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2019 HSR&D/QUERI National Conference Abstract

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1132 — ACTIVet A randomized controlled trial to investigate the efficacy of a pre-visit educational video intervention in patients with type 2 diabetes

Lead/Presenter: Howard Gordon,  COIN - Hines
All Authors: Gordon HS ((Jesse Brown VAMC, Center of Innovation for Complex Chronic Healthcare, University of Illinois at Chicago)), Oksana Pugach (Institute for Health Research and Policy, University of Illinois at Chicago), Richard Street (Texas A&M University, College Station, TX) Ben Gerber (University of Illinois at Chicago) Natalia Skorohod (Jesse Brown VAMC, Chicago) Pooja Solanki (Jesse Brown VAMC, Chicago)

Objectives:
In this investigation, we evaluated the efficacy of a brief video to improve patient self-efficacy to communicate with their physician, and to improve medication adherence and hemoglobin A1c (A1c).

Methods:
Patients (N = 147) with type 2 diabetes mellitus that was not well controlled (A1c > 7.5) were enrolled in a randomized controlled trial. The intervention was an 11-minute video based on communication and social behavioral theories that encouraged patients to use active communication behaviors when communicating with a physician. The control was similar length and discussed dietary recommendations, but not doctor-patient communication. Patients watched the assigned video between baseline and intervention visits. Randomization was 1:1 and was blocked by race and gender. Three outcomes (1) Patient reported self-efficacy (range 5-25); Adherence ; and A1c were measured twice, at baseline and after the intervention. Co-variates included demographics, health literacy, and trust. Analyses compared the intervention and control groups using bivariate statistics and multiple regression.

Results:
There were no statistically significant differences in age, race, gender, education, marital status, income, health literacy, quality of life or trust in physician in the control and intervention groups (P > 0.10). In bivariate analysis, self-efficacy at visit 1 among intervention and control was not statistically different (P = 0.94), but at visit 2 self-efficacy was somewhat lower (P = 0.07) in the intervention group compared with the control group. Adherence was not different between intervention and control. HgA1c was lower after visit 2 in both intervention and control (P < 0.05). After adjusting for gender, race, and baseline PEPPI score using multiple regression, patients in the intervention group had higher self-efficacy compared with patients in the control group [Beta 0.68 (SE 0.32); P = 0.03]. In similar regression analysis adjusting for baseline HgA1c, patients in the intervention group had lower HgA1c compared with patients in the control group [Beta -0.45 (SE 0.20); P = 0.02].

Implications:
A brief pre-visit video intervention improved diabetes patients' self-efficacy in interacting with their physician and led to lower HgA1c

Impacts:
Video-based interventions that use role modeling of active communication behaviors have promise for improving doctor-patient communication and medical outcomes and should be evaluated in larger populations.