Practice-based Intervention for Vietnamese and Korean Patients

This pilot project examined the feasibility of an multilingual interactive video education intervention "an interactive Mobile Doctor intervention (iMD)" to promote patient-provider discussion on tobacco use for Korean- and Vietnamese-speaking male patients at primary care settings.

Study Overview

• Status: Completed
• Conditions: Smoking Cessation; Tobacco Use
• Intervention / Treatment: Behavioral: Interactive Mobile Doctor ("iMD")

Detailed Description

While California has made significant strides in tobacco control and is leading the nation in reducing smoking use, the decline is not observed in all groups. Select groups still have much higher smoking rates and thus bear an unequal burden of tobacco-related illnesses and deaths. Of important note, Asian American men as a combined group have a higher smoking rate than non-Hispanic Whites (22% vs. 18%, respectively); in particular, the highest smoking prevalence has been observed in Vietnamese (31%) and Korean (30%) men among major Asian subgroups. Research also shows that smoking rates are higher for Asian American men with low acculturation (e.g., immigrant status, low English proficiency) than for those who are more acculturated; yet the reverse trend is observed in Asian American women. These findings underscore the need for more targeted tobacco control efforts. The scientific literature suggests that provider advice to quit smoking can influence a smoker's decision to quit. However, research has shown that Asian Americans are less likely to receive such provider advice. Providers often have very limited face-time with patients during the short clinic visit, which presents a challenge as to whether they can incorporate smoking cessation messages during the visit. Overall, little research has focused on smoking cessation in the clinic setting, particularly research that focuses on Asian Americans. The purpose of the pilot study was to develop a more streamlined smoking cessation intervention that can be integrated into the clinic visit, especially to maximize the time when patients are waiting to see their providers. The research question was whether providing culturally appropriate video education that includes provider advice and was tailored to a patient's readiness for quitting smoking will increase whether a patient receives smoking cessation education according to the recommended Clinical Practice Guideline and whether this results in a decrease in tobacco use in low-income Vietnamese and Korean patients. Using a community-based participatory research approach, the investigators created the iMD that delivers tailored in-language video messages via a mobile tablet to Korean and Vietnamese male smokers right before their clinic visit with a provider. iMD delivers the "5 A's" and generates a bilingual tailored printout. Participants were Korean- and Vietnamese-speaking patients who self-identify as daily smokers and receive primary care at a federally-qualified health center. This study evaluated the feasibility and acceptability of iMD from the patients' perspectives. This study examined patient-provider discussion on tobacco use from patients' self-report and electronic health record (EHR), and self-reported quit attempts and smoking abstinence at 3 months post iMD visit.

• Study Type: Interventional
• Enrollment (Actual): 47
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• current smokers identified on electronic health records (EHR)
• have a scheduled primary care visit during the recruitment period

Exclusion Criteria:

• already quit smoking or not smoking daily in the past 7 days
• had already quit smoking or not smoking daily in the past 7 days
• had canceled or rescheduled their primary care visit outside of the study period

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Smoking Cessation Group; Patients received the interactive mobile doctor (iMD) intervention.

Behavioral: Interactive Mobile Doctor ("iMD"); iMD delivers tailored interactive video education via a mobile tablet to smoking patients right before their clinic visit with a provider. iMD delivers the "5 A's" (ask, advise, assess, assist, and arrange) and generates a bilingual tailored printout, which aims to increase patient-provider discussion on tobacco use and to promote smoking cessation. This version of iMD delivers the intervention in Korean or Vietnamese languages as preferred by the patient.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participation Rate	proportion of eligible participants consent to participate	Baseline
Acceptability	proportion of participants who rated the intervention as moderately to extremely satisfied	through study completion, an average of 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient-provider discussion	self-reported by patient whether discussion on tobacco use took place at the indexed clinical encounter	"through study completion, an average of 1 year
Physician delivery of 5As	EHR-documented physician's delivery of assess, advice, assist, or arrange at the indexed clinical encounter	"through study completion, an average of 1 year
Quit attempt	self-reported at least one or more 24 hour quit attempts	3-month
Abstinence	self-reported 7-day point prevalent smoking abstinence	3-month

Collaborators and Investigators

• Sponsor: Asian Health Services
• Collaborators: University of California, San Francisco
• Investigators: Principal Investigator: Thu Quach, PhD, MPH, Asian Health Services; Principal Investigator: Janice Tsoh, University of California, San Francisco

Study record dates

Study Major Dates

• Study Start: August 1, 2012
• Primary Completion (Actual): July 1, 2015
• Study Completion (Actual): July 1, 2015

Study Registration Dates

• First Submitted: February 20, 2017
• First Submitted That Met QC Criteria: February 22, 2017
• First Posted (Actual): February 27, 2017

Study Record Updates

• Last Update Posted (Actual): February 27, 2017
• Last Update Submitted That Met QC Criteria: February 22, 2017
• Last Verified: February 1, 2017

More Information

Terms related to this study

• Keywords: patients; smoking; Asian; tobacco use; digital health intervention; provider advice
• Other Study ID Numbers: 21BT-0056