title: A qualitative analysis to optimize a telemonitoring intervention for heart failure patients from disparity communities.
abstract: The use of telemonitoring is a promising approach to optimizing outcomes in the treatment of heart failure (HF) for patients living in the community. HF telemonitoring interventions, however, have not been tested for use with individuals residing in disparity communities.
  
  
  
  The current study describes the results of a community based participatory research approach to adapting a telemonitoring HF intervention so that it is acceptable and feasible for use with a lower-income, Black and Hispanic patient population. The study uses the ADAPT-ITT framework to engage key community stakeholders in the process of adapting the intervention in the context of two consecutive focus groups. In addition, data from a third focus group involving HF telemonitoring patient participants was also conducted. All three focus group discussions were audio recorded and professionally transcribed and lasted approximately two hours each. Structural coding was used to mark responses to topical questions in the interview guide.
  
  
  
  This is the first study to describe the formative process of a community-based participatory research study aimed at optimizing telehealth utilization among African-American and Latino patients from disparity communities. Two major themes emerged from qualitative analyses of the focus group data. The first theme that arose involved suggested changes to the equipment that would maximize usability. Subthemes identified included issues that reflect the patient populations targeted, such as Spanish translation, font size and medical jargon. The second theme that arose involved suggested changes to the RCT study structure in order to maximize participant engagement. Subthemes also identified issues that reflect concerns of the targeted patient populations, such as the provision of reassurances regarding identity protection to undocumented patients in implementing an intervention that utilizes a camera, and that their involvement in telehealth monitoring would not replace their clinic care, which for many disparity patients is their only connection to medical care.
  
  
  
  The adaptation, based on the analysis of the data from the three focus groups, resulted in an intervention that is acceptable and feasible for HF patients residing in disparity communities.
  
  
  
  NCT02196922 ; ClinicalTrials.gov (US National Institutes of Health).
authors.affiliation: Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.|Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA.|Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA.
authors.forename: R
authors.initials: R
authors.lastname: Pekmezaris
authors.affiliation: Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA. Rschwartz3@northwell.edu.|Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA. Rschwartz3@northwell.edu.
authors.forename: R M
authors.initials: RM
authors.lastname: Schwartz
authors.affiliation: SUNY Downstate School of Medicine, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
authors.forename: T N
authors.initials: TN
authors.lastname: Taylor
authors.affiliation: Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.|Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA.|Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA.
authors.forename: P
authors.initials: P
authors.lastname: DiMarzio
authors.affiliation: Department of Medicine, Hofstra Northwell School of Medicine, Manhasset, NY, USA.|Department of Occupational Medicine, Epidemiology, and Prevention, Hofstra Northwell School of Medicine, 175 Community Drive, Great Neck, NY, 11021, USA.|Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA.
authors.forename: C N
authors.initials: CN
authors.lastname: Nouryan
authors.affiliation: Community Advisory Board, Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA.
authors.forename: L
authors.initials: L
authors.lastname: Murray
authors.affiliation: Community Advisory Board, Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA.
authors.forename: G
authors.initials: G
authors.lastname: McKenzie
authors.affiliation: Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA.
authors.forename: D
authors.initials: D
authors.lastname: Ahern
authors.affiliation: Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA.
authors.forename: S
authors.initials: S
authors.lastname: Castillo
authors.affiliation: Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA.
authors.forename: K
authors.initials: K
authors.lastname: Pecinka
authors.affiliation: Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA.
authors.forename: L
authors.initials: L
authors.lastname: Bauer
authors.affiliation: Northwell Health, 175 Community Drive, Great Neck, NY, 11021, USA.
authors.forename: T
authors.initials: T
authors.lastname: Orona
authors.affiliation: Nassau University Medical Center, 2201 Hempstead Tpke, East Meadow, NY, 11554, USA.|Department of Cardiology, Hofstra Northwell School of Medicine, Manhasset, NY, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Makaryus
mesh_terms: D001741:Black or African American; D055812:Community-Based Participatory Research / Q000379:methods* / Q000592:standards; D054625:Healthcare Disparities; D006333:Heart Failure / Q000175:diagnosis* / Q000628:therapy; D006630:Hispanic or Latino; D006801:Humans; D018670:Monitoring, Ambulatory / Q000379:methods* / Q000592:standards; D036301:Qualitative Research; D017216:Telemedicine / Q000379:methods* / Q000592:standards