Catharine Wang1, Michael K Paasche-Orlow2, Deborah J Bowen3, Howard Cabral4, Michael R Winter5, Tricia Norkunas Cunningham6, Michelle Trevino-Talbot6, Diana M Toledo7, Dharma E Cortes8, MaryAnn Campion9, Timothy Bickmore10. 1. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA. Electronic address: clwang@bu.edu. 2. Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA. 3. Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA. 4. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA. 5. Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA. 6. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA. 7. Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 8. Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA. 9. Department of Genetics, Stanford University, Stanford, CA, USA. 10. Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA.
Abstract
OBJECTIVES: This study is a randomized controlled trial comparing the efficacy of a virtual counselor (VICKY) to the My Family Health Portrait (MFHP) tool for collecting family health history (FHx). METHODS: A total of 279 participants were recruited from a large safety-net hospital and block randomized by health literacy to use one of the digital FHx tools, followed by a genetic counselor interview. A final sample of 273 participants were included for analyses of primary study aims pertaining to tool concordance, which assessed agreement between tool and genetic counselor. RESULTS: Tool completion differed significantly between tools (VICKY = 97%, MFHP = 51%; p < .0001). Concordance between tool and genetic counselor was significantly greater for participants randomized to VICKY compared to MFHP for ascertaining first- and second-degree relatives (ps<.0001), and most health conditions examined. There was significant interaction by health literacy, with greater differences in concordance observed between tools among those with limited literacy. CONCLUSIONS: A virtual counselor overcomes many of the literacy-related barriers to using traditional digital tools and highlights an approach that may be important to consider when collecting health histories from vulnerable populations. PRACTICE IMPLICATIONS: The usability of digital health history tools will have important implications for the quality of the data collected and its downstream clinical utility.
OBJECTIVES: This study is a randomized controlled trial comparing the efficacy of a virtual counselor (VICKY) to the My Family Health Portrait (MFHP) tool for collecting family health history (FHx). METHODS: A total of 279 participants were recruited from a large safety-net hospital and block randomized by health literacy to use one of the digital FHx tools, followed by a genetic counselor interview. A final sample of 273 participants were included for analyses of primary study aims pertaining to tool concordance, which assessed agreement between tool and genetic counselor. RESULTS: Tool completion differed significantly between tools (VICKY = 97%, MFHP = 51%; p < .0001). Concordance between tool and genetic counselor was significantly greater for participants randomized to VICKY compared to MFHP for ascertaining first- and second-degree relatives (ps<.0001), and most health conditions examined. There was significant interaction by health literacy, with greater differences in concordance observed between tools among those with limited literacy. CONCLUSIONS: A virtual counselor overcomes many of the literacy-related barriers to using traditional digital tools and highlights an approach that may be important to consider when collecting health histories from vulnerable populations. PRACTICE IMPLICATIONS: The usability of digital health history tools will have important implications for the quality of the data collected and its downstream clinical utility.
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