART as it leads to disclosure and acceptance of HIV-positive status, better emotional well-being and subsequently improved ART adherence.Contribution:This study underscores the importance of a family-oriented, patient-centred care approach in managing HIV and ART adherence.

EMPLOYMENT OUTCOMES FOLLOWING THORACOLUMBAR FRACTURES: LONG-TERM FOLLOW-UP GREATER THAN FIVE YEARS

Study designRetrospective study.ObjectivesTo identify patient outcomes, in particular employment, >5-years following traumatic thoracolumbar fracture.Methods235 patients between the ages of 18–65 were identified from the hospital radiology database having sustained a traumatic thoracolumbar fracture on CT or MRI between 01/01/2013 and 31/01/2017. Questionnaires were sent out via post and available emails, with a reminder letter and phone calls. Retrospective data was gathered about employment status pre-fracture and >5-years post injury.Results26 patients had died at follow up leaving 209 patients. 108 (52%) were treated surgically and 101 (48%) conservatively. 106 replies were received with 85 (80%) opting in and 21 (20%) opting out. 68 (80%) patients completed the full questionnaire with 17 (20%) filling out a shortened questionnaire via a phone conversation. 52 (61%) patients underwent surgery and 33 (39%) were treated conservatively. The average follow up was 8 years. Prior to injury 66 (78%) were employed and 19 (22%) unemployed (of which 6 were full time students and 8 were retired). 49 (74%) of the previously employed patients returned to work at follow up with 35 (53%) working the same or increased hours. Regarding employment, there was no significant difference between surgically and conservatively treated patients (P=0.355) or the classification of the fracture (P=0.303). 16 (19%) patients reported back pain prior to their injury whilst 69 (81%) did not. There were 58 (68%) cases of new pain at follow up with the most affected area being the lumbar region in 43 (51%) patients. 32 (38%) patients reported neurological deficit post injury: 19 with subjective symptoms, 9 with objective symptoms and 4 suffered paralysis.Conclusion>5-years following a traumatic thoracolumbar fracture most individuals return to employment. There was no significant difference between the severity of the fracture or how patients are treated on their employment outcomes.

Health care professionals expectations on mobile exergaming to decrease sedentary time in patients with heart failure

Abstract Background Exergaming is a promising intervention to decrease sedentary time in patients with Heart Failure (HF). For the implementation for mobile exergaming in clinical practice it is important to assess the expectations Health Care Professionals (HCPs) for this new technology for patients with HF. Purpose To explore the expectations of HCPs on mobile exergaming to decrease sedentary time in patients with heart failure. Method A qualitative design was used. Data on expectations HCPs have with exergaming for patients with HF were collected between September to October 2023 with semi-structured interviews. A total of 17 interviews including nine cardiologists, two rehabilitation physicians, five nurses and one physiotherapist. Data was analyzed using thematic analysis. Results In total five themes were found: (1) Exergaming can be complementary or alternative; (2) Exergaming benefit from familiarization and socialization; (3) Exergaming support adherence and motivation; (4) Technology knowledge and skills is required; (5) The patients sex influenced expectations on exergaming. HCPs expected that exergaming could be a complementary technology following cardiac rehabilitation. HCPs expressed that exergaming should not be used as an alternative for physical activity advice or cardiac rehabilitation. The importance of a good familiarization to exergaming was seen as important and express that increased social interaction e.g. family involvement when introducing exergaming to a patient could make the familiarization easier. Exergaming was expected to be a motivator and increase adherence to physical activity and potential reduce sedentary time. Mobile phone reminders for physically activity were seen as important for patients’ motivation. The lack of technology knowledge was seen as a barrier for exergaming. HCPs expects that exergaming will be harder for older patients with HF. There was a divergence of opinions on the ease of exergaming between men and women, with some expecting it to be easier for men, while others believe that women possess more technology knowledge, especially concerning mobile phones. Conclusion HCPs expected that exergaming could motivate and improve adherence to physical activity and be a complementary technology to use for decreasing patients’ sedentary time in clinical settings. Implementation should involve adequate time for familiarization, family engagement, and additional support to master technology for older patients with heart failure. Future research should further explore HCP attitudes and potential differences in exergaming prescription and adoption with regard to the patient’s sex.

The effect of multiple nursing interventions on physical activity and health promotion in the elderly: A randomized controlled trial

Health promotion and physical activity practices for the elderly are important but still not sufficient. This study aimed to determine if the effects of education through home visit, mobile application (Google Fit), group walking, and phone reminder interventions on health promotion and physical activity in the elderly. The study has a randomized controlled design with pretest-posttest interventions and a control group. The study sample consisted of 66 elderly individuals, 33 of whom were assigned to the intervention group and 33 to the control group by randomization. Multiple nursing interventions, including education through home visit, mobile application (Google Fit) use, group walking, and phone reminder messages, were implemented by the researcher in line with Pender's Health Promotion Model. The first month score of the intervention group participants on the healthy lifestyle habits subscale was higher than that of the control group participants (all p-values < 0.05). The effect size was 0.577 (high effect size) and the confidence interval was 0.085-1.07. It can be recommended that interventions with reminders and repetitions regarding healthy lifestyle behaviors to health promotion in the elderly be planned.

Development of a Medication Refill System - A Collaboration Between Telemedicine and Pharmacy Departments

Background: The Saturday Clinic for the Uninsured (SCU) has an on-site dispensary that provides free medications to patients. Many patients request urgent refills when they run out leaving them without medications prior to their appointments. A prior study showed a reminder phone call can effectively assist with medication refills.1 However, little data exists for how to develop such a system at a free clinic. Our team implemented this methodology utilizing a system where patients were contacted before their medications ran out to arrange refills and analyzed its effectiveness. Methods: All clinic patients receiving medications from the on-site dispensary had their expected refill date logged. Patients 3 weeks away from needing a refill had their chart reviewed to determine if they should be contacted. When indicated, patients were contacted one time via telephone by students to assess their needs and schedule refills. System outcomes were gathered over 18 weeks and analyzed to determine the number of potential medication gaps prevented and system success rate. Results: 131 patient charts were reviewed for potential follow-up. 58 patients were contacted, of which 32 patients were reached and spoken with resulting in 32 refills scheduled. The system prevented 24.4% of potential medication gaps with a system success rate of 55.2%. Conclusion: This system successfully reduced medication gaps among patients. The most and least effective methods for scheduling refills were by directly speaking with patients and leaving voicemails respectively. A trend observed was a decrease in urgent patient calls regarding medication gaps. Future directions include making multiple contact attempts, using multiple contact methods including texts and emails, and evaluating adherence.

Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study.

In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. This study aims to assess the APM self-management program's feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. Response rates were 70% (44/63) at postintervention and 56% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46% (29/63) of the participants completed the program. We interviewed 24% (15/63) of the participants. The interview's first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. These findings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652.

Efficacy of a phone reminder to improve adherence to post-partum glucose tolerance testing after gestational diabetes and clinical predictors of post-partum follow-up compliance

AimTo assess the effectiveness of a phone reminder to improve adherence to post-partum glucose tolerance testing in women with gestational diabetes mellitus (GDM) and to identify clinical predictors of adherence to post-partum follow-up. MethodsRetrospective study including 543 women with GDM. We assessed the adherence rate to post-partum glucose tolerance testing in women who received a phone reminder (n = 297) compared to women not alerted (n = 246). Demographic and clinical variables were collected to identify the predictors of adherence to the post-partum oral glucose tolerance test (OGTT). ResultsThe adherence to post-partum OGTT was higher in women who received the phone reminder compared to those not alerted (60.6 % vs. 35.4 %, p < 0.001). Women less compliant compared to those more compliant, had a higher pre-pregnancy body mass index (BMI) (29.3 ± 7.9 vs. 27.0 ± 6.1 Kg/m2, p = 0.03). The adherence was lower in pre-pregnant obese compared to non-obese women (42.7 % vs. 52.0 %, p < 0.05), in women with only one, compared to multiple OGTT alterations during pregnancy (44.5 % vs. 57.8 %, p < 0.05), and in women non-insulin treated compared to those insulin-treated (40.0 % vs. 57.1 % vs, p < 0.001). ConclusionsThe phone reminder improved post-partum follow-up adherence. Pre-pregnancy BMI, number of OGTT alterations and type of therapy could identify poorly adherent women.

Cash transfers to enhance completion of TB screening among household contacts in rural Tanzania.

<sec id="st1"><title>BACKGROUND</title>Tanzanian TB guidelines recommend facility-based TB screening for symptomatic household contacts (HHCs) or those aged <5 years, but cost remains a major barrier. In this study, we evaluate the use of unconditional cash transfers (UCTs) to facilitate completion of HHC TB screening.</sec><sec id="st2"><title>METHODS</title>In this prospective interventional study, we enrolled index people diagnosed with TB (PWTB) within 8 weeks of TB treatment initiation from the TB clinic at Haydom Lutheran Hospital, Haydom, Tanzania, and surrounding TB dispensaries in rural Tanzania. The study provided at the time of enrollment an UCT up to 40,000 Tanzanian shillings (USD16.91) directly to heads of households with PWTB, covered medical costs from screening activities and provided three bi-weekly phone reminders to facilitate HHC TB screening. The primary outcome was TB screening completion for all HHCs compared to the same period of the preceding year.</sec><sec id="st3"><title>RESULTS</title>We enrolled 120 index PWTB, including 398 HHCs between July and December 2022. The median age for index PWTB was 35 years; 38% were females. Sixty-five (54%) households completed screening for all HHCs, compared to 7% during the same period of the preceding year.</sec><sec id="st4"><title>CONCLUSION</title>These interventions may considerably improve completion of HHC TB screening in rural Tanzania.</sec>.

Utilization of Mobile Reminders in Improving the Completeness and Timeliness of Routine Childhood Immunization in Kano Metropolis, Nigeria: A Randomized Controlled Trial

This study examined the effectiveness of mobile phone reminders in improving the completeness and timeliness of childhood immunization. We conducted a parallel arm cluster randomized controlled trial in four primary health care facilities in Nigeria. Reminders were sent to eligible participants in the intervention group at specific intervals when their children were scheduled to receive the vaccines administered at the sixth, 10, and 14 weeks after birth. Immunization records of all participants' children were then tracked to assess their immunization status. The immunization status of the intervention (n = 275) and control (n = 261) arms was analyzed. Completeness and timeliness of the vaccine series were significantly higher (p < .001) among children of participants in the intervention (n = 169, 61.5% and n = 138, 50.2%) than those in the control group (n = 35, 13.4% and n = 13, 5%) arm. Mobile phone reminders were established to be effective in increasing the completeness and timeliness of childhood immunization.

Colon cancer screening disparities among limited English proficient patients during implementation of patient navigation services.

17 Background: Age-appropriate colon cancer screening has long demonstrated effectiveness in reducing colon cancer incidence and mortality. However, despite a gradual rise in compliance with colon cancer screening, significant disparities remain, particularly among patients with limited English proficiency (LEP). Multitarget stool DNA (MT-sDNA) testing (Exact Sciences, Madison, WI) has been available over the past decade in the United States as a lower-cost and non-invasive option for screening. In 2019, Exact Sciences began to offer patient navigation services comprising outbound phone, text, and e-mail reminders, and inbound phone support (&gt;200 languages) with all MT-sDNA orders. In this study, we aimed to evaluate the disparity in successful MT-sDNA testing between LEP and EP patients in a time frame when patient navigation services were active. Methods: We performed a retrospective cohort study of patients 45-75 years old enrolled in the primary care setting of our institution who received an order for MT-sDNA screening during a period in which patient navigation services began to be offered. A multi-state Cox model was constructed with time to MT-sDNA or other CRC screening predicted by English proficiency accounting for age and gender. Wald tests were used to test the association of CRC screening completion and English proficiency. Rates of completion of MT-sDNA screening and other CRC screening following MT-sDNA test ordering were calculated using the Kaplan-Meier method. Results: Of the 5016 patients evaluated and referred for multitarget stool DNA testing from May 1st, 2021, and May 1st, 2022, 154 patients were of LEP, and 4862 were English proficient (EP). At 180 days following a MT-sDNA test order the rate of completion for the LEP patients was 50.2% (95% CI: 42.8-58.7%) versus 70.3% (95% 69.1-71.6%) for EP individuals (p=0.001). A small portion of individuals also completed another type of CRC screen, 3.3% for LEP and 2.5% for EP (p=0.99). Conclusions: This study is consistent with the existing research demonstrating LEP as a significant demographic group linked with decreased participation in cancer screening. Our findings indicated that despite the availability of patient navigation services, individuals with LEP were still less likely to complete an MT-sDNA test successfully when compared to those with EP. [Table: see text]

Health information systems in extreme contexts: Using mobile phones to fight AIDS in Uganda

AbstractThe HIV/AIDS pandemic is a global issue that has unequally affected several countries. Due to the complexity of this condition and the human drama it represents to those most affected by it, several fields have contributed to solving or at least alleviating this situation, and the information systems (IS) field has not been absent from these efforts. With the importance of antiretroviral therapy (ART) as a starting point, several initiatives in the IS field have focused on ways to improve the adherence and effectiveness of this therapy: mobile phone reminders (for pill intake and appointments), and mobile interfaces between patients and health workers are popular contributions. However, many of these solutions have been difficult to implement or deploy in some countries in the Global South, which are among the most affected by this pandemic. This paper presents one such case. Using a case‐study approach with an extreme‐case selection technique, the paper studies an m‐health system for HIV patients in the Kalangala region of Uganda. Using Heeks' design—reality gap model for data analysis, the paper shows that the rich interaction between social context and technology should be considered a central concern when designing or deploying such systems.

Mobile phone intervention to reduce dropout from treatment at an outpatient mental health service for older people in Nigeria.

Half of older Africans drop out of treatment after a single contact with biomedical mental health services. This study examined the effect of introducing a mobile phone reminder intervention delivered by volunteering health staff to reduce dropout from an outpatient mental health service for older people in Nigeria. 405 patients were studied using a quasi-experimental design: 169 who attended clinic pre-intervention (2016-2017) and 236 who attended during intervention (2018-2019). We estimated annual dropout rates, reasons for dropout and predictors of drop-out. We found a trend for decreasing dropout rates during intervention (p<0.001). The most common reasons for dropout were distance to the clinic (19.5%) and unavailability of a caregiver (47.6%). Current single status (O.R =2.02, 95% C. I=1.02-3.99) and treatment without adjunctive pharmacotherapy (O. R=2.14, 95% CI; 1.07-4.26) predicted dropout. Mobile phone call reminders improved treatment engagement in this population. Findings are important for policy to improve access to mental healthcare in Africa.

A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial

BackgroundProcess evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial.MethodsGO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components – warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG.ResultsAll sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high – 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG.ConclusionsThis process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation.Trial registrationClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

A National Survey of Oncologists' Perspectives on the Ethical Implications of Artificial Intelligence in Cancer Care

Introduction Artificial Intelligence (AI) is an emerging technology that promises advancements across blood cancer discovery and care delivery. There are already FDA-approved uses of AI in hematology and oncology but few data available about its use or utility. Concerns have been raised over AI's potential biases, “explainability,” and who is responsible for its use. Oncologists' familiarity with AI and perspectives on these issues are not well known and are critical to understanding the ethical deployment of AI in blood cancer care. Methods From January to July 2023, we performed a national cross-sectional survey of practicing oncologists. A draft survey instrument was developed by a team with content and methodological expertise. Iterative refinement occurred through cognitive debriefing with 5 practicing hematologist/oncologists. The final instrument included 24 questions covering domains of AI familiarity, predictions, explainability, and responsibilities. A random sample of US oncologists was identified using the National Plan &amp; Provider Enumeration System. Paper surveys were mailed with $25 incentivizing gift cards. Reminder letters and phone calls were used for non-responders with an electronic survey option provided. Responses were analyzed descriptively. X2 testing assessed bivariate associations between responses and participant practice setting, with odds ratios (OR) reported. Results Of 399 mailed surveys, 12 were undeliverable and 201 were completed for a response rate of 51.9%. Question missingness was &amp;lt;1%. Participants were 63.2% White, 16.9% Indian Asian, 10.0% Eastern Asian or Pacific Islander, and 4.5% Black; 6.0% were Hispanic. They represented 37 states. The majority were male (63.7%), 40-59 years old (54.2%), and had no specific training in AI (52.2%); 68.2% had at least 11 years in practice and 29.9% practiced at a primary academic hospital. Questions assessing overall familiarity with and predictions related to AI are shown in Table 1. Those at primary academic hospitals were more likely to be familiar with radiology models (OR 2.82, p&amp;lt;0.001) but not pathology, prognostic, or clinical decision models (all p&amp;gt;0.05). They were more likely to predict that AI would improve side effect management (OR 2.01, p=0.03) and end-of-life decision making (OR 2.07, p=0.02). High proportions of respondents thought that AI prognostic (67.1%) and clinical decision models (62.1%) needed to be explainable by clinicians and researchers to be used in clinic. When posed with a scenario where an FDA-approved AI model selects a different regimen than the oncologist planned to propose (Figure 1), the largest proportion reported they would present both options and let the patient decide (37.3%). Of those recommending a regimen, respondents from primary academic hospitals more frequently recommend the AI-generated regimen (56.1%), while respondents from elsewhere recommended their original regimen (69.0%; OR 2.85, p=0.007). Acceptability of some direct-to-patient AI model applications is shown in Table 1. A majority of respondents (90.5%) thought that AI developers should be responsible for medico-legal problems caused by AI use; 47.8% thought that physicians using the tool should be responsible. Though most (76.1%) agreed that it was oncologists' responsibility to protect patients from biased AI tools, few (27.3%) were confident in their ability to identify how representative the data used in an AI model was relative to the population with that cancer (including 66.7% of those who agreed it was oncologists' responsibility). More respondents thought that patients should need to consent to the use of AI tools in cancer treatment decisions (81.1%) than cancer diagnosis (55.7%); those from primary academic hospitals were less likely to respond that patients should consent for treatment or diagnosis (OR 0.43, p=0.02 and OR 0.44, p=0.009). Conclusions In this national survey of oncologists' views on AI, there was optimism about its impact on care with notable caveats related to end-of-life care, patient trust, and care disparities. Despite many approving use of AI models too complex for patients to explain, a substantial proportion deferred to patient choice when AI and physician recommendations differed. There was also dissonance between accepting responsibility to protect patients from bias and respondents' self-perceived ability to do so.

Mental health of sexual assault victims and predictors of their use of support from in-house psychologists at Belgian sexual assault care centres

ABSTRACT Background: Sexual assault (SA) can induce a negative impact on victims’ mental health. Specialised SA services generally offer medical care and a forensic examination to SA victims. However, there is a large variation in how these services provide mental health support. Objective: This study aims to assess mental health problems of SA victims attending the Belgian Sexual Assault Care Centres (SACCs) and identify predictors for victims’ use of support from in-house psychologists. Method: Health records of victims ≥ 16 years who presented within one week post-SA to one of the three Belgian SACCs between 25 October 2017 and 31 October 2019 were reviewed. An AIC-based stepwise backward binary logistic regression was used to analyse the association between victim, assault, service use and mental health characteristics and follow-up by a SACC-psychologist. Results: Of the 555 victims, more than half had a history of mental health problems. Of those assessed, over 70% showed symptoms of posttraumatic stress disorder (PTSD), depression and/or anxiety disorder. One in two victims consulted a SACC-psychologist. Victims with a mental health history (OR 1.46, p = .04), victims accompanied by a support person during acute care (OR 1.51, p = .04), and victims who were assaulted by an acquaintance in comparison to those assaulted by a stranger (OR 1.60, p = .039) were more likely to attend their appointment with the SACC-psychologist. Conclusion: The study reaffirms the high mental health burden among victims attending specialised SA services, stressing the need to provide effective mental health interventions at these services and improve their longer-term use by victims. Prescheduling of appointments with an in-house psychologist in combination with phone reminders may improve the uptake of such services. Health care providers must be vigilant about potential barriers faced by victims without a mental health history or social support in attending appointments with mental health professionals.

Hub-and-Spoke centralized intervention to optimize colorectal cancer screening and follow-up: A pragmatic, cluster-randomized controlled trial protocol

BackgroundGuidelines recommend screening for colorectal cancer (CRC), but participation and abnormal test follow up rates are suboptimal, with disparities by demography. Evidence-based interventions exist to promote screening, but community adoption and implementation are limited. MethodsThe San Diego Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) program is an academic-community partnership testing regional implementation of a Hub-and-Spoke model for increasing CRC screening and follow-up. The “hub” is a non-academic, non-profit organization that includes 17 community health center (CHC) systems, serving over 190 rural and urban clinic sites. The “spokes” are 3 CHC systems that oversee 11–28 clinics each, totaling over 60 clinics. Using a cluster-randomized trial design, 9 clinics were randomized to intervention and 16 to usual care. Within intervention clinics, approximately 5000 eligible patients not up-to-date with CRC screening per year were identified for intervention. Interventions include an invitation primer, a mailed fecal immunochemical test with completion instructions, and phone and text-based reminders (hub) and patient navigation protocol to promote colonoscopy completion after abnormal FIT (spoke). Outcomes include: 1) proportion of patients up-to-date with screening after three years in intervention versus non-intervention clinics; 2) proportion of patients with abnormal FIT completing colonoscopy within six months of the abnormal result. Implementation science measures are collected to assess acceptability, intervention and usual care adaptations, and sustainability of the intervention strategies. ConclusionThis large-scale, regional cluster randomized trial among CHCs serving diverse populations is anticipated to accelerate progress in CRC prevention in underserved populations.Trial registration: NCT04941300