Pullyblank Kristin, Atav Serdar
Center for Rural Community Health, Bassett Research Institute, Bassett Medical Center, Cooperstown, NY, United States.
Decker College of Nursing and Health Sciences, Binghamton University, State University of New York, Binghamton, NY, United States.
JMIR Form Res. 2022 Nov 30;6(11):e38357. doi: 10.2196/38357.
In-person, evidence-based, peer-facilitated chronic disease self-management programs have been shown to be effective for individuals from a variety of backgrounds, including rural and minority populations and those with lower socioeconomic status. Based in social learning theory, these programs use group processes to help participants better manage their chronic disease symptoms and improve their quality of life. During the pandemic, these in-person programs were forced to rapidly transition to remote delivery platforms, and it was unclear whether doing so increased disparities within our rural population.
The objectives of this analysis were to ascertain self-management program enrollment and completion characteristics between 2 remote delivery platforms, as well as determine the individual level characteristics that drove enrollment and completion across delivery modes.
We analyzed enrollment and completion characteristics of 183 individuals who either enrolled in a self-management workshop delivered through a web-based videoconference (VC) system or through a traditional, audio-only conference call (CC) offered by our health care network between April and December 2020. Chi-square tests of association were used to describe the characteristics of and differences between groups. Logistic regression analysis was used to determine significant predictors of enrollment and completion.
Those who enrolled in the VC platform were significantly likelier to be younger and college educated than those who enrolled in the CC platform. Those who completed a program, regardless of delivery mode, were likelier to be older and college educated than those who did not complete a program. Multivariate analyses indicated that of those enrolled in the CC platform, completers were likelier to not be enrolled in Medicaid. Among those enrolled in the VC platform, completers were older, college graduates, female, and likelier to have reported poorer health than those who did not complete the program.
The transition of self-management programs to remote delivery modes, particularly to those that rely on VC platforms, revealed that certain demographic groups may no longer be able or willing to access the service. Efforts need to be made to increase engagement in remote self-management workshops. In addition, equivalent quality services that do not rely on a digital platform must continue to be offered in order to promote health equity.
基于证据的、由同伴推动的面对面慢性病自我管理项目已被证明对来自各种背景的个人有效，包括农村和少数族裔人群以及社会经济地位较低的人群。基于社会学习理论，这些项目利用小组流程帮助参与者更好地管理慢性病症状并提高生活质量。在疫情期间，这些面对面项目被迫迅速转向远程交付平台，尚不清楚这样做是否会加剧农村人口内部的差异。
本分析的目的是确定两个远程交付平台之间自我管理项目的注册和完成特征，并确定推动不同交付模式下注册和完成的个体层面特征。
我们分析了2020年4月至12月期间参加通过网络视频会议（VC）系统提供的自我管理工作坊或参加我们医疗保健网络提供的传统纯音频电话会议（CC）的183个人的注册和完成特征。使用卡方关联检验来描述组间特征和差异。使用逻辑回归分析来确定注册和完成的显著预测因素。
与参加CC平台的人相比，参加VC平台的人明显更年轻且受过大学教育。无论交付模式如何，完成项目的人比未完成项目的人年龄更大且受过大学教育。多变量分析表明，在参加CC平台的人中，完成者更不可能参加医疗补助计划。在参加VC平台的人中，完成者年龄更大、是大学毕业生、女性，并且比未完成项目的人更有可能报告健康状况较差。
自我管理项目向远程交付模式的转变，特别是向那些依赖VC平台的模式转变，表明某些人口群体可能不再能够或愿意获得该服务。需要努力提高对远程自我管理工作坊的参与度。此外，必须继续提供不依赖数字平台的同等质量服务，以促进健康公平。
