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Using a Touch Screen Audio-Enhanced Computer-Assisted Self Interviewing (TS-ACASI) System for Measuring Medication Adherence (ADH) in Populations with Varied Levels of Computer Experience

R. Margaret Whelan1, Sharon B. Mannheimer, MD2, Julie Franks, PhD3, Yael Hirsch-Moverman, MPH4, Nancy I. Holson, MPH5, and Wafaa El-Sadr, MD, MPH4. (1) Infectious Diseases Division, Columbia University/Harlem Hospital, 506 Lenox Ave, Room 3101A, New York, NY 10037, 212-939-2381, rmw2102@columbia.edu, (2) Harlem Hospital Center, Columbia University College of Physicians and Surgeons, 506 Lenox Ave, Room 3101A, New York, NY 10037, (3) Harlem Hospital Center, Columbia University, 506 Lenox Avenue rm 3101-A, New York, NY 10037, (4) Infectious Diseases Division, Harlem Hospital, 506 Lenox Avenue, Room 3101A, New York, NY 10037, (5) Department of Infectious Diseases, Harlem Hospital, 506 Lenox Ave., New York, NY 10037

Background: Using a TS-ACASI to measure ADH may be a good way to overcome social desirability limits of interviewer-administered questionnaires. Varying levels of computer experience in the targeted population may affect acceptability of the TS-ACASI interviewing method.

Methods: In an ongoing RCT promoting latent TB infection treatment completion, an interviewer-administered ADH questionnaire was converted to TS-ACASI format in English and French. TS-ACASI design (voice-over tone and accent; volume, color, graphics, and layout) was appropriate to population characteristics, including literacy levels and impaired vision and hearing. Multicultural community health workers piloted TS-ACASI. Participants (pts) completed TS-ACASI ADH questionnaires at monthly follow-up visits, and an interviewer-administered acceptability interview after first TS-ACASI use.

Results: Of 71 pts, 59% were foreign born, 69% completed high school, 61% were unemployed, 44% had a history of homelessness. 21% reported ‘no computer experience’; 27% ‘a little’; 27% ‘some’; and 25% ‘a lot’. Computer experience was associated with completing high school (p<.001), being employed (p=.014), and no history of homelessness (p=.048). Pts reported that the following features made TS-ACASI experience ‘very easy’: voice-over accent (92%), speed (79%), volume (83%), overall sound (81%), and instructions (82%). TS-ACASI aspects that pts found helpful were color scheme (94%), layout (97%) and overall appearance (82%). 86% were very satisfied with the experience. Responses to acceptability questions were not associated with computer experience.

Conclusion: Appropriately-designed TS-ACASI can be used in diverse populations with varied levels of computer experience. Systems should be tailored to population characteristics and pilot tested to ensure ease of use.

Learning Objectives:

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Measuring Health and Disease in the Population I

The 132nd Annual Meeting (November 6-10, 2004) of APHA