HIV
Conditions
Brief summary
The purpose of this study is to rigorously assess a program designed to empower patient living with HIV, to improve their health care and health, and to reduce disparities.
Detailed description
Our project has four major aims: 1. Assess improvement in patient empowerment 2. Assess improvement in patients' receipt of evidence-based care 3. Assess improvement in patients' health 4. Assess reduction in disparities in empowerment
Interventions
BEHAVIORALpatient activation training
Patient activation training involves six, 90-minute, group (8-12 person) training sessions facilitated by trained peers and training staff and one (20-30 minute) pre-visit coaching session conducted by staff. The hands on group training includes: 1) HIV education; 2) use of a handheld smart device; 3) use of an HIV electronic personal health record app that runs on the smart device; 4) identification of patients' visit need priorities and skills for communicating with their HIV provider. The pre-visit coaching includes identification of patient concerns and patient behavioral rehearsal for asking about these concerns.
OTHERUsual care
Usual HIV care
Sponsors
Patient-Centered Outcomes Research Institute
University of Rochester
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* age18 years or older, * confirmed HIV diagnosis * receipt of care within a participating site.
Exclusion criteria
* inability to provide informed consent * limited English proficiency (Trainings and Personal Health Record are currently only available in English)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Patient Activation Measure (PAM) | Baseline and 1 year | Our primary outcome measure is patient empowerment based on changes in the Patient Activation Measure or PAM. The Patient Activation Measure (PAM) is a 13-item measure that assesses patient knowledge, skill, and confidence for self-management. People who score high on the PAM normally understand the importance of taking an active role in managing their health and have the skills and confidence to do so.The scores for the 13-item measure range in value from 0-100, with higher scores indicating greater activation. LEVEL 1 (0-47): May not yet believe that the patient role is important LEVEL 2 (47.1 - 55.1): Lacks confidence and knowledge to take action LEVEL 3 (55.2 - 67.0): Beginning to take action LEVEL 4 (67.1 - 100): Adapting new behaviors, but may have difficulty maintaining over time |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Decisional Self-Efficacy Scale (DSES) | Baseline and 1 year | Our next secondary outcome measure is decision making based on changes in the Decisional Self-Efficacy Scale or DSES. The Decisional Self-Efficacy Scale (DSES) is an 11-item measure that assesses patient confidence in their ability to make health care decisions. People who score high on the DSES normally have an easier time making health care decisions. The scores for the 11-item measure range in value from 0-100, with higher scores indicating greater confidence in making an informed choice. |
| Change in Perceived Involvement in Care Scale (PICS) | Baseline and 1 year | Our third secondary outcome measure is involvement in care based on changes in the Perceived Involvement in Care Scale or PICS. The Perceived Involvement in Care Scale (PICS) is an 8-item measure that assesses patient perceived proficiency in communicating concerning their health care with the doctor. People who score high on the PICS normally are satisfied with how well they feel they communicate with the doctor about their care. The scores for the 8-item measure range in value from 8-40, with higher scores indicating greater perceived involvement in their care. |
| Change in Instrument on Doctor Patient Communication Skills (IDPCS) | Baseline and 1 year | Our fourth secondary outcome measure is clinician patient centeredness based on changes in the Instrument on Doctor Patient Communication Skills or IDPCS. The Instrument on Doctor Patient Communication Skills (IDPCS) is a 19-item measure that assesses patient perception of the doctor's communication proficiency with them. People who score high on the IDPCS normally are satisfied with the way the doctor speak with them about their care. The scores for the 19-item measure range in value from 19-95, with higher scores indicating greater quality communication by the doctor. |
| Change in HIV Adherence Self-Efficacy Scale (ASES) | Baseline and 1 year | Our fifth secondary outcome measure is HIV adherence self-efficacy based on changes in the HIV Adherence Self-Efficacy Scale or ASES. The HIV Adherence Self-Efficacy Scale (ASES) is a 15-item measure that assesses patient self-efficacy for adherence to HIV treatment plan including but not limited to taking HIV medications. People who score high on the ASES normally are very confident of sticking to their HIV treatment plan even when it is hard. The scores for the 15-item measure range in value from 0-150, with higher scores indicating greater adherence self-efficacy. |
| Change in eHealth Literacy Scale (eHEALS) | Baseline and 1 year | Our first secondary outcome measure is eHealth literacy based on changes in the eHealth Literacy Scale or eHEALS. The eHealth Literacy Scale (eHEALS) is an 8-item measure that assesses patient comfort, knowledge, and skills at finding health information on the internet and evaluating whether or not it is reliable. People who score high on the eHEALS normally are very comfortable finding reliable information on the internet. The scores for the 8-item measure range in value from 8-40, with higher scores indicating greater perceived skills at using online health information to help solve health problems. |
| Change in Undetectable Viral Load | Baseline and 1 year | Our seventh secondary outcome measure is undetectable viral load based on changes to participants' HIV viral load. The HIV viral load measurements were abstracted from the participants' personal health record (PHR). In our study, people who had a HIV viral load of \<50 were considered to have undetectable viral load. |
| Change in Evidence-based Preventative Care | Baseline and 1 year | Our eighth secondary outcome measure is prevention-seeking behavior based on chart abstracted information based on our preventive care index. We created a preventive care index for each participant by assigning one point of each intervention they received post-randomization divided by the total number of interventions for which they were eligible. The index included eleven preventive care measures: Human Papillomavirus, Influenza, Tetanus, Hepatitis A, B, C testing, Hepatitis A & B vaccinations, cervical cancer screening (PAP), mammography and any colon cancer screening. People who score high on the evidence-based preventative care normally are more able to prevent illnesses or diseases. The score for the measure range in value from 0-1, with higher scores indicating greater ability to stay healthy. |
| Change in Short Form Health Survey: [Mental Health] (SF12) | Baseline and 1 year | Our ninth secondary outcome measure is mental well-being and quality of life based on changes on the Short Form Health Survey or SF12. The Short Form Health Survey (SF12) is a 12-item measure with 6 items that assesses patient mental well-being/quality of life and 6 items that assesses patient physical well-being/quality of life. People who score high on the SF-12 are normally in good mental and physical health. The scores for the 12-item measure includes two scales whose range in value from 0-100, with higher scores indicating a better health state. |
| Change in Short Form Health Survey: [Physical Health] (SF12) | Baseline and 1 year | Our final secondary outcome measure is physical well-being and quality of life based on changes on the Short Form Health Survey or SF12. The Short Form Health Survey (SF12) is a 12-item measure with 6 items that assesses patient mental well-being/quality of life and 6 items that assesses patient physical well-being/quality of life. People who score high on the SF-12 are normally in good mental and physical health. The scores for the 12-item measure includes two scales whose range in value from 0-100, with higher scores indicating a better health state. |
| Change in Self-Reported Adherence | Baseline and 1 year | Our sixth secondary outcome measure is adherence to combination antiretroviral treatment (cART) based on changes on survey of recommended items for assessing self-reported antiretroviral adherence. Our survey included two recommended assessment items with the focus on one-item measure that assesses patient self-reported adherence to taking HIV medications. People who score high on the self-reported adherence cART normally are very confident of being more adherent to taking their HIV medications. The score for the one-item measure range in value from 0-100 percent, with higher scores indicating greater adherence to cART. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Patient Empowerment Participants will take part in six 90-minute sessions focused on development of basic information technology competency within a context that supports patient autonomy, competence and human relationships.
Patient Empowerment and Autonomy Training: Participants will be given supports to address patient autonomy, competence and development of provider-patient relationships.
Patient Empowerment and Autonomy Training | 180 |
| Standard Care Participants will be followed through usual source of care, without receiving the empowerment training. | 179 |
| Total | 359 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 12 | 10 |
| Overall Study | Participant indicated lack of time | 1 | 3 |
| Overall Study | Protocol Violation | 0 | 1 |
| Overall Study | Withdrawal by Subject | 3 | 0 |
Baseline characteristics
| Characteristic | Patient Empowerment | Total | Standard Care |
|---|---|---|---|
| Age, Continuous | 51.71 years STANDARD_DEVIATION 10.71 | 51.48 years STANDARD_DEVIATION 11 | 51.24 years STANDARD_DEVIATION 11.31 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 36 Participants | 83 Participants | 47 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 144 Participants | 276 Participants | 132 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 98 Participants | 187 Participants | 89 Participants |
| Race (NIH/OMB) More than one race | 18 Participants | 30 Participants | 12 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 20 Participants | 61 Participants | 41 Participants |
| Race (NIH/OMB) White | 43 Participants | 80 Participants | 37 Participants |
| Sex/Gender, Customized Female | 68 participants | 143 participants | 75 participants |
| Sex/Gender, Customized Male | 112 participants | 213 participants | 101 participants |
| Sex/Gender, Customized Transgender | 0 participants | 3 participants | 3 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 180 | 0 / 180 |
| other Total, other adverse events | 0 / 180 | 0 / 180 |
| serious Total, serious adverse events | 0 / 180 | 0 / 180 |
Outcome results
Primary
Change in Patient Activation Measure (PAM)
Our primary outcome measure is patient empowerment based on changes in the Patient Activation Measure or PAM. The Patient Activation Measure (PAM) is a 13-item measure that assesses patient knowledge, skill, and confidence for self-management. People who score high on the PAM normally understand the importance of taking an active role in managing their health and have the skills and confidence to do so.The scores for the 13-item measure range in value from 0-100, with higher scores indicating greater activation. LEVEL 1 (0-47): May not yet believe that the patient role is important LEVEL 2 (47.1 - 55.1): Lacks confidence and knowledge to take action LEVEL 3 (55.2 - 67.0): Beginning to take action LEVEL 4 (67.1 - 100): Adapting new behaviors, but may have difficulty maintaining over time
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in Patient Activation Measure (PAM) | 73.35 score on a scale | Standard Deviation 1.13 |
| Standard Care | Change in Patient Activation Measure (PAM) | 70.53 score on a scale | Standard Deviation 1.14 |
Secondary
Change in Decisional Self-Efficacy Scale (DSES)
Our next secondary outcome measure is decision making based on changes in the Decisional Self-Efficacy Scale or DSES. The Decisional Self-Efficacy Scale (DSES) is an 11-item measure that assesses patient confidence in their ability to make health care decisions. People who score high on the DSES normally have an easier time making health care decisions. The scores for the 11-item measure range in value from 0-100, with higher scores indicating greater confidence in making an informed choice.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in Decisional Self-Efficacy Scale (DSES) | 91.89 score on a scale | Standard Deviation 0.86 |
| Standard Care | Change in Decisional Self-Efficacy Scale (DSES) | 90.81 score on a scale | Standard Deviation 0.87 |
Secondary
Change in eHealth Literacy Scale (eHEALS)
Our first secondary outcome measure is eHealth literacy based on changes in the eHealth Literacy Scale or eHEALS. The eHealth Literacy Scale (eHEALS) is an 8-item measure that assesses patient comfort, knowledge, and skills at finding health information on the internet and evaluating whether or not it is reliable. People who score high on the eHEALS normally are very comfortable finding reliable information on the internet. The scores for the 8-item measure range in value from 8-40, with higher scores indicating greater perceived skills at using online health information to help solve health problems.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in eHealth Literacy Scale (eHEALS) | 29.81 score on a scale | Standard Deviation 1.45 |
| Standard Care | Change in eHealth Literacy Scale (eHEALS) | 27.67 score on a scale | Standard Deviation 1.42 |
Secondary
Change in Evidence-based Preventative Care
Our eighth secondary outcome measure is prevention-seeking behavior based on chart abstracted information based on our preventive care index. We created a preventive care index for each participant by assigning one point of each intervention they received post-randomization divided by the total number of interventions for which they were eligible. The index included eleven preventive care measures: Human Papillomavirus, Influenza, Tetanus, Hepatitis A, B, C testing, Hepatitis A & B vaccinations, cervical cancer screening (PAP), mammography and any colon cancer screening. People who score high on the evidence-based preventative care normally are more able to prevent illnesses or diseases. The score for the measure range in value from 0-1, with higher scores indicating greater ability to stay healthy.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in Evidence-based Preventative Care | 0.35 score on a scale | Standard Deviation 0.01 |
| Standard Care | Change in Evidence-based Preventative Care | 0.35 score on a scale | Standard Deviation 0.02 |
Secondary
Change in HIV Adherence Self-Efficacy Scale (ASES)
Our fifth secondary outcome measure is HIV adherence self-efficacy based on changes in the HIV Adherence Self-Efficacy Scale or ASES. The HIV Adherence Self-Efficacy Scale (ASES) is a 15-item measure that assesses patient self-efficacy for adherence to HIV treatment plan including but not limited to taking HIV medications. People who score high on the ASES normally are very confident of sticking to their HIV treatment plan even when it is hard. The scores for the 15-item measure range in value from 0-150, with higher scores indicating greater adherence self-efficacy.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in HIV Adherence Self-Efficacy Scale (ASES) | 102.80 score on a scale | Standard Deviation 1.08 |
| Standard Care | Change in HIV Adherence Self-Efficacy Scale (ASES) | 103.13 score on a scale | Standard Deviation 1.07 |
Secondary
Change in Instrument on Doctor Patient Communication Skills (IDPCS)
Our fourth secondary outcome measure is clinician patient centeredness based on changes in the Instrument on Doctor Patient Communication Skills or IDPCS. The Instrument on Doctor Patient Communication Skills (IDPCS) is a 19-item measure that assesses patient perception of the doctor's communication proficiency with them. People who score high on the IDPCS normally are satisfied with the way the doctor speak with them about their care. The scores for the 19-item measure range in value from 19-95, with higher scores indicating greater quality communication by the doctor.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in Instrument on Doctor Patient Communication Skills (IDPCS) | 85.06 score on a scale | Standard Deviation 1.24 |
| Standard Care | Change in Instrument on Doctor Patient Communication Skills (IDPCS) | 83.49 score on a scale | Standard Deviation 1.25 |
Secondary
Change in Perceived Involvement in Care Scale (PICS)
Our third secondary outcome measure is involvement in care based on changes in the Perceived Involvement in Care Scale or PICS. The Perceived Involvement in Care Scale (PICS) is an 8-item measure that assesses patient perceived proficiency in communicating concerning their health care with the doctor. People who score high on the PICS normally are satisfied with how well they feel they communicate with the doctor about their care. The scores for the 8-item measure range in value from 8-40, with higher scores indicating greater perceived involvement in their care.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in Perceived Involvement in Care Scale (PICS) | 33.74 score on a scale | Standard Deviation 0.94 |
| Standard Care | Change in Perceived Involvement in Care Scale (PICS) | 32.47 score on a scale | Standard Deviation 0.9 |
Secondary
Change in Self-Reported Adherence
Our sixth secondary outcome measure is adherence to combination antiretroviral treatment (cART) based on changes on survey of recommended items for assessing self-reported antiretroviral adherence. Our survey included two recommended assessment items with the focus on one-item measure that assesses patient self-reported adherence to taking HIV medications. People who score high on the self-reported adherence cART normally are very confident of being more adherent to taking their HIV medications. The score for the one-item measure range in value from 0-100 percent, with higher scores indicating greater adherence to cART.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in Self-Reported Adherence | 89.33 percentage of cART adherence in past mth | Standard Deviation 1.09 |
| Standard Care | Change in Self-Reported Adherence | 89.90 percentage of cART adherence in past mth | Standard Deviation 1.09 |
Secondary
Change in Short Form Health Survey: [Mental Health] (SF12)
Our ninth secondary outcome measure is mental well-being and quality of life based on changes on the Short Form Health Survey or SF12. The Short Form Health Survey (SF12) is a 12-item measure with 6 items that assesses patient mental well-being/quality of life and 6 items that assesses patient physical well-being/quality of life. People who score high on the SF-12 are normally in good mental and physical health. The scores for the 12-item measure includes two scales whose range in value from 0-100, with higher scores indicating a better health state.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in Short Form Health Survey: [Mental Health] (SF12) | 46.38 score on a scale | Standard Deviation 0.73 |
| Standard Care | Change in Short Form Health Survey: [Mental Health] (SF12) | 46.99 score on a scale | Standard Deviation 0.73 |
Secondary
Change in Short Form Health Survey: [Physical Health] (SF12)
Our final secondary outcome measure is physical well-being and quality of life based on changes on the Short Form Health Survey or SF12. The Short Form Health Survey (SF12) is a 12-item measure with 6 items that assesses patient mental well-being/quality of life and 6 items that assesses patient physical well-being/quality of life. People who score high on the SF-12 are normally in good mental and physical health. The scores for the 12-item measure includes two scales whose range in value from 0-100, with higher scores indicating a better health state.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in Short Form Health Survey: [Physical Health] (SF12) | 44.83 score on a scale | Standard Deviation 0.71 |
| Standard Care | Change in Short Form Health Survey: [Physical Health] (SF12) | 45.13 score on a scale | Standard Deviation 0.72 |
Secondary
Change in Undetectable Viral Load
Our seventh secondary outcome measure is undetectable viral load based on changes to participants' HIV viral load. The HIV viral load measurements were abstracted from the participants' personal health record (PHR). In our study, people who had a HIV viral load of \<50 were considered to have undetectable viral load.
Time frame: Baseline and 1 year
Population: Multiple imputation was used to account for those with missing or incomplete data.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Patient Empowerment | Change in Undetectable Viral Load | 87 percentage of participants | Standard Deviation 3.1 |
| Standard Care | Change in Undetectable Viral Load | 86 percentage of participants | Standard Deviation 3.1 |