University of California, San Francisco, San Francisco, CA, United States.
JMIR Mhealth Uhealth. 2021 May 11;9(5):e24520. doi: 10.2196/24520.
Limited English proficiency (LEP) is an important driver of health disparities. Many successful patient-level interventions to prevent chronic disease progression and complications have used automated telephone self-management support, which relies on patient activation and communication to achieve improved health outcomes. It is not clear whether these interventions are similarly applicable to patients with LEP compared to patients with English proficiency.
The objectives of this study were as follows: (1) To examine the impact of LEP on patient engagement (primary outcome) with a 12-month language-concordant self-management program that included automated telephone self-management support, designed for patients with chronic kidney disease (CKD). (2) To assess the impact of LEP on change in systolic blood pressure (SBP) and albuminuria (secondary outcomes) resulting from the self-management program.
This was a secondary analysis of the Kidney Awareness Registry and Education (KARE) pilot trial (NCT01530958) which was funded by the National Institutes of Health in August 2011, approved by the University of California Institutional Review Board in October 2011 (No. 11-07399), and executed between 2013 and 2015. Multivariable logistic and linear models were used to examine various facets of patient engagement with the CKD self-management support program by LEP status. Patient engagement was defined by patient's use of educational materials, completion of a health coaching action plan, and degree of participation with automated telephone self-management support. Changes in SBP and albuminuria at 12 months by LEP status were determined using multivariable linear mixed models.
Of 137 study participants, 53 (38.7%) reported LEP, of which 45 (85%) were Spanish speaking and 8 (15%) Cantonese speaking. While patients with LEP and English proficiency similarly used the program's educational materials (85% [17/20] vs 88% [30/34], P=.69) and completed an action plan (81% [22/27] vs 74% [35/47], P=.49), those with LEP engaged more with the automated telephone self-management support component. Average call completion was 66% among patients with LEP compared with 57% among those with English proficiency; patients with LEP requested more health coach telephone calls (P=.08) and had a significantly longer average automated call duration (3.3 [SD 1.4] min vs 2.2 [1.1 min], P<.001), indicating higher patient engagement. Patients with LEP randomized to self-management support had a larger, though nonstatistically significant (P=.74), change in SBP (-4.5 mmHg; 95% CI -9.4 to 0.3) and albuminuria (-72.4 mg/dL; 95% CI -208.9 to 64.1) compared with patients with English proficiency randomized to self-management support (-2.1 mmHg; 95% CI -8.6 to 4.3 and -11.1 mg/dL; 95% CI -166.9 to 144.7).
Patients with LEP with CKD were equally or more engaged with a language-concordant, culturally appropriate telehealth intervention compared with their English-speaking counterparts. Augmented telehealth may be useful in mitigating communication barriers among patients with LEP.
ClinicalTrials.gov NCT01530958; https://clinicaltrials.gov/ct2/show/NCT01530958.
有限的英语水平（LEP）是造成健康差异的一个重要因素。许多成功的预防慢性病进展和并发症的患者级干预措施都使用了自动化电话自我管理支持，这依赖于患者的积极性和沟通来实现改善健康结果。目前尚不清楚这些干预措施在LEP 患者中的应用是否与英语水平患者相似。
本研究的目的如下：（1）通过 12 个月的语言一致的自我管理计划来检验 LEP 对患者参与度的影响，该计划包括自动化电话自我管理支持，专为慢性肾脏病（CKD）患者设计。（2）评估 LEP 对自我管理计划导致的收缩压（SBP）和白蛋白尿变化的影响。
这是 2011 年 8 月由美国国立卫生研究院资助的肾脏意识登记和教育（KARE）试验的二次分析（NCT01530958），于 2011 年 10 月获得加利福尼亚大学机构审查委员会的批准（No.11-07399），并于 2013 年至 2015 年执行。使用多变量逻辑和线性模型来检查 LEP 状态下患者对 CKD 自我管理支持计划的各种方面的参与程度。患者的参与度通过患者使用教育材料、完成健康教练行动计划以及与自动化电话自我管理支持的参与程度来定义。使用多变量线性混合模型确定 12 个月时 SBP 和白蛋白尿的变化。
在 137 名研究参与者中，53 名（38.7%）报告有 LEP，其中 45 名（85%）是西班牙语，8 名（15%）是粤语。虽然 LEP 和英语水平相当的患者都使用了该计划的教育材料（85%[17/20]对 88%[30/34]，P=.69）和完成行动计划（81%[22/27]对 74%[35/47]，P=.49），但 LEP 患者与自动化电话自我管理支持组件的互动更多。LEP 患者的平均通话完成率为 66%，而英语水平患者为 57%；LEP 患者要求更多的健康教练电话（P=.08），并且平均自动通话时间明显更长（3.3[SD 1.4]min 对 2.2[1.1min]，P<.001），表明更高的患者参与度。与接受自我管理支持的英语水平患者相比，接受自我管理支持的 LEP 患者的 SBP 变化更大（-4.5mmHg；95%CI-9.4 至 0.3）和白蛋白尿变化更大（-72.4mg/dL；95%CI-208.9 至 64.1），但差异无统计学意义（P=.74）。
与英语水平患者相比，患有 CKD 的 LEP 患者与语言一致、文化适宜的远程医疗干预措施的参与度相同或更高。增强型远程医疗可能有助于缓解 LEP 患者的沟通障碍。
ClinicalTrials.gov NCT01530958；https://clinicaltrials.gov/ct2/show/NCT01530958。
