Methods: A community participatory approach using many small research cycles were used to answer the research questions.
This approach was used to overcome existing challenges or barriers to reducing health disparities by starting from the experience of individuals from the disenfranchised groups. We engaged the target communities to focus on what they identified as important.
Results: During Phase 1, three major themes emerged consistently, in all four communities and across all focus groups in communications with healthcare providers that the communities perceived as preventing them from getting what they want and need to manage their health. Themes are “wait,” “won’t,” and “want.” Strategies identified as useful were codified into a communication structure, SBAR3, which serves as the basis for the eSMART-HD screen-based simulation. SBAR3 stands for “share your story” (S), “bring your background” (B), “ask for what you want or need” (A), “review the plan” (R1), “reflect on whether it is right for me” (R2), and “repeat the plan” (R3).
In Phase 2, 141 subjects have participated (94 in the intervention group and 47 in the attention control group). Our data support the feasibility of administering eSMART (69% consent rate, 0% attrition over 4 months). Narrative data reveal use of our self-management communication structure with their health care providers. Initial efficacy is supported by higher QPPI scores after the initial dose of the intervention (t=-3.3, p <.01). A clinically and statistically significant decrease was seen in systolic blood pressure (F=3.621, df=3,204) and diastolic blood pressure (F=4.346, df=3,204).
Phase II Extension
Twenty eight community dwelling young adults participated in the extension of eSMART to those with symptoms of anxiety and depression. Symptoms were measured using the HAD-S. There was a statistically significant interaction between group assignment and time, F(3, 69) =3.65.
Conclusion: Findings suggest that interactions with virtual healthcare providers (avatars) in a serious game for health may support users and improve symptoms (blood pressure and depression).