BACKGROUND/RATIONALE:
Early detection of HIV disease is a crucial health issue in the VA. In the U.S., up to 25% of persons who are infected with HIV are unaware of their status. Despite frequent opportunities for early diagnosis, only 30-50% of VA patients with documented risk factors for HIV infection have been tested. Earlier detection of HIV helps prevent serious HIV-related health problems, leads to cost-effective early treatment, and helps reduce risky behaviors that spread the virus.


OBJECTIVE(S):
The objectives of this study are to: (a) assess Veteran and provider attitudes/beliefs about the MyHealtheVet (MHV) website and its use to transmit public health messages; (b) develop draft messages that educate patients about the CDC guidelines and encourage them to be tested for HIV (and other health conditions); (c) evaluate patient and provider reactions to these messages; and (d) select one message and refine it, in preparation email broadcasting.

METHODS:
We conducted 2 patient focus groups at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, MA and 2 focus groups with primary care providers at the VA Medical Center in Manchester, NH. Patients were recruited with fliers in the primary care service and in the Veterans' computer center. Providers were recruited through a presentation at the weekly primary care staff meeting. Focus group guides were used to lead the discussions. In addition, at the 2nd patient and 2nd provider focus groups we presented draft text of messages about disease screening to obtain participant perceptions and suggestions for improvement. All focus groups were audio-recorded and later transcribed. We conducted grounded thematic analyses of the focus group audio recordings and transcripts, identifying key concepts linked to both patient and provider perceptions of HIV testing and social marketing strategies.

FINDINGS/RESULTS:
Patients found the concept of disease screening social marketing unproblematic and wanted these messages to link to additional health and disease-related information. Some expressed concern, however, about receiving a direct email message that included content regarding HIV. Most preferred that any direct emails to Veterans solely be used to link them to content that is on MyHealtheVet. Providers expressed more concerns than patients, however, the concerns were surmountable with appropriate crafting of messages and advance notice to providers before the VA broadcasts electronic messages to patients. Providers felt messages might create undue worry in patients, and would lead to a large increase in call and visit volume that would be unmanageable given the current primary care resources.

IMPACT:
Discussions with patients and providers indicate that electronic means of communicating important disease screening education with Veterans is viable, as long as patient and provider concerns are addressed. This method of communication may provide another mode to reach out to Veterans and to increase important disease screening rates.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. McInnes DK, Gifford AL, Kazis LE, Wagner TH. Disparities in health-related internet use by US veterans: results from a national survey. Informatics in primary care. 2010 Jun 15; 18(1):59-68. [view]
2. Valdiserri RO, Nazi K, McInnes DK, Ross D, Kinsinger L. Need to improve routine HIV testing of U.S. Veterans in care: results of an Internet survey. Journal of community health. 2010 Jun 1; 35(3):215-9. [view]
3. McInnes DK, Hyun JK, Trafton JA, Asch SM, Gifford AL. Program characteristics associated with testing for HIV and hepatitis C in veterans substance use disorder clinics. Psychiatric services (Washington, D.C.). 2010 Jan 1; 61(1):90-4. [view]
4. McInnes DK, Solomon JL, Bokhour BG, Asch SM, Ross D, Nazi KM, Gifford AL. Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives. BMC research notes. 2011 Aug 15; 4:295. [view]

Conference Presentations

1. McInnes DK, Solomon J, Bokhour BG, Asch SM, Burgess JF, Ross D, Nazi KM, Gifford AL. Electronic communication to encourage disease screening: patient and provider attitudes. Poster session presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL. [view]
2. McInnes DK, Solomon J, Bokhour BG, Asch SM, Burgess JF, Ross D, Nazi KM, Gifford AL. Electronic Social Marketing for Disease Screening: Patient and Provider Perspectives. Paper presented at: National Institutes of Health Conference on the Science of Dissemination and Implementation: Methods and Measurement; 2010 Mar 15; Bethesda, MD. [view]
3. Bokhour BG, Solomon J, Knapp H, McInnes DK, Ching W, Lowe L, McCoy L, Asch SM, Gifford AL. Improving VA Provider Communication about HIV Testing: A Qualitative Approach to Designing a Communication Intervention. Poster session presented at: VA QUERI National Meeting; 2008 Dec 12; Phoenix, AZ. [view]
4. McInnes DK, Gifford AL, Asch S, Bokhour BG, Burgess JF, McCoy L, Nazi K, Ross D, Solomon J. My HealtheVet for communication and social marketing. Working Group Presentation. Paper presented at: AcademyHealth Annual Research Meeting; 2009 Jun 28; Chicago, IL. [view]
5. Weaver FM, Hogan TP, Charters K, Nazi K, Weingardt K, McInnes DK, Gifford A, Chumble NR, Saleem J, Haggstrom D. Strengthening the Study of Personal Health Records in VA: Emerging Research Issues Surrounding the “My HealtheVet” System. Paper presented at: VA QUERI National Meeting; 2008 Dec 12; Phoenix, AZ. [view]
6. Solomon J, Cohn ES, Cortes DE, Haidet P, Fix GM, Bokhour BG. U.S. Primary Care Providers’ ‘Narrative Mind Reading’ of Patients: Examples from Hypertension and Asthma (Mis)management. Presented at: American Anthropological Association Society for Medical Anthropology International Conference; 2009 Sep 24; New Haven, CT. [view]

DRA: none
DRE: none
Keywords: none
MeSH Terms: none