Utility of a virtual counselor (VICKY) to collect family health histories among vulnerable patient populations: A randomized controlled trial

Catharine Wang; Michael K Paasche-Orlow; Deborah J Bowen; Howard Cabral; Michael R Winter; Tricia Norkunas Cunningham; Michelle Trevino-Talbot; Diana M Toledo; Dharma E Cortes; MaryAnn Campion; Timothy Bickmore

doi:10.1016/j.pec.2021.02.034

Utility of a virtual counselor (VICKY) to collect family health histories among vulnerable patient populations: A randomized controlled trial

Patient Educ Couns. 2021 May;104(5):979-988. doi: 10.1016/j.pec.2021.02.034. Epub 2021 Feb 18.

Affiliations

¹ Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA. Electronic address: clwang@bu.edu.
² Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
³ Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA.
⁴ Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
⁵ Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA, USA.
⁶ Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
⁷ Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
⁸ Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA.
⁹ Department of Genetics, Stanford University, Stanford, CA, USA.
¹⁰ Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA.

Abstract

Objectives: This study is a randomized controlled trial comparing the efficacy of a virtual counselor (VICKY) to the My Family Health Portrait (MFHP) tool for collecting family health history (FHx).

Methods: A total of 279 participants were recruited from a large safety-net hospital and block randomized by health literacy to use one of the digital FHx tools, followed by a genetic counselor interview. A final sample of 273 participants were included for analyses of primary study aims pertaining to tool concordance, which assessed agreement between tool and genetic counselor.

Results: Tool completion differed significantly between tools (VICKY = 97%, MFHP = 51%; p < .0001). Concordance between tool and genetic counselor was significantly greater for participants randomized to VICKY compared to MFHP for ascertaining first- and second-degree relatives (ps<.0001), and most health conditions examined. There was significant interaction by health literacy, with greater differences in concordance observed between tools among those with limited literacy.

Conclusions: A virtual counselor overcomes many of the literacy-related barriers to using traditional digital tools and highlights an approach that may be important to consider when collecting health histories from vulnerable populations.

Practice implications: The usability of digital health history tools will have important implications for the quality of the data collected and its downstream clinical utility.

Trial registration: ClinicalTrials.gov NCT02344433.

Keywords: Ehealth; Family health history; Health disparities; Health literacy; Virtual counselor; Vulnerable populations.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Counselors*
Family
Family Health
Health Literacy*
Humans
Medical History Taking
Vulnerable Populations

Associated data

ClinicalTrials.gov/NCT02344433

Grants and funding

R01 HG007746/HG/NHGRI NIH HHS/United States