Nápoles Anna María, Appelle Nicole, Kalkhoran Sara, Vijayaraghavan Maya, Alvarado Nicholas, Satterfield Jason
Division of General Internal Medicine, Department of Medicine, University of California San Francisco (UCSF), Box 0856, 3333 California Street, Suite 335, San Francisco, CA, 94118, USA.
Division of General Internal Medicine, Department of Medicine, UCSF, Box 0320, 1545 Divisadero St., San Francisco, CA, 94115, USA.
BMC Med Inform Decis Mak. 2016 Apr 19;16:44. doi: 10.1186/s12911-016-0284-5.
Digital health interventions using hybrid delivery models may offer efficient alternatives to traditional behavioral counseling by addressing obstacles of time, resources, and knowledge. Using a computer-facilitated 5As (ask, advise, assess, assist, arrange) model as an example (CF5As), we aimed to identify factors from the perspectives of primary care providers and clinical staff that were likely to influence introduction of digital technology and a CF5As smoking cessation counseling intervention. In the CF5As model, patients self-administer a tablet intervention that provides 5As smoking cessation counseling, produces patient and provider handouts recommending next steps, and is followed by a patient-provider encounter to reinforce key cessation messages, provide assistance, and arrange follow-up.
Semi-structured in-person interviews of administrative and clinical staff and primary care providers from three primary care clinics.
Thirty-five interviews were completed (12 administrative staff, ten clinical staff, and 13 primary care providers). Twelve were from an academic internal medicine practice, 12 from a public hospital academic general medicine clinic, and 11 from a public hospital HIV clinic. Most were women (91 %); mean age (SD) was 42 years (11.1). Perceived usefulness of the CF5As focused on its relevance for various health behavior counseling purposes, potential gains in counseling efficiency, confidentiality of data collection, occupying patients while waiting, and serving as a cue to action. Perceived ease of use was viewed to depend on the ability to accommodate: clinic workflow; heavy patient volumes; and patient characterisitics, e.g., low literacy. Social norms potentially affecting implementation included beliefs in the promise/burden of technology, priority of smoking cessation counseling relative to other patient needs, and perception of CF5As as just "one more thing to do" in an overburdened system. The most frequently cited facilitating conditions were staffing levels and smoking cessation resources and training; the most cited hindering factors were visit time constraints and patients' complex health care needs.
Integrating CF5As and other technology-enhanced behavioral counseling interventions in primary care requires flexibility to accommodate work flow and perceptions of overload in dynamic environments. Identifying factors that promote and hinder CF5As adoption could inform implementation of other CF behavioral health interventions in primary care.
采用混合交付模式的数字健康干预措施，通过解决时间、资源和知识方面的障碍，可能为传统行为咨询提供有效的替代方案。以计算机辅助的5A（询问、建议、评估、协助、安排）模式（CF5A）为例，我们旨在从初级保健提供者和临床工作人员的角度确定可能影响数字技术引入以及CF5A戒烟咨询干预措施的因素。在CF5A模式中，患者自行管理平板电脑干预措施，该措施提供5A戒烟咨询，生成患者和提供者的资料手册以推荐后续步骤，随后进行医患会面以强化关键的戒烟信息、提供协助并安排随访。
对来自三家初级保健诊所的行政和临床工作人员以及初级保健提供者进行半结构化的面对面访谈。
共完成35次访谈（12名行政人员、10名临床工作人员和13名初级保健提供者）。其中12人来自学术性内科诊所，12人来自公立医院学术性普通内科诊所，11人来自公立医院艾滋病毒诊所。大多数为女性（91%）；平均年龄（标准差）为42岁（11.1）。对CF5A的感知有用性集中在其与各种健康行为咨询目的的相关性、咨询效率的潜在提高、数据收集的保密性、患者候诊时的占用情况以及作为行动提示方面。感知易用性被认为取决于能否适应：诊所工作流程；大量的患者数量；以及患者特征，例如低文化水平。可能影响实施的社会规范包括对技术前景/负担的信念、相对于其他患者需求而言戒烟咨询的优先级，以及在负担过重的系统中将CF5A视为“又一件要做的事”的看法。最常被提及的促进条件是人员配备水平、戒烟资源和培训；最常被提及的阻碍因素是就诊时间限制和患者复杂的医疗需求。
在初级保健中整合CF5A和其他技术增强的行为咨询干预措施需要灵活性，以适应动态环境中的工作流程和过载感知。确定促进和阻碍CF5A采用的因素可为在初级保健中实施其他CF行为健康干预措施提供参考。
