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Keywords to recruit Spanish- and English-speaking participants: evidence from an online postpartum depression randomized controlled trial.

ABSTRACT: One of the advantages of Internet-based research is the ability to efficiently recruit large, diverse samples of international participants. Currently, there is a dearth of information on the behind-the-scenes process to setting up successful online recruitment tools.The objective of the study was to examine the comparative impact of Spanish- and English-language keywords for a Google AdWords campaign to recruit pregnant women to an Internet intervention and to describe the characteristics of those who enrolled in the trial.Spanish- and English-language Google AdWords campaigns were created to advertise and recruit pregnant women to a Web-based randomized controlled trial for the prevention of postpartum depression, the Mothers and Babies/Mamás y Bebés Internet Project. Search engine users who clicked on the ads in response to keyword queries (eg, pregnancy, depression and pregnancy) were directed to the fully automated study website. Data on the performance of keywords associated with each Google ad reflect Web user queries from February 2009 to June 2012. Demographic information, self-reported depression symptom scores, major depressive episode status, and Internet use data were collected from enrolled participants before randomization in the intervention study.The Google ads received high exposure (12,983,196 impressions) and interest (176,295 clicks) from a global sample of Web users; 6745 pregnant women consented to participate and 2575 completed enrollment in the intervention study. Keywords that were descriptive of pregnancy and distress or pregnancy and health resulted in higher consent and enrollment rates (i.e., high-performing ads). In both languages, broad keywords (eg, pregnancy) had the highest exposure, more consented participants, and greatest cost per consent (up to US $25.77 per consent). The online ads recruited a predominantly Spanish-speaking sample from Latin America of Mestizo racial identity. The English-speaking sample was also diverse with most participants residing in regions of Asia and Africa. Spanish-speaking participants were significantly more likely to be of Latino ethnic background, not married, completed fewer years of formal education, and were more likely to have accessed the Internet for depression information (P<.001).The Internet is an effective method for reaching an international sample of pregnant women interested in online interventions to manage changes in their mood during the perinatal period. To increase efficiency, Internet advertisements need to be monitored and tailored to reflect the target population's conceptualization of health issues being studied.ClinicalTrials.gov NCT00816725; http://clinicaltrials.gov/show/NCT00816725 (Archived by WebCite at http://www.webcitation.org/6LumonjZP).

SUBMITTER: Barrera AZ

PROVIDER: S-EPMC3906894 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Keywords to recruit Spanish- and English-speaking participants: evidence from an online postpartum depression randomized controlled trial.

Barrera Alinne Z AZ Kelman Alex R AR Muñoz Ricardo F RF

Journal of medical Internet research 20140109 1

<h4>Background</h4>One of the advantages of Internet-based research is the ability to efficiently recruit large, diverse samples of international participants. Currently, there is a dearth of information on the behind-the-scenes process to setting up successful online recruitment tools.<h4>Objective</h4>The objective of the study was to examine the comparative impact of Spanish- and English-language keywords for a Google AdWords campaign to recruit pregnant women to an Internet intervention and ...[more]

PMID: 24407163

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Project description:Effective communication with primary care physicians is important yet incompletely understood for Spanish-speaking parents. We predicted lower satisfaction among Spanish-speaking compared to English-speaking Latino and non-Latino parents.Cross-sectional analysis at 2-month well visits within the Greenlight study at 4 pediatric resident clinics. Parents reported satisfaction with 14 physician communication items using the validated Communication Assessment Tool (CAT). High satisfaction was defined as "excellent" on each CAT item. Mean estimations compared satisfaction for communication items among Spanish- and English-speaking Latinos and non-Latinos. We used generalized linear regression modeling, adjusted for parent age, education, income, and clinic site. Among Spanish-speaking parents, we compared visits conducted in Spanish with and without an interpreter, and in English.Compared to English-speaking Latino (n = 127) and non-Latino parents (n = 432), fewer Spanish-speaking parents (n = 303) reported satisfaction with 14 communication items. No significant differences were found between English-speaking Latinos and non-Latinos. Greatest differences were found in the use of a greeting that made the parent comfortable (59.4% of Spanish-speaking Latinos endorsing "excellent" vs 77.5% English-speaking Latinos, P < .01) and discussing follow-up (62.5% of Spanish-speaking Latinos vs 79.8% English-speaking Latinos, P < .01). After adjusting for parent age, education, income, and study site, Spanish-speaking Latinos were still less likely to report high satisfaction with these communication items. Satisfaction was not different among Spanish-speaking parents when the physician spoke Spanish versus used an interpreter.Satisfaction with physician communication was associated with language but not ethnicity. Spanish-speaking parents less frequently report satisfaction with communication, and innovative solutions to enhance communication quality are needed.

Project description:Purpose The purpose of this study was to examine the diagnostic accuracy of traditional measures of phonological ability developed for monolingual English-speaking children with their bilingual peers in both English and Spanish. We predicted that a composite measure, derived from a combination of English and Spanish phonological measures, would result in higher diagnostic accuracy than examining the individual phonological measures of bilingual children separately by language. Method Sixty-six children, ages 3;3-6;3 (years;months), participated in this study: 29 typically developing bilingual Spanish-English-speaking children (x = 5;3), five bilingual Spanish-English-speaking children with speech sound disorders (x = 4;6), 26 typically developing monolingual English-speaking children (x = 4;8), and six monolingual English-speaking children with speech sound disorders (x = 4;9). Children were recorded producing single words using the Assessments of English and Spanish Phonology, and productions were phonetically transcribed and analyzed using the Logical International Phonetics Program. Overall consonants correct-revised; accuracy of early-, middle-, and late-developing sounds; and percent occurrence of phonological error patterns in both English and Spanish were calculated. Receiver operating characteristic curves and support vector machine models were applied to observe diagnostic accuracy, separately and combined, for each speaker group and each language. Results Findings indicated the combination of measures improved diagnostic accuracy within both the English and Spanish of bilingual children and significantly increased accuracy when measures from both languages of bilingual children were combined. Combining measures for the productions of monolingual English-speaking children did not increase diagnostic accuracy. Conclusion To prevent misdiagnosis of speech sound disorders in bilingual preschoolers, the composite phonological abilities of bilingual children need to be assessed across both gross and discrete measures of phonological ability. Supplemental Material https://doi.org/10.23641/asha.16632604.

Project description:BackgroundLimited health literacy (HL) contributes to poor health outcomes and disparities, and direct measurement is often time-intensive. Self-reported HL questions have not been validated among Spanish-speaking and diverse English-speaking populations.ObjectiveTo evaluate three self-reported questions: 1 "How confident are you filling out medical forms?"; 2 "How often do you have problems learning about your medical condition because of difficulty understanding written information?"; and 3 "How often do you have someone help you read hospital materials?" Answers were based on a 5-point Likert scale.DesignThis was a validation study nested within a trial of diabetes self-management support in the San Francisco Department of Public Health.ParticipantsEnglish and Spanish-speaking adults with type 2 diabetes receiving primary care.MethodsUsing the Test of Functional Health Literacy in Adults (s-TOFHLA) in English and Spanish as the reference, we classified HL as inadequate, marginal, or adequate. We calculated the C-index and test characteristics of the three questions and summative scale compared to the s-TOFHLA and assessed variations in performance by language, race/ethnicity, age, and education.Key resultsOf 296 participants, 48% were Spanish-speaking; 9% were White, non-Hispanic; 47% had inadequate HL and 12% had marginal HL. Overall, 57% reported being confident with forms "somewhat" or less. The "confident with forms" question performed best for detecting inadequate (C-index = 0.82, (0.77-0.87)) and inadequate plus marginal HL (C index = 0.81, (0.76-0.86); p<0.01 for differences from other questions), and performed comparably to the summative scale. The "confident with forms" question and scale also performed best across language, race/ethnicity, educational attainment, and age.ConclusionsA single self-reported HL question about confidence with forms and a summative scale of three questions discriminated between Spanish and English speakers with adequate HL and those with inadequate and/or inadequate plus marginal HL. The "confident with forms" question or the summative scale may be useful for estimating HL in clinical research involving Spanish-speaking and English-speaking, chronically-ill, diverse populations.

Project description:Introduction: Digital technologies, including text messaging and mobile phone apps, can be leveraged to increase people's physical activity and manage health. Chatbots, powered by artificial intelligence, can automatically interact with individuals through natural conversation. They may be more engaging than one-way messaging interventions. To our knowledge, physical activity chatbots have not been developed with low-income participants, nor in Spanish-the second most dominant language in the U.S. We recommend best practices for physical activity chatbots in English and Spanish for low-income women. Methods: We designed a prototype physical activity text-message based conversational agent based on various psychotherapeutic techniques. We recruited participants through SNAP-Ed (Supplemental Nutrition Assistance Program Education) in California (Alameda County) and Tennessee (Shelby County). We conducted qualitative interviews with participants during testing of our prototype chatbot, held a Wizard of Oz study, and facilitated a co-design workshop in Spanish with a subset of our participants. Results: We included 10 Spanish- and 8 English-speaking women between 27 and 41 years old. The majority was Hispanic/Latina (n = 14), 2 were White and 2 were Black/African American. More than half were monolingual Spanish speakers, and the majority was born outside the US (>50% in Mexico). Most participants were unfamiliar with chatbots and were initially skeptical. After testing our prototype, most users felt positively about health chatbots. They desired a personalized chatbot that addresses their concerns about privacy, and stressed the need for a comprehensive system to also aid with nutrition, health information, stress, and involve family members. Differences between English and monolingual Spanish speakers were found mostly in exercise app use, digital literacy, and the wish for family inclusion. Conclusion: Low-income Spanish- and English-speaking women are interested in using chatbots to improve their physical activity and other health related aspects. Researchers developing health chatbots for this population should focus on issues of digital literacy, app familiarity, linguistic and cultural issues, privacy concerns, and personalization. Designing and testing this intervention for and with this group using co-creation techniques and involving community partners will increase the probability that it will ultimately be effective.

Project description:Background/objectivesAdvance care planning (ACP) rates are low in diverse, vulnerable older adults, yet little is known about the unique barriers they face and how these barriers impact ACP documentation rates.DesignValidated questionnaires listing patient, family/friend, and clinician/system-level ACP barriers and an open-ended question on ACP barriers.SettingTwo San Francisco public/Department of Veterans Affairs hospitals.ParticipantsOne thousand two hundred and forty-one English and Spanish-speaking patients, aged 55 and older, with two or more chronic conditions.MeasurementsThe open-ended question on ACP barriers was analyzed using content analysis. We conducted chart review for prior ACP documentation. We used chi-square/Wilcoxon rank-sum tests and logistic regression to assess associations between ACP barriers and demographic characteristics/ACP documentation.ResultsParticipant mean age was 65 ± 7.4 years; they were 74% from racial/ethnic minority groups, 36% Spanish-speaking, and 36% with limited health literacy. A total of 26 barriers were identified (15 patient, 4 family/friend, 7 clinician/system-level), and 91% reported at least one ACP barrier (mean: 5.6 ± 4.0). The most common barriers were: (patient-level) discomfort thinking about ACP (60%), wanting to leave health decisions to "God" (44%); (family/friend-level) not wanting to burden friends/family (33%), assuming friends/family already knew their preferences (31%); (clinician/system-level) assuming doctors already knew their preferences (41%), and mistrust (37%). Compared with those with no barriers, participants with at least one reported barrier were more likely to be from a racial/ethnic minority group (76% vs 53%), Spanish-speaking (39% vs 6%), with fair-to-poor health (48% vs 34%), and limited health literacy (39% vs 9%) (p < 0.001 for all). Participants who reported barriers were less likely to have ACP documentation (adjusted odds ratio = 0.64, 95% confidence interval [0.42, 0.98]).ConclusionEnglish- and Spanish-speaking older adults reported 26 unique barriers to ACP, with higher barriers among vulnerable populations, and barriers were associated with lower ACP documentation. Barriers must be considered when developing customized ACP interventions for diverse older adults.

Project description:IntroductionAdvance care planning (ACP) is a process that allows patients to identify their goals for medical care. Traditionally, ACP has focused on completing advance directives; however, we have expanded the ACP paradigm to also prepare patients to communicate their wishes and make informed decisions. To this end, we created an ACP website called PREPARE (http://www.prepareforyourcare.org) to prepare diverse English-speaking and Spanish-speaking older adults for medical decision-making. Here, we describe the study protocol for a randomised controlled efficacy trial of PREPARE in a safety-net setting. The goal is to determine the efficacy of PREPARE to engage diverse English-speaking and Spanish-speaking older adults in a full spectrum of ACP behaviours.Methods and analysisWe include English-speaking and Spanish-speaking adults from an urban public hospital who are ≥55 years old, have ≥2 chronic medical conditions and have seen a primary care physician ≥2 times in the last year. Participants are randomised to the PREPARE intervention (review PREPARE and an easy-to-read advance directive) or the control arm (only the easy-to-read advance directive). The primary outcome is documentation of an advance directive and/or ACP discussion. Secondary outcomes include ACP behaviour change processes measured with validated surveys (eg, self-efficacy, readiness) and a broad range of ACP actions (eg, choosing a surrogate, identifying goals for care, discussing ACP with clinicians and/or surrogates). Using blinded outcome ascertainment, outcomes will be measured at 1 week and at 3, 6 and 12 months, and compared between study arms using mixed-effects logistic regression and mixed-effects linear, Poisson or negative binomial regression.Ethics and disseminationThis study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards and a data safety monitoring board. The results of this study will be disseminated to academic and community stakeholders.Trial registration numbersNCT01990235; NCT02072941; Pre-results.

Dataset Information

Keywords to recruit Spanish- and English-speaking participants: evidence from an online postpartum depression randomized controlled trial.

Publications

Keywords to recruit Spanish- and English-speaking participants: evidence from an online postpartum depression randomized controlled trial.

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