Layperson Telepresenters: Increasing Capacity for Telehealth in Underserved Communities.

Purpose: With numerous advancements in telemedicine over the past few years, there has been a huge shift toward home-based digital care. However, the absence of telepresenters in the home to facilitate these teleconsultations can result in incomplete and insufficient patient assessments, both of which can affect overall health outcomes. We describe the feasibility of training laypersons to serve as telepresenters in a community-based telemedicine setting. Methods: Community members were recruited to become trained telepresenters. The training protocol consisted of four modules: (1) didactics, (2) vital signs, (3) physical examinations, and (4) proficiency. Trainees complete surveys regarding the training and were observed on skills competency and interactions with patients and providers. Results: A total of 32 volunteers completed the training. Layperson telepresenters (LTPs) gained knowledge and confidence to perform their role successfully, as well as received positive ratings from patients, distant providers, and onsite program personnel on all aspects of their performance as telepresenters. Conclusions: Although further research is needed to determine the impact and generalizability of these results, this pilot study demonstrated the initial feasibility of training LTPs.

Digital Food Records in Community-Based Interventions: Mixed-Methods Pilot Study.

BACKGROUND: A pressing need exists to understand and optimize the use of dietary assessment tools that can be used in community-based participatory research (CBPR) interventions. A digital food record, which uses a mobile device to capture the dietary intake through text and photography inputs, is a particularly promising mobile assessment method. However, little is understood about the acceptability and feasibility of digital food records in CBPR and how to best tailor dietary assessment tools to the needs of a community. OBJECTIVE: The objective of our study was to evaluate the acceptability and feasibility of digital food records among church-based populations in resource-limited wards of Washington, DC, USA, using a mixed-methods approach. METHODS: This community-based pilot study was conducted as part of the Washington, DC Cardiovascular Health and Needs Assessment. Participants (n=17) received a mobile device (iPod Touch) to photodocument their dietary intake for a 3-day digital food record using a mobile app, FitNinja (Vibrent Health). The acceptability of the digital food record was explored through the thematic analysis of verbatim transcripts from a moderated focus group (n=8). In addition, the feasibility was evaluated by the percentage of participants complying with instructions (ie, capturing both before and after meal photos for at least 2 meals/day for 3 days). RESULTS: Qualitative themes identified were related to (1) the feasibility and acceptability of the mobile device and app, including issues in recording the dietary information and difficulty with photodocumentation; (2) suggestions for additional support and training experiences; and (3) comparisons with other mobile apps. Overall, the participants accepted the digital food record by demonstrating satisfaction with the tool and intent to continue the use (eg, participants recorded an average of 5.2, SD 7, consecutive days). Furthermore, of the 17 participants, 15 photodocumented at least 1 meal during the study period and 3 fully complied with the digital food record instructions. CONCLUSIONS: This study demonstrated digital food records as an acceptable tool in CBPR and identified contributors and barriers to the feasibility of digital food records for future research. Engaging community members in the implementation of novel assessment methods allows for the tailoring of technology to the needs of the community and optimizing community-based interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT01927783; https://www.clinicaltrials.gov/ct2/show/NCT01927783 (Archived by WebCite at http://www.webcitation.org/70WzaFWb6).