Using Information Technology to Reduce Asthma Disparities in Underserved Populations: A Pilot Study

Abstract

Background. Low health literacy has been identified as an independent predictor of poor asthma control. The Institute of Medicine considers the role of information technology (IT) as critical in providing “safe, effective, patient centered, timely, efficient, and equitable” care with the potential to reduce health disparities in underserved populations. The aim of this study was to design and evaluate an interactive computer-based questionnaire to assess asthma symptoms in children of parents with limited health literacy and/or limited English proficiency. Methods. Volunteer caregivers attending a mobile asthma clinic were randomly assigned to complete the electronic or the paper-and-pencil version of an asthma screening questionnaire (ASQ) in their language of choice (English or Spanish). In the electronic version, a tablet computer was used to present the ASQ questions as video clips and to collect information through the touchscreen. Participants also completed a demographic questionnaire, a brief health literacy questionnaire, and a system usability and satisfaction questionnaire. Reliability of the paper and electronic self-assessments was evaluated by comparing each participant's answers to information they provided during a nurse-guided structured interview (gold standard). Results. A total of 48 parents participated in the study, 26 completed the electronic ASQ and 21 the paper-and-pencil form. Thirty-five percent of the children had well-controlled asthma (n = 17). Most participants were Spanish speaking (67%) Hispanic (n = 44) mothers (n = 43) with a median age of 32 years. More than half had ≤8 years of education (n = 25) and earned <$20,000 per year (n = 27). The median health literacy score was 32 (range 0–36). The correlation between health literacy scores and years of education was significant (ρ = .47, p < .01). Concordance between the electronic ASQ and the nurse interview was significantly higher than concordance between the paper ASQ and the nurse interview (68% versus 54%; p < .01). All parents who completed the electronic questionnaire reported being satisfied; 96% felt comfortable using it, and found it simple to use. Conclusions. By facilitating the assessment of asthma symptoms at manageable cost, interactive information technology tools may help reduce barriers to access due to inadequate levels of English proficiency and health literacy.

• asthma
• children
• computer-based assessment
• English proficiency
• health literacy
• parents
• self-report

Acknowledgments

This work was supported by Arizona State University (ASU) New College Research and Creative Activities Grant Program, and was conducted at the ASU–West Campus and the Phoenix Children's Hospital Breathmobile clinic. Support for Dr. Vargas was also provided by the National Institutes of Health/National Center on Minority Health and Health Disparities (P20 MD002316; solicited RFA MD-06-003 Establishing Exploratory NCMHD Centers of Excellence; http://grants.nih.gov/grants/guide/rfa-files/RFA-MD-06-003.html).

We thank the parents who participated in the study and the Breathmobile staff: Gena Wilson, CPNP; Audrey Schoonmaker, RN; Sherry Hunkler, RRT; and Ramona Rodriguez for their invaluable help in the conduct of the study. We want to acknowledge the contribution of Peggy Radford, MD, and Judith Harris, CPNP, to the conception of this study, data analysis, and the final editing of the manuscript. We also acknowledge Elias Robles, PhD, and Perla A. Vargas, PhD, participation in the study design and implementation, data collection and analysis, and preparation of the manuscript. We thank Rebecca Wilson for her participation in producing the video clips.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.