To compare the effect of a web-enabled, iPod-based intervention called Get Ready and Empowered About Treatment (GREAT) plus usual care versus usual care alone on patient activation among people living with HIV
|Randomized controlled trial
|360 adults with confirmed HIV diagnoses
- GREAT intervention
- Standard clinical care
Primary: patient activation, which includes patient knowledge, skill, and confidence for self-care
Secondary: electronic health literacy, patient decision-making self-efficacy, patient involvement in care, patient-reported adherence to antiretroviral therapy, viral suppression, health status and quality of life, receipt of evidence-based care
|Follow-up for primary outcome was 2 to 4 weeks after patient’s postintervention visit with HIV clinician
The research team recruited 360 patients from diverse backgrounds from three HIV practices and five federally qualified health centers in New York and New Jersey. The average patient age was about 51. About half of the patients had never used an iPod before.
The research team randomly assigned patients to receive the GREAT intervention plus usual care or to receive usual care alone. The team provided the GREAT intervention group with web-enabled iPods loaded with an electronic personal health record (ePHR) program customized to the needs of people with HIV. The program included drop-down menus for common HIV medications and common lab tests with brief explanations. Patients could enter their own health data into the ePHR. Patients in the intervention group attended six 90-minute group training sessions that taught participants how to use the iPod and search the internet for health information. Staff and peer trainers encouraged patients to take their iPods to HIV medical appointments. A majority (84%) of intervention patients attended at least one group training session; patients attended an average of 3.6 training sessions. Patients in the usual care group visited their clinicians as normal.
The research team directed intervention-group patients to meet with a health coach once individually to prepare them for their next HIV clinician office visit. A majority (76%) of these patients met with a health coach. Additionally, the research team provided clinicians in both the intervention and usual care groups with one 60-minute training session on supporting patient activation.
The research team developed the intervention with input from patients, HIV medical directors, HIV service organization representatives, HIV outreach workers, and clinicians.
Patients receiving the GREAT intervention had significantly greater improvement in patient activation (p=0.0271; 2.82; 95% confidence interval [CI] 0.32, 5.32) than patients in the usual care group. Patient activation is a measure of patient knowledge, skill, and confidence for self-care. The intervention group also had significantly greater improvement in electronic health literacy (p<0.0001; 2.67; 95% CI 1.38, 3.95) and patient involvement in care (p=0.0038; 1.27; 95% CI 0.41, 2.13) than the usual care group.
Compared with the usual care group, the intervention group did not have statistically significant improvements in patient decision-making self-efficacy, health status and quality of life, patient-reported adherence to antiretroviral therapy, viral suppression, or receipt of evidence-based care.
Seventy-five percent of patients in the study had no detectable viral load at baseline, which may have made it difficult to detect the intervention’s effect on viral suppression.
Follow-up after a single health coaching session and clinician visit may not be enough to detect improvements in evidence-based care.
The study took place in two states. The results may not be generalizable to other geographic locations.
Conclusions and Relevance
The web-enabled, iPod-based patient-activation program for people with HIV improved patient activation and electronic health literacy compared with usual care.
Healthcare organizations that provide care to people with HIV may consider using this program to help patients attain higher electronic health literacy and feel more activated in their care.
Future Research Needs
Future research could implement this intervention with patients without viral suppression at baseline. Future research could also incorporate additional training modules that address lifestyle factors, including nutrition, physical activity, and use of apps that support these.