Engaging patients in their care via mHealth
Name:
Dr. Megan Gregory
Email
megan.gregory@ufl.edu
Phone
(352) 294-8126
Faculty Department/Division
Health Outcomes and Biomedical Informatics
This project is primarily:
Translational
Research Project Description:
Our team is developing a stream of work around patient engagement in their healthcare via mobile health, in vascular surgery, cancer, and other clinical areas. The projects may entail literature review, data collection, analysis, and contributing to manuscripts.
Does this project have an international component or travel?
No
Qualitative investigation of barriers and facilitators to parent/caregiver adoption and use of health information technology
Name:
Dr. Jessica Ray
Email
Jessica.ray@ufl.edu
Phone
(321) 356-4346
Faculty Department/Division
Health Outcomes and Biomedical Informatics
This project is primarily:
Basic
Research Project Description:
Background & Significance
Nearly one in five children in the United States is living with obesity, with even higher rates in black and Hispanic children.1 Parent/Caregiver and adolescent health literacy have been linked to childhood obesity, potentially limiting engagement in shared decision making, proactive communication with clinicians, and management adherence.2 Use of the patient portal and health information technology (HIT) by caregivers in the pediatric primary care setting is positively associated with management changes for other chronic health conditions such as asthma.3 While 90 percent of United States health care systems offer patient portal access to electronic health records (EHR), only 15 to 39 percent of patients activate an account and disparities exist in both activation and use of these tools.4 In the local pediatric setting, parents of younger children, male patients, Black or African American patients, and those with public insurance are less likely to activate or use patient portal accounts.4 While the COVID-19 pandemic brought rapid expansion of digital health technologies, early reports suggest that disparities in access to patient portals remained during the early stages of the pandemic. The current work explores current barriers and facilitators to patient portal and health information technology adoption by parents/caregivers of children ages 2 through 11 years.
The aim of this investigation is to identify what factors serve as barriers and facilitators to a caregiver’s activation and use of the patient portal and other health information technologies. Caregivers will be recruited using purposeful sampling across demographic factors to allow for a diverse perspective.
Hypothesis & Rationale
Identifying barriers and facilitators to caregiver’s activation and use of the patient portal and other health information technologies will provide foundations for both new technology development to meet caregiver needs and potential strategies for implementation of those new technologies. We hypothesize that there will be multifactorial issues driving adoption and use as well as non-adoption of health information technologies. Thematic analysis of qualitative semi-structured interviews will allow for the examination of these factors.
Methods
We will recruit using purposeful sampling to capture a range of experiences and comfort levels with technology. The sample will include pediatric caregivers (patient/legal guardian) who have experience with MyChart as well as those without experience with MyChart. Participants will be recruited for interviews through the Integrated Data Repository’s Consent2Share program, HealthStreet, and from the survey distributed in the IRB202300307 study. A semi-structured interview guide will be used to conduct approximately 20 to 30 interviews to allow for thematic saturation. Interviews will be coded by the principal investigator and the research coordinator in NVivo using an inductive grounded theory approach and the constant comparative method.
Inclusion criteria: Adults 18 and older that are the current caregiver (parent/legal guardian) of one or more pediatric patients ages 2 to 11. Participants must be conversationally fluent in English.
Role of Medical Student
The medical student will assist with data analysis of qualitative interviews. Interviews will be analyzed using a grounded theory approach. We will use NVivo software for coding. Themes will be derived through a systematic, inductive approach to coding using constant comparative method. The medical student will assist the principal investigator and research coordinator with coding transcripts and will attend regular team meetings to review and discuss all codings, iteratively developing the codebook.
Funding
Internally funded (Department of Health Outcomes and Biomedical Informatics)
Relevant Publications
- Kinney, A. P., & Sankaranarayanan, B. (2021). Effects of Patient Portal Use on Patient Satisfaction: Survey and Partial Least Squares Analysis. Journal of medical Internet research, 23(8), e19820. https://doi.org/10.2196/19820
- Popovac, M., & Roomaney, R. (2022). Measuring online health-seeking behaviour: Construction and initial validation of a new scale. British journal of health psychology, 27(3), 756–776. https://doi.org/10.1111/bjhp.12571
Does this project have an international component or travel?
No
Comparative Effectiveness of Mobile Health Smoking Cessation Approaches Among Underserved Patients in Primary Care
Faculty Information
Name:
Dr. Ramzi Salloum
Email
rsalloum@ufl.edu
Phone
(352) 294-4997
Faculty Department/Division
Health Outcomes and Biomedical Informatics
This project is primarily:
Clinical
Research Project Description:
Tobacco smoking is the leading cause of preventable disease, disability, and death in the United States. Smoking harms nearly every organ in the body and costs the United States billions of dollars each year. Recent improvements in digital technology and in behavioral science have led to two breakthroughs in mobile health (mHealth) treatments for smoking cessation.
One treatment, iCanQuit, is the only mHealth smoking cessation approach shown effective in a large (phase 3) clinical trial. iCanQuit is a modern, cognitive-behavioral treatment that promotes cessation through greater acceptance of triggers for smoking and commitment to personal values. The second, Motiv8, promotes smoking cessation with automatic financial rewards based on actual evidence of smoking abstinence. Motiv8 is part of the new generation of technology-enabled health incentive treatments that can reach an increasingly diverse range of people.
This project is directly responsive to the 2020 Surgeon General’s report on smoking cessation. The report identifies a gap in the evidence related to the effectiveness of mHealth smoking cessation treatments compared to other forms of treatment, such as state quit lines that provide telephone counseling. To fill this gap, the “PROMOTE-UP Florida Study” will compare the combination of iCanQuit and Motiv8, iCanQuit alone, and the Florida Quitline.
The objective of this study is to Evaluate the comparative effectiveness of iCanQuit alone, iCanQuit and Motiv8 combined, against the Florida Quitline in a pragmatic trial of primary care patients, assess how and for whom the interventions help patients in achieving smoking abstinence, and identify barriers and facilitators to implementing the interventions in clinical practice using the consolidated framework for implementation research.
Medical students’ involvement with the project will be geared towards their interests. Potential opportunities included assisting with participants recruitment, and dissemination of study at scientific meetings and in peer-reviewed publications.
Does this project have an international component or travel?
No
I-PRO: MyPAIN and Pain Manager Integration into UF Health Epic IRB Protocol
Name:
Dr. Ramzi Salloum
Email
rsalloum@ufl.edu
Phone
(352) 294-4997
Faculty Department/Division
Health Outcomes and Biomedical Informatics
This project is primarily:
Clinical
Research Project Description:
The U.S. continues to face public health crises related to both chronic pain and opioid overdoses. Thirty percent of Americans suffer from chronic noncancer pain at a cost of $600 billion annually. Most patients with chronic pain first turn to primary care clinicians, who must choose from myriad treatment options based on relative risks and benefits, patient history, symptoms, and goals. Recently, with attention to opioid-related risks, prescribing has declined. However, clinical experts have countered with concerns that some patients, for whom opioid-related benefits outweigh risks, are being inappropriately discontinued from opioids. Unfortunately, primary care clinicians lack usable tools to help them partner with their patients in choosing pain treatment options that best balance risks and benefits in the context of patient history, symptoms, and goals. Thus, primary care clinicians and patients would benefit from effectively implementing clinical decision support (CDS) for this shared decision-making process.
The objective of this study is to evaluate the adaptation and implementation of an existing interoperable Clinical Decision Support (CDS) tool for pain treatment shared decision-making, with tailored implementation support, in new clinical settings in the OneFlorida Clinical Research Consortium. Our central hypothesis is that tailored implementation support will increase CDS adoption and shared decision-making. We further hypothesize that increases in shared decision-making will lead to improved patient outcomes, pain and physical function. The research will generate evidence on strategies to support the implementation of interoperable CDS in new clinical settings across different types of electronic health records. The study will also inform tailored implementation strategies to be further tested in a subsequent hybrid effectiveness-implementation trial. Together, these efforts will lead to important new technology and evidence that patients, clinicians, and health systems can use to improve care for millions of Americans who suffer from pain and other chronic conditions.
Does this project have an international component or travel?
No
Point-of-care intervention to address financial hardship in families facing pediatric cancer
Name:
Dr. Ramzi Salloum
Email
rsalloum@ufl.edu
Phone
(352) 294-4997
Faculty Department/Division
Health Outcomes and Biomedical Informatics
This project is primarily:
Clinical
Research Project Description:
The costs of cancer care have increased by almost 40% from 2010 to 2020. As a result, patients and their families are bearing more of the economic burden of cancer care. This is due primarily to barriers in insurance design, such as annual increases in deductibles and copayments as well as the use of multi-tiered pharmacy benefits, which have led to growing out-of-pocket expenses. These increases in cost sharing for cancer care result in greater economic distress (“financial hardship”) for patients and their families.
The impact of financial hardship is particularly concerning for pediatric cancer. Indeed, even if a child is covered by their parent’s medical insurance, families can spend large portions of their income on out-of-pocket expenses (i.e., copayments, coinsurance, and deductibles), in addition to other expenses that may not be covered (e.g., transportation, lodging, food, and childcare). Compounding matters further, the parents and guardians also face time away from work and potentially lost income. This comes at a time when young families are more vulnerable as they are trying to build financial stability. Finally, given the unique challenges of planning for an unforeseen event like pediatric cancer many families are forced to make treatment decisions based on financial hardship. Taken together, these unique aspects of the financial hardship associated with pediatric cancer underscore the pressing need to explore ways to mitigate this impact at a financially vulnerable time.
Among adults diagnosed with cancer, discussion of financial concerns with a professional financial counselor has been shown to reduce cancer-related financial burden. Financial counseling professionals help adult cancer patients organize their finances, apply diagnostic indicators to determine their financial position, help with options to improve their financial situation in the face of cancer and provide other helpful skills and strategies to help address the overall burden. Although financial counseling has been shown to be effective among adults with cancer, we are unaware of prior research into the implementation of financial counseling targeted at families facing pediatric cancer. Indeed, professional counseling provided by an Accredited Financial Counselor (AFC®) may be extremely helpful in guiding families facing pediatric cancer as they navigate their cancer journey. What is needed now are targeted research efforts to explore the best ways to expand financial counseling to the specific and unique setting of pediatric cancer.
Together, the Extension System and the OneFlorida Clinical Research Consortium provide ideal conditions for evaluating family-centered financial counseling. We will test the feasibility and acceptability of a point-of-care intervention to connect families of pediatric cancer patients with targeted, family-centered financial counseling services. This research will be conducted in pediatric oncology practices affiliated with the OneFlorida Clinical Research Consortium. OneFlorida is a collaborative, statewide clinical research network that includes 12 healthcare delivery and payer partners, covering all 67 Florida counties. In order to optimize access to financial counseling, services will be provided via telehealth by accredited financial counselors in the Extension System across the state of Florida. By providing financial counseling using telehealth, we can facilitate the implementation of financial and health insurance counseling among families of pediatric cancer patients, allowing for a broader geographic reach.
Pediatric cancer patients and their families experience financial hardship and toxicity; consequently, there is an urgent need for real-world interventions to alleviate these burdens. To address this gap, our project will investigate a novel point-of-care intervention among families facing a pediatric cancer diagnosis. We will advance scientific knowledge regarding the implementation of financial counseling in pediatric cancer care settings by evaluating financial counseling in a pragmatic trial.
Does this project have an international component or travel?
No