Optimizing Computer-Based Video to Increase HIV Testing in Emergency Departments

优化基于计算机的视频以增加急诊科的艾滋病毒检测

• 批准号: 8140952
• 负责人: Ian David Aronson
• 金额: $ 15.03万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-15 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8140952
• 关键词: AIDS prevention; Accident and Emergency department; Affect; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Computers; Country; Data; Data Collection; Diagnosis; Dimensions; Drug user; Effectiveness; Environment; Evaluation; Female; Future; Gender; HIV; Handheld Computers; Health Services Accessibility; Healthcare; Hospitals; Hour; Human Resources; Human immunodeficiency virus test; Individual; Infection; Intervention; Knowledge; Law Enforcement; Lead; Learning; Low Literacy Population; Methodology; Modeling; Participant; Patients; Population; Prevalence; Prevention education; Prevention program; Professional counselor; Provider; Public Health; Randomized; Randomized Controlled Trials; Reading; Reporting; Research; Research Personnel; Risk; Services; Solutions; Staging; Stigmata; Testing; Time; Training; Triage; United States; Visit; Work; Workload; base; care seeking; comparative; design; disorder prevention; experience; high risk; high risk behavior; instrument; male; post intervention; public health priorities; social stigma; theories; therapy design; tool; uptake

DESCRIPTION (provided by applicant): In this project, we propose to develop and conduct a preliminary evaluation of a computer-based video intervention designed to increase HIV test acceptance in hospital emergency departments (EDs) across the United States. People most in need of HIV testing and prevention education, including drug users and other HIV-infected individuals who are unaware of their infection status, often have little or no access to healthcare outside the ED. Current efforts to offer routine HIV testing in the ED often miss patients who would benefit most. Due to ED staff limitations, most notably time and an already heavy workload, many EDs are not able to offer all patients a test or adequately provide necessary pre-test information. Further, because HIV testing is voluntary, patients at highest risk may decline. Undiagnosed cases of HIV present a significant public health problem, as people who do not know they are infected cannot receive treatment, and may unknowingly spread HIV to others. The intervention developed in this study can be used not only to offer HIV testing to more patients, but to increase the number of patients who agree to be tested. The proposed intervention will employ computer-based video that communicates standardized public health messages in ways patients understand. A video portraying a skilled provider engagingly explaining the importance of HIV testing can be individually delivered on handheld computers to all patients in an ED, while making only minimal personnel demands. Because viewing a video does not require reading, videos are especially suited to lower-literacy populations that seek care in an ED. The proposed research will involve a randomized controlled trial among ED patients who initially decline an HIV test at ED triage to determine what types of video content lead to increases in HIV test uptake and related knowledge. We will also gather data on patient acceptance and the feasibility of the intervention to inform further research to refine the intervention and expand it for use in an array of clinical environments. This study will also provide a new methodology to comparatively evaluate how video content can be optimized for greatest impact. Participants will be randomized into groups that use handheld computers to view different educational video segments and respond to pre- post-intervention data collection instruments. At the end of the intervention, the computers will ask participants if they would like an HIV test. AIM 1 Develop a computer-based video intervention to increase HIV test acceptance and knowledge among ED patients who initially decline an HIV test offered at triage. AIM 2 Evaluate critical dimensions of video content through an early stage randomized controlled trial examining acceptability, feasibility, and effectiveness. This study will begin a valuable line of research testing how video can be optimized for greatest effectiveness while simultaneously educating high-risk patients who might otherwise not be reached. PUBLIC HEALTH RELEVANCE: The Centers for Disease Control and Prevention recommends routine HIV testing in emergency departments (EDs) because people who visit an ED may lack access to other forms of healthcare, and if they are not tested for HIV, may be infected for years before receiving a diagnosis. Unfortunately, current testing efforts often fail to reach those most at risk. This study will develop and evaluate the acceptability, feasibility and preliminary effectiveness of an automated, computer-based video intervention, which offers considerable promise for increasing HIV test acceptance in EDs across the United States, thus having a marked public health impact.

描述（由申请人提供）：在该项目中，我们建议开发并进行基于计算机的视频干预的初步评估，旨在提高美国各地医院急诊科 (ED) 对艾滋病毒检测的接受度。最需要艾滋病毒检测和预防教育的人，包括吸毒者和其他不知道自己感染状况的艾滋病毒感染者，通常很少或根本无法获得急诊室以外的医疗服务。目前在急诊室提供常规艾滋病毒检测的努力常常错过了最能受益的患者。由于急诊科人员的限制，尤其是时间和已经很重的工作量，许多急诊科无法为所有患者提供检测或充分提供必要的检测前信息。此外，由于艾滋病毒检测是自愿的，高危患者的检测结果可能会下降。未确诊的艾滋病毒病例是一个重大的公共卫生问题，因为不知道自己被感染的人无法接受治疗，并且可能在不知不觉中将艾滋病毒传播给其他人。这项研究中开发的干预措施不仅可以用于为更多患者提供艾滋病毒检测，还可以增加同意接受检测的患者数量。 拟议的干预措施将采用基于计算机的视频，以患者理解的方式传达标准化的公共卫生信息。一段视频描绘了熟练的提供者引人入胜地解释艾滋病毒检测重要性的视频，可以通过手持计算机单独传送给急诊室的所有患者，同时只需要很少的人员需求。由于观看视频不需要阅读，因此视频特别适合在急诊室寻求护理的文化程度较低的人群。 拟议的研究将涉及对最初在急诊分诊时拒绝进行艾滋病毒检测的急诊科患者进行一项随机对照试验，以确定哪些类型的视频内容会导致艾滋病毒检测和相关知识的增加。我们还将收集有关患者接受度和干预可行性的数据，为进一步的研究提供信息，以完善干预措施并将其扩展到一系列临床环境中。这项研究还将提供一种新的方法来比较评估如何优化视频内容以获得最大影响。参与者将被随机分组​​，使用手持电脑观看不同的教育视频片段并对干预前后数据收集工具做出反应。干预结束时，计算机会询问参与者是否愿意进行艾滋病毒检测。 目标 1 开发基于计算机的视频干预措施，以提高最初拒绝分诊时提供的 HIV 检测的 ED 患者对 HIV 检测的接受度和知识。 目标 2 通过早期随机对照试验评估视频内容的关键维度，检查可接受性、可行性和有效性。 这项研究将开始一系列有价值的研究，测试如何优化视频以获得最大效果，同时教育那些可能无法接触到的高风险患者。 公共卫生相关性：疾病控制和预防中心建议在急诊室 (ED) 进行常规 HIV 检测，因为到急诊室就诊的人可能无法获得其他形式的医疗保健，而且如果不进行 HIV 检测，可能会被感染多年在接受诊断之前。不幸的是，当前的测试工作往往无法惠及那些风险最高的人。这项研究将开发和评估基于计算机的自动化视频干预的可接受性、可行性和初步有效性，这为提高美国急诊室对艾滋病毒检测的接受度提供了广阔的前景，从而对公共卫生产生显着影响。