Health CommunicationNCT03616106
Information Visualizations to Facilitate HIV-related Patient-provider Communication (Info Viz: HIV)
A study testing Infographic intervention in people with Health Communication, run by Columbia University at 1 site in Dominican Republic.
Trial summary
To complete the study aims, a mixed methods study that includes a single group pretest-posttest study design will be used to pilot test the infographic intervention. In-depth interviews will be completed with a selection of participants to explore participant perceptions of HIV-related communication using… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Health Communication
- What is being tested?
- Infographic intervention
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 59 participants
- Where
- 1 siteDominican Republic
- Study dates
- 9 Oct 2018to 9 Aug 2019
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Adult (≥) 18 years of age
- Spanish-speaking
- Living with HIV and have a detectable viral load
- Attend Clínica de Familia La Romana
- Plan to receive care at the same clinic for the next year
Who cannot join
- Does not meet inclusion criteria
- Not able to understand study procedures or provide informed consent
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Information Visualizations to Facilitate Patient-provider Communication in HIV Care: Info Viz HIV
To complete the study aims, a mixed methods study that includes a single group pretest-posttest study design will be used to pilot test the infographic intervention. In-depth interviews will be completed with a selection of participants to explore participant perceptions of HIV-related communication using infographics. Data will be collected from participants through baseline (at enrollment) and follow up assessments (at 3-, 6-, and 9-month follow up visits). Follow up interviews will be conducted with the providers involved in the intervention to ascertain their perspectives on the clinical utility of infographics.
Read the detailed description
The Caribbean has among the highest HIV prevalence in the world. Regionally, the majority of HIV/AIDS cases are located on the island of Hispaniola, comprised of the Dominican Republic (DR) and Haiti. Due to a large international response and widespread availability of antiretroviral therapy (ART), in recent years the incidence of HIV in the DR has declined and prevalence hovers around 1% in the general population. The effective and long-term management of this condition depends on infected individuals being able to acquire ART and apply the learned information and self-management skills that lead to optimal adherence.
HIV-related disparities exist in developing countries, such as the DR, where minority groups and/or those with low socioeconomic status experience higher disease burdens and worse health outcomes than those with higher socioeconomic status. These disparities may be exacerbated when individuals are unable to understand the health information, as low health literacy has been associated with worse health outcomes, less use of healthcare services, poorer knowledge of illness, and worse self-management. The effective management of HIV requires patients to acquire, comprehend, and use large amounts of complex information, including how to manage variations in health status, medications and their side effects, nutrition and exercise needs, and healthy coping. Health care providers can help patients understand pertinent health information by offering it in targeted, culturally-, language-, and literacy-appropriate ways.
One such strategy is to use infographics to assist communication through visual representations of information. Participatory design of infographics supports presentation of information in a culturally appropriate and visually appealing format which can improve information understanding, health behaviors, attention span, and ability to recall information. It is critical to develop and test methods to improve the way health information is delivered to patients in these clinical contexts so patients, including those with low health literacy, can acquire and comprehend the information needed to improve self-management behavior and treatment outcomes.
Preliminary studies showed many persons living with HIV (PLWH) attending Clínica de Familia La Romana do not fully comprehend and use the health information they receive through current modalities. In response, culturally relevant, evidence-based infographics to improve information delivery during clinical visits were developed with a participatory design methodology (manuscript under review). The next phase of this study is to rigorously assess if using these infographics is a feasible, acceptable, and efficacious method to enhance HIV-related clinician-patient communication and lead to improved patient outcomes. Additionally, a thorough exploration into the cultural factors of patient-provider communication in the Dominican Republic that can influence infographic use for clinician-patient communication in a clinical setting is warranted.
- Conditions
- Health Communication
- Being tested
- Infographic intervention
- Keywords
- Information Visualization
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Infographic interventionOther
All study participants will receive health education using infographics during their regularly scheduled clinic appointments.
| Study group | Role | What they receive |
|---|---|---|
| Intervention Group | Experimental | Participants in the intervention group will receive health education using infographics (Infographic Intervention) during their regularly scheduled clinic visits. Receives: Other: Infographic intervention |
What is being measured
The primary outcome is the main question the study is designed to answer.
Association Between Mean CD4 Count at Baseline and 3-month Visit
Association between mean CD4 count at baseline and 3-month visits.
Measured: Baseline and 3-month visit
Association Between Mean CD4 Count at Baseline and 6-month Visit
Association between mean CD4 count at baseline and 6-month visits.
Measured: Baseline and 6-month visit
Association Between Mean CD4 Count at Baseline and 9-month Visit
Association between mean CD4 count at baseline and 9-month visits.
Measured: Baseline and 9-month visit
Association Between Mean Viral Load at Baseline and at 3-month Visits
Test of association of mean viral load at baseline and at 3-month visits.
Measured: Baseline and 3-months
Association Between Mean Viral Load at Baseline and at 6-month Visits
Test of association of mean viral load at baseline and at 6-month visits.
Measured: Baseline and 6-months
Association Between Mean Viral Load at Baseline and at 9-month Visits
Test of association of mean viral load at baseline and at 9-month visits.
Measured: Baseline and 9-months
Secondary outcomes (25)
Satisfaction With Care Scale Score
3 questions from the overall evaluation of the HIV clinic scale were administered for a total of 19 possible points on this scale. Range of possible scores is 1-19, with 19 being highest possible satisfaction with care. The breakdown of scoring by question is as follows:
- Question 1 is a 1-7 scale with 1 being completely unsatisfied and 7 being completely satisfied
- Question 2 is a 1-5 scale where 1 is definitely not and 5 is definitely yes
- Question 3 is a 1-7 scale where 1 is terrible and 7 is marvelous
Measured: Baseline, 3-, 6-, and 9-month visits
Medication Adherence
Adherence will be measured with the validated simplified medication adherence questionnaire (SMAQ)-6 scale, a 6-item questionnaire. A person is considered "non-adherent" if there is a "yes" answer for any of items 1,2,3, and 5. Additionally, if they answer that they have missed more than two doses in the past week (item 4) or if they have gone more than two days without taking their medication in the past 3 months (item 6). Therefore, participants are classified as either adherent or not adherent based on their answers to these questions. Any participant that didn't complete study visits or did not answer that question was considered "missing."
Measured: Baseline, 3-, 6-, and 9-month visits
Participant's Self-reported Health-related Quality of Life Score - Physical Functioning
Health-related quality of life will be measured with the Patient-Reported Outcomes Measurement Information System® (PROMIS)-29 measure, which measures 7 domains of health-related quality of life with 4 questions in each section pertaining to how that participant's health influences their life. In general, each question has five response options ranging in values from 1-5. To find the total raw score for this form with all the questions answered, the values from the responses of each question are summed. Raw scores are then translated into a T-score for each participant, which rescales the raw score into a standardized T-score with a mean of 50 and standard deviation (SD) of 10. Consequently, a person with a T-score of 40 would be one SD below the mean.
Measured: Up to 9 months from baseline
Participants' Self-reported Health Status Over Past 4 Weeks.
General health status was assessed with one item where participants are asked to rank their health in the past four weeks as excellent, good, fair, poor, or very poor. Results are presented as the number of participants that self-rated their health in each of those categories.
Measured: Baseline, 3-months, 6-months, and 9-months
Health Literacy
Health literacy will be assessed using the short assessment of health literacy- Spanish. Scores range from 0 - 18 and above a 15 indicates that participants are likely to have adequate health literacy. Participants are then categorized as health literate or not health literate. The final number of participants who are health literate are reported here.
Measured: Baseline visit only
Percent of Participants Who Complete an In-depth Qualitative Interview
Participants will be invited to participate in an in-depth qualitative interview regarding their experiences. The number who participate will be reported as a percent of the total who are enrolled.
Measured: 9 months from baseline
Participant's Self-reported Health-related Quality of Life Score - Anxiety
Health-related quality of life will be measured with the Patient-Reported Outcomes Measurement Information System® (PROMIS)-29 measure, which measures 7 domains of health-related quality of life with 4 questions in each section pertaining to how that participant's health influences their life. In general, each question has five response options ranging in values from 1-5. To find the total raw score for this form with all the questions answered, the values from the responses of each question are summed. Raw scores are then translated into a T-score for each participant, which rescales the raw score into a standardized T-score with a mean of 50 and standard deviation (SD) of 10. Consequently, a person with a T-score of 40 would be one SD below the mean.
Measured: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Depression
Health-related quality of life will be measured with the Patient-Reported Outcomes Measurement Information System® (PROMIS)-29 measure, which measures 7 domains of health-related quality of life with 4 questions in each section pertaining to how that participant's health influences their life. In general, each question has five response options ranging in values from 1-5. To find the total raw score for this form with all the questions answered, the values from the responses of each question are summed. Raw scores are then translated into a T-score for each participant, which rescales the raw score into a standardized T-score with a mean of 50 and standard deviation (SD) of 10. Consequently, a person with a T-score of 40 would be one SD below the mean.
Measured: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Fatigue
Health-related quality of life will be measured with the Patient-Reported Outcomes Measurement Information System® (PROMIS)-29 measure, which measures 7 domains of health-related quality of life with 4 questions in each section pertaining to how that participant's health influences their life. In general, each question has five response options ranging in values from 1-5. To find the total raw score for this form with all the questions answered, the values from the responses of each question are summed. Raw scores are then translated into a T-score for each participant, which rescales the raw score into a standardized T-score with a mean of 50 and standard deviation (SD) of 10. Consequently, a person with a T-score of 40 would be one SD below the mean.
Measured: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Sleep Disturbance
Health-related quality of life will be measured with the Patient-Reported Outcomes Measurement Information System® (PROMIS)-29 measure, which measures 7 domains of health-related quality of life with 4 questions in each section pertaining to how that participant's health influences their life. In general, each question has five response options ranging in values from 1-5. To find the total raw score for this form with all the questions answered, the values from the responses of each question are summed. Raw scores are then translated into a T-score for each participant, which rescales the raw score into a standardized T-score with a mean of 50 and standard deviation (SD) of 10. Consequently, a person with a T-score of 40 would be one SD below the mean.
Measured: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Social Activity Participation
Health-related quality of life will be measured with the Patient-Reported Outcomes Measurement Information System® (PROMIS)-29 measure, which measures 7 domains of health-related quality of life with 4 questions in each section pertaining to how that participant's health influences their life. In general, each question has five response options ranging in values from 1-5. To find the total raw score for this form with all the questions answered, the values from the responses of each question are summed. Raw scores are then translated into a T-score for each participant, which rescales the raw score into a standardized T-score with a mean of 50 and standard deviation (SD) of 10. Consequently, a person with a T-score of 40 would be one SD below the mean.
Measured: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Pain Interference
Health-related quality of life will be measured with the Patient-Reported Outcomes Measurement Information System® (PROMIS)-29 measure, which measures 7 domains of health-related quality of life with 4 questions in each section pertaining to how that participant's health influences their life. In general, each question has five response options ranging in values from 1-5. To find the total raw score for this form with all the questions answered, the values from the responses of each question are summed. Raw scores are then translated into a T-score for each participant, which rescales the raw score into a standardized T-score with a mean of 50 and standard deviation (SD) of 10. Consequently, a person with a T-score of 40 would be one SD below the mean.
Measured: Baseline, 3-, 6-, and 9-months
Satisfaction With Provider Scale Score at Each Time Point
4 questions from the overall evaluation of the health care provider scale were administered for a total score of 29. The range of scores is 3-29, with 29 being the highest possible satisfaction with their health care provider. The scoring breakdown by each included question is as follows:
- Question 1 is 1- 7 points where 1 is completely dissatisfied and 7 is completely satisfied
- Question 2 is providing an integer value of trust in care provider on a scale from 1 to 10
- Question 3 is 1- 7 points where 1 is terrible and 7 is marvelous
- Question 4 is 0- 5 points where 0 is definitely not and 5 is definitely yes
Measured: Baseline, 3-, 6-, and 9-month visits
Association Between Mean HIV-related Knowledge Scores at Baseline and 3-month Visits.
14 questions pertaining to HIV-related knowledge were developed according to the information that will be included in the intervention. Participants will receive one point for each correct answer and then the scores for each question will be summed to obtain a final score. Therefore, the minimum score will be 0 and maximum score will be 14 where the scores closer to 14 indicate patients have more HIV-related knowledge.
Measured: Baseline and 3-month visits
Association Between Mean HIV-related Knowledge Scores at Baseline and 6-month Visits.
14 questions pertaining to HIV-related knowledge were developed according to the information that will be included in the intervention. Participants will receive one point for each correct answer and then the scores for each question will be summed to obtain a final score. Therefore, the minimum score will be 0 and maximum score will be 14 where the scores closer to 14 indicate patients have more HIV-related knowledge.
Measured: Baseline and 6-month visits
Association Between Mean HIV-related Knowledge Scores at Baseline and 9-month Visits.
14 questions pertaining to HIV-related knowledge were developed according to the information that will be included in the intervention. Participants will receive one point for each correct answer and then the scores for each question will be summed to obtain a final score. Therefore, the minimum score will be 0 and maximum score will be 14 where the scores closer to 14 indicate patients have more HIV-related knowledge.
Measured: Baseline and 9-month visits
Association of Engagement With Clinician Scale Score at Baseline and 3-months.
The Engagement with Health Care Providers scale is a 13 item scale through which clients rate how they feel about their interactions with their providers. Answers are recorded on a 4-point scale (1=always true and 4=never true). The range of scores is between 13 and 52. Lower scores (with 13 being the lowest score) indicate more provider engagement.
Measured: Baseline and 3-months
Association of Engagement With Clinician Scale Score at Baseline and 6-months.
The Engagement with Health Care Providers scale is a 13 item scale through which clients rate how they feel about their interactions with their providers. Answers are recorded on a 4-point scale (1=always true and 4=never true). The range of scores is between 13 and 52. Lower scores (with 13 being the lowest score) indicate more provider engagement.
Measured: Baseline and 6-months
Association of Engagement With Clinician Scale Score at Baseline and 9-months.
The Engagement with Health Care Providers scale is a 13 item scale through which clients rate how they feel about their interactions with their providers. Answers are recorded on a 4-point scale (1=always true and 4=never true). The range of scores is between 13 and 52. Lower scores (with 13 being the lowest score) indicate more provider engagement.
Measured: Baseline and 9-months
Association Between SEMCD Scale Score at Baseline and 3-month Visits
Self-efficacy to manage chronic disease scale (SEMCD) will be used. This is a 6-item measure where 1 is not at all confident and 10 is completely confident. The total range of scores is 1-10. Final scores are calculated as the mean of the 6 questions, where higher scores indicate higher self-efficacy.
Measured: Baseline, 3-month visits
Association Between SEMCD Scale Score at Baseline and 6-month Visits
Self-efficacy to manage chronic disease scale (SEMCD) will be used. This is a 6-item measure where 1 is not at all confident and 10 is completely confident. The total range of scores is 1-10. Final scores are calculated as the mean of the 6 questions, where higher scores indicate higher self-efficacy.
Measured: Baseline, 6-month visits
Association Between SEMCD Scale Score at Baseline and 9-month Visits
Self-efficacy to manage chronic disease scale (SEMCD) will be used. This is a 6-item measure where 1 is not at all confident and 10 is completely confident. The total range of scores is 1-10. Final scores are calculated as the mean of the 6 questions, where higher scores indicate higher self-efficacy.
Measured: Baseline, 9-month visits
Association Between Current Self-reported Health Status as Reported at Baseline and 3-months
Participants are asked to rank their current health status on a scale between 0 and 100 where 0 is "death" or the worst possible health (as bad or worse than being dead) and 100 is "perfect health", or the best possible health (without HIV infection).
Measured: Baseline, 3-months
Association Between Current Self-reported Health Status as Reported at Baseline and 6-months
Participants are asked to rank their current health status on a scale between 0 and 100 where 0 is "death" or the worst possible health (as bad or worse than being dead) and 100 is "perfect health", or the best possible health (without HIV infection).
Measured: Baseline, 6-months
Association Between Current Self-reported Health Status as Reported at Baseline and 9-months
Participants are asked to rank their current health status on a scale between 0 and 100 where 0 is "death" or the worst possible health (as bad or worse than being dead) and 100 is "perfect health", or the best possible health (without HIV infection).
Measured: Baseline, 9-months
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted6 Aug 2018
- Study start9 Oct 2018
- Primary completion9 Aug 2019
- Study completion9 Aug 2019
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Publications (27)Papers the sponsor has linked to this study.
- Other trials for Health CommunicationStudies of the same condition, open and under way.
- More trials run by Columbia UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Not applicable
- Intervention model
- Single group
- Model description
- This study will use a single group pretest-posttest design to evaluate if using infographics during clinic visits can lead to improved patient outcomes.
- Masking
- None (open label)
- Enrolment
- 59 participants (actual)
Sponsor and investigators
- Lead sponsor
- Columbia University
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute of Nursing Research (NINR)
- Responsible party
- Principal investigator, Rebecca Schnall, RN, MPH, PhD, Columbia University
- Investigators
- Rebecca Schnall, PhD, MPH, RN, Principal investigator, Columbia UniversitySamantha B Stonbraker, PhD, MPH, RN, Study director, Columbia University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03616106
- Sponsor's protocol ID
- AAAR9023
- Other IDs
- 1K99NR017829-01A1
- Status last verified
- Aug 2020
- First submitted
- 23 Jul 2018
- Last updated
- 3 Sep 2020
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Yes: De-identified data of individual participant data will be made available to qualified researchers seeking to replicate methods or to those working on a new study who need the evidence-base to do so in a rigorous way. All de-identified participant data will be shared with other researchers. Please note that all of this data will be in Spanish.
Publications
Knobel H, Alonso J, Casado JL, Collazos J, Gonzalez J, Ruiz I, Kindelan JM, Carmona A, Juega J, Ocampo A; GEEMA Study Group. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS. 2002 Mar 8;16(4):605-13. doi: 10.1097/00002030-200203080-00012.
PubMed 11873004Ritter PL, Lorig K. The English and Spanish Self-Efficacy to Manage Chronic Disease Scale measures were validated using multiple studies. J Clin Epidemiol. 2014 Nov;67(11):1265-73. doi: 10.1016/j.jclinepi.2014.06.009. Epub 2014 Aug 3.
PubMed 25091546Bakken S, Holzemer WL, Brown MA, Powell-Cope GM, Turner JG, Inouye J, Nokes KM, Corless IB. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care STDS. 2000 Apr;14(4):189-97. doi: 10.1089/108729100317795.
PubMed 10806637Dang BN, Westbrook RA, Hartman CM, Giordano TP. Retaining HIV Patients in Care: The Role of Initial Patient Care Experiences. AIDS Behav. 2016 Oct;20(10):2477-2487. doi: 10.1007/s10461-016-1340-y.
PubMed 26910339Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai JS, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R; PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. 2010 Nov;63(11):1179-94. doi: 10.1016/j.jclinepi.2010.04.011. Epub 2010 Aug 4.
PubMed 20685078De Boni R, Veloso VG, Grinsztejn B. Epidemiology of HIV in Latin America and the Caribbean. Curr Opin HIV AIDS. 2014 Mar;9(2):192-8. doi: 10.1097/COH.0000000000000031.
PubMed 24356327Figueroa JP. Review of HIV in the Caribbean: significant progress and outstanding challenges. Curr HIV/AIDS Rep. 2014 Jun;11(2):158-67. doi: 10.1007/s11904-014-0199-7.
PubMed 24623473Rojas P, Malow R, Ruffin B, Rothe EM, Rosenberg R. The HIV/AIDS Epidemic in the Dominican Republic: Key Contributing Factors. J Int Assoc Physicians AIDS Care (Chic). 2011 Sep-Oct;10(5):306-15. doi: 10.1177/1545109710397770. Epub 2011 Mar 2.
PubMed 21368008Gebre Y, Forbes NM, Peters A. Review of HIV treatment progress, gaps, and challenges in the Caribbean, 2005-2015. Rev Panam Salud Publica. 2016 Dec;40(6):468-473.
PubMed 28718497Perez-Escamilla R. Acculturation, nutrition, and health disparities in Latinos. Am J Clin Nutr. 2011 May;93(5):1163S-7S. doi: 10.3945/ajcn.110.003467. Epub 2011 Mar 2.
PubMed 21367946Barreto SM, Miranda JJ, Figueroa JP, Schmidt MI, Munoz S, Kuri-Morales PP, Silva JB Jr. Epidemiology in Latin America and the Caribbean: current situation and challenges. Int J Epidemiol. 2012 Apr;41(2):557-71. doi: 10.1093/ije/dys017. Epub 2012 Mar 9.
PubMed 22407860Wawrzyniak AJ, Ownby RL, McCoy K, Waldrop-Valverde D. Health literacy: impact on the health of HIV-infected individuals. Curr HIV/AIDS Rep. 2013 Dec;10(4):295-304. doi: 10.1007/s11904-013-0178-4.
PubMed 24222474Laws MB, Lee Y, Rogers WH, Beach MC, Saha S, Korthuis PT, Sharp V, Cohn J, Moore R, Wilson IB. Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity. AIDS Behav. 2014 Jul;18(7):1279-87. doi: 10.1007/s10461-014-0697-z.
PubMed 24464408Kalichman SC, Rompa D. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. J Acquir Immune Defic Syndr. 2000 Dec 1;25(4):337-44. doi: 10.1097/00042560-200012010-00007.
PubMed 11114834Zhang NJ, Terry A, McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Ann Pharmacother. 2014 Jun;48(6):741-51. doi: 10.1177/1060028014526562. Epub 2014 Mar 11.
PubMed 24619949
Study at a glance
From the registry record, last updated by the sponsor on 3 Sep 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Information Visualizations to Facilitate Patient-provider Communication in HIV Care: Info Viz HIV
- ClinicalTrials.gov ID
- NCT03616106
- Acronym / sponsor ID
- AAAR9023
- Conditions
- Health Communication
- Keywords
- Information Visualization
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 59 participants (actual)
- Lead sponsor
- Columbia UniversityUniversity, hospital or other
- Collaborators
- National Institute of Nursing Research (NINR)
- Study start
- 9 Oct 2018 (actual)
- Primary completion
- 9 Aug 2019 (actual)
- Study completion
- 9 Aug 2019 (actual)
- First posted
- 6 Aug 2018 (actual)
- Results
- Posted 3 Sep 2020
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
To complete the study aims, a mixed methods study that includes a single group pretest-posttest study design will be used to pilot test the infographic intervention. In-depth interviews will be completed with a selection of participants to explore participant perceptions of HIV-related communication using infographics. Data will be collected from participants through baseline (at enrollment) and follow up assessments (at 3-, 6-, and 9-month follow up visits). Follow up interviews will be conducted with the providers involved in the intervention to ascertain their perspectives on the clinical utility of infographics.
Detailed description
The Caribbean has among the highest HIV prevalence in the world. Regionally, the majority of HIV/AIDS cases are located on the island of Hispaniola, comprised of the Dominican Republic (DR) and Haiti. Due to a large international response and widespread availability of antiretroviral therapy (ART), in recent years the incidence of HIV in the DR has declined and prevalence hovers around 1% in the general population. The effective and long-term management of this condition depends on infected individuals being able to acquire ART and apply the learned information and self-management skills that lead to optimal adherence.
HIV-related disparities exist in developing countries, such as the DR, where minority groups and/or those with low socioeconomic status experience higher disease burdens and worse health outcomes than those with higher socioeconomic status. These disparities may be exacerbated when individuals are unable to understand the health information, as low health literacy has been associated with worse health outcomes, less use of healthcare services, poorer knowledge of illness, and worse self-management. The effective management of HIV requires patients to acquire, comprehend, and use large amounts of complex information, including how to manage variations in health status, medications and their side effects, nutrition and exercise needs, and healthy coping. Health care providers can help patients understand pertinent health information by offering it in targeted, culturally-, language-, and literacy-appropriate ways.
One such strategy is to use infographics to assist communication through visual representations of information. Participatory design of infographics supports presentation of information in a culturally appropriate and visually appealing format which can improve information understanding, health behaviors, attention span, and ability to recall information. It is critical to develop and test methods to improve the way health information is delivered to patients in these clinical contexts so patients, including those with low health literacy, can acquire and comprehend the information needed to improve self-management behavior and treatment outcomes.
Preliminary studies showed many persons living with HIV (PLWH) attending Clínica de Familia La Romana do not fully comprehend and use the health information they receive through current modalities. In response, culturally relevant, evidence-based infographics to improve information delivery during clinical visits were developed with a participatory design methodology (manuscript under review). The next phase of this study is to rigorously assess if using these infographics is a feasible, acceptable, and efficacious method to enhance HIV-related clinician-patient communication and lead to improved patient outcomes. Additionally, a thorough exploration into the cultural factors of patient-provider communication in the Dominican Republic that can influence infographic use for clinician-patient communication in a clinical setting is warranted.
Study design
- Primary purpose
- Health services research
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
- Model description
- This study will use a single group pretest-posttest design to evaluate if using infographics during clinic visits can lead to improved patient outcomes.
| Arm | Type | Receives |
|---|---|---|
| Intervention Group | Experimental | Other: Infographic interventionParticipants in the intervention group will receive health education using infographics (Infographic Intervention) during their regularly scheduled clinic visits. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Adult (≥) 18 years of age
- Spanish-speaking
- Living with HIV and have a detectable viral load
- Attend Clínica de Familia La Romana
- Plan to receive care at the same clinic for the next year
Key exclusion criteria (2 listed)
- Does not meet inclusion criteria
- Not able to understand study procedures or provide informed consent
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Infographic interventionAll study participants will receive health education using infographics during their regularly scheduled clinic appointments. | Other | Intervention Group |
Primary outcome
Association Between Mean CD4 Count at Baseline and 3-month Visit
Time frame: Baseline and 3-month visit
Association between mean CD4 count at baseline and 3-month visits.
Association Between Mean CD4 Count at Baseline and 6-month Visit
Time frame: Baseline and 6-month visit
Association between mean CD4 count at baseline and 6-month visits.
Association Between Mean CD4 Count at Baseline and 9-month Visit
Time frame: Baseline and 9-month visit
Association between mean CD4 count at baseline and 9-month visits.
Association Between Mean Viral Load at Baseline and at 3-month Visits
Time frame: Baseline and 3-months
Test of association of mean viral load at baseline and at 3-month visits.
Association Between Mean Viral Load at Baseline and at 6-month Visits
Time frame: Baseline and 6-months
Test of association of mean viral load at baseline and at 6-month visits.
Association Between Mean Viral Load at Baseline and at 9-month Visits
Time frame: Baseline and 9-months
Test of association of mean viral load at baseline and at 9-month visits.
25 secondary outcomes
Satisfaction With Care Scale Score
Time frame: Baseline, 3-, 6-, and 9-month visits
Medication Adherence
Time frame: Baseline, 3-, 6-, and 9-month visits
Participant's Self-reported Health-related Quality of Life Score - Physical Functioning
Time frame: Up to 9 months from baseline
Participants' Self-reported Health Status Over Past 4 Weeks.
Time frame: Baseline, 3-months, 6-months, and 9-months
Health Literacy
Time frame: Baseline visit only
Percent of Participants Who Complete an In-depth Qualitative Interview
Time frame: 9 months from baseline
Participant's Self-reported Health-related Quality of Life Score - Anxiety
Time frame: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Depression
Time frame: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Fatigue
Time frame: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Sleep Disturbance
Time frame: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Social Activity Participation
Time frame: Baseline, 3-, 6-, and 9-months
Participant's Self-reported Health-related Quality of Life Score - Pain Interference
Time frame: Baseline, 3-, 6-, and 9-months
Satisfaction With Provider Scale Score at Each Time Point
Time frame: Baseline, 3-, 6-, and 9-month visits
Association Between Mean HIV-related Knowledge Scores at Baseline and 3-month Visits.
Time frame: Baseline and 3-month visits
Association Between Mean HIV-related Knowledge Scores at Baseline and 6-month Visits.
Time frame: Baseline and 6-month visits
Association Between Mean HIV-related Knowledge Scores at Baseline and 9-month Visits.
Time frame: Baseline and 9-month visits
Association of Engagement With Clinician Scale Score at Baseline and 3-months.
Time frame: Baseline and 3-months
Association of Engagement With Clinician Scale Score at Baseline and 6-months.
Time frame: Baseline and 6-months
Association of Engagement With Clinician Scale Score at Baseline and 9-months.
Time frame: Baseline and 9-months
Association Between SEMCD Scale Score at Baseline and 3-month Visits
Time frame: Baseline, 3-month visits
Association Between SEMCD Scale Score at Baseline and 6-month Visits
Time frame: Baseline, 6-month visits
Association Between SEMCD Scale Score at Baseline and 9-month Visits
Time frame: Baseline, 9-month visits
Association Between Current Self-reported Health Status as Reported at Baseline and 3-months
Time frame: Baseline, 3-months
Association Between Current Self-reported Health Status as Reported at Baseline and 6-months
Time frame: Baseline, 6-months
Association Between Current Self-reported Health Status as Reported at Baseline and 9-months
Time frame: Baseline, 9-months
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 3 Sep 2020.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Background: PubMed 11873004Knobel H, Alonso J, Casado JL, Collazos J, Gonzalez J, Ruiz I, Kindelan JM, Carmona A, Juega J, Ocampo A; GEEMA Study Group. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS. 2002 Mar 8;16(4):605-13. doi: 10.1097/00002030-200203080-00012.
- Background: PubMed 25091546Ritter PL, Lorig K. The English and Spanish Self-Efficacy to Manage Chronic Disease Scale measures were validated using multiple studies. J Clin Epidemiol. 2014 Nov;67(11):1265-73. doi: 10.1016/j.jclinepi.2014.06.009. Epub 2014 Aug 3.
- Background: PubMed 10806637Bakken S, Holzemer WL, Brown MA, Powell-Cope GM, Turner JG, Inouye J, Nokes KM, Corless IB. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care STDS. 2000 Apr;14(4):189-97. doi: 10.1089/108729100317795.
- Background: PubMed 26910339Dang BN, Westbrook RA, Hartman CM, Giordano TP. Retaining HIV Patients in Care: The Role of Initial Patient Care Experiences. AIDS Behav. 2016 Oct;20(10):2477-2487. doi: 10.1007/s10461-016-1340-y.
- Background: PubMed 20685078Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai JS, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R; PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. 2010 Nov;63(11):1179-94. doi: 10.1016/j.jclinepi.2010.04.011. Epub 2010 Aug 4.
- Background: PubMed 24356327De Boni R, Veloso VG, Grinsztejn B. Epidemiology of HIV in Latin America and the Caribbean. Curr Opin HIV AIDS. 2014 Mar;9(2):192-8. doi: 10.1097/COH.0000000000000031.
- Background: PubMed 24623473Figueroa JP. Review of HIV in the Caribbean: significant progress and outstanding challenges. Curr HIV/AIDS Rep. 2014 Jun;11(2):158-67. doi: 10.1007/s11904-014-0199-7.
- Background: PubMed 21368008Rojas P, Malow R, Ruffin B, Rothe EM, Rosenberg R. The HIV/AIDS Epidemic in the Dominican Republic: Key Contributing Factors. J Int Assoc Physicians AIDS Care (Chic). 2011 Sep-Oct;10(5):306-15. doi: 10.1177/1545109710397770. Epub 2011 Mar 2.
- Background: PubMed 28718497Gebre Y, Forbes NM, Peters A. Review of HIV treatment progress, gaps, and challenges in the Caribbean, 2005-2015. Rev Panam Salud Publica. 2016 Dec;40(6):468-473.
- Background: PubMed 21367946Perez-Escamilla R. Acculturation, nutrition, and health disparities in Latinos. Am J Clin Nutr. 2011 May;93(5):1163S-7S. doi: 10.3945/ajcn.110.003467. Epub 2011 Mar 2.
- Background: PubMed 22407860Barreto SM, Miranda JJ, Figueroa JP, Schmidt MI, Munoz S, Kuri-Morales PP, Silva JB Jr. Epidemiology in Latin America and the Caribbean: current situation and challenges. Int J Epidemiol. 2012 Apr;41(2):557-71. doi: 10.1093/ije/dys017. Epub 2012 Mar 9.
- Background: PubMed 24222474Wawrzyniak AJ, Ownby RL, McCoy K, Waldrop-Valverde D. Health literacy: impact on the health of HIV-infected individuals. Curr HIV/AIDS Rep. 2013 Dec;10(4):295-304. doi: 10.1007/s11904-013-0178-4.
- Source of the Health Status Assessment published by the AIDS Clinical Trials Group (ACTG) Outcomes CommitteeLink provided by the sponsor.
- Individual participant dataSharing planned: Yes. De-identified data of individual participant data will be made available to qualified researchers seeking to replicate methods or to those working on a new study who need the evidence-base to do so in a rigorous way. All de-identified participant data will be shared with other researchers. Please note that all of this data will be in Spanish.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Rebecca Schnall, PhD, MPH, RN principal investigator
Columbia University
Samantha B Stonbraker, PhD, MPH, RN study director
Columbia University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Infographic intervention in people with Health Communication, run by Columbia University at 1 site in Dominican Republic.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 3 Sep 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Dominican Republic. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 3 Sep 2020). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Association Between Mean CD4 Count at Baseline and 3-month Visit (time frame: Baseline and 3-month visit). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT03616106, which also lists 27 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Sep 2020.