Informed consent for opt-in HIV testing via tablet kiosk: an assessment of patient comprehension and acceptability

Abstract

Although implementation of HIV testing in the emergency department has met with some success, one commonly cited challenge is the consent process. Kiosks offer one potential strategy to overcome this barrier. This pilot cross-sectional survey study examined patient comprehension of opt-in HIV testing consent and acceptability of using a kiosk to provide consent. Subjects were guided through a simulated consent process using a kiosk and then completed a survey of consent comprehension and acceptability of kiosk use. Subjects were 50.3% female, Black (74.4%), and had an education level of high school or less (61.3%). Subjects found the kiosk very easy or easy to use (83.9%) and reported they were very or mostly comfortable using the kiosk to consent to HIV testing (89.4%). Subjects understood the required aspects of consent: HIV testing was voluntary (93.0%, n = 185) and that refusal would not impact their care (98.5%, n = 196; 99.0%, n = 197). Following a simulated consent process, subjects demonstrated a high rate of comprehension about the vital components of HIV testing consent. Subjects reported they were comfortable using the kiosk, found the kiosk easy to use, and reported a positive experience using the kiosk to provide consent for HIV testing.

Keywords

HIV HIV consent HIV testing tablet kiosk patient acceptability comprehension

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References

Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Ann Emerg Med 2007; 49: 575–577.

Hoover

Tao

Heffelfinger

. Monitoring HIV testing at visits to emergency departments in the United States: very-low rate of HIV testing. J Acquir Immune Defic Syndr 2013; 62: 90–94.

Haukoos

White

Lyons

et al.

Operational methods of HIV testing in emergency departments: a systematic review. Ann Emerg Med 2011; 58: S96–S103.

Rothman

Hsieh

Harvey

et al.

2009 US emergency department HIV testing practices. Ann Emerg Med 2011; 58: S3–S9.e4.

Kelen

Rothman

. Emergency department-based HIV testing: too little, but not too late. Ann Emerg Med 2009; 54: 65–71.

Moran

Talan

. Processes and models for HIV screening in the emergency department: can and should we do this? Ann Emerg Med 2011; 58: S172–S173.

Arbelaez

Wright

Losina

et al.

Emergency provider attitudes and barriers to universal HIV testing in the emergency department. J Emerg Med 2012; 42: 7–14.

Irvin

Flagel

Fox

. The emergency department is not the ideal place for routine HIV testing. Ann Emerg Med 2007; 49: 722–722.

Jain

Wyatt

Burke

et al.

Knowledge of the centers for disease control and prevention’s 2006 routine HIV testing recommendations among New York City internal medicine residents. AIDS Patient Care STDS 2009; 23: 167–176.

10.

Cohan

Gomez

Dowling

et al.

HIV testing attitudes and practices among clinicians in the era of updated Centers for Disease Control and Prevention recommendations. J Acquir Immune Defic Syndr 2009; 50: 114–116.

11.

Burke

Sepkowitz

Bernstein

et al.

Why don’t physicians test for HIV? A review of the US literature. AIDS 2007; 21: 1617–1624.

12.

Haukoos

Hopkins

Byyny

et al.

Patient acceptance of rapid HIV testing practices in an urban emergency department: assessment of the 2006 CDC recommendations for HIV screening in health care settings. Ann Emerg Med 2008; 51: 303–309.e1.

13.

Zetola

Klausner

Haller

et al.

Association between rates of HIV testing and elimination of written consents in San Francisco. JAMA 2007; 297: 1057–1062.

14.

Coletti

Heagerty

Sheon

et al.

Randomized, controlled evaluation of a prototype informed consent process for HIV vaccine efficacy trials. J Acquir Immune Defic Syndr 2003; 32: 161–169.

15.

Calderon

Haughey

Bijur

et al.

An educational HIV pretest counseling video program for off-hours testing in the emergency department. Ann Emerg Med 2006; 48: 27.e1–27.e1.

16.

Calderon

Leider

Hailpern

et al.

A randomized control trial evaluating the educational effectiveness of a rapid HIV posttest counseling video. Sex Transm Dis 2009; 36: 207–210.

17.

Calderon

Haughey

Leider

et al.

Increasing willingness to be tested for human immunodeficiency virus in the emergency department during off-hour tours: a randomized trial. Sex Transm Dis 2007; 34: 1025–1029.

18.

Haukoos

Hopkins

Bender

et al.

Use of kiosks and patient understanding of opt-out and opt-in consent for routine rapid human immunodeficiency virus screening in the emergency department. Acad Emerg Med 2012; 19: 287–293.

19.

Kurth

Severynen

Spielberg

. Addressing unmet need for HIV testing in emergency care settings: a role for computer-facilitated rapid HIV testing? AIDS Educ Prev 2013; 25: 287–301.

20.

Gaydos

Solis

Hsieh

et al.

Use of tablet-based kiosks in the emergency department to guide patient HIV self-testing with a point-of-care oral fluid test. Int J STD AIDS 2013; 24: 716–721.

21.

Hsieh

Gauvey-Kern

Peterson

et al.

An emergency department registration kiosk can increase HIV screening in high risk patients. J Telemed Telecare 2014; 20: 454–459.

22.

Hsieh

Jung

Shahan

et al.

Outcomes and cost analysis of 3 operational models for rapid HIV testing services in an academic inner-city emergency department. Ann Emerg Med 2011; 58: S133–S139.

23.

Sun

Knapp

Shamouelian

et al.

Effect of an education kiosk on patient knowledge about rapid HIV screening. J Telemed Telecare 2010; 16: 158–161.

24.

Trepka

Newman

Huffman

et al.

Food safety education using an interactive multimedia kiosk in a WIC setting: correlates of client satisfaction and practical issues. J Nutr Educ Behav 2010; 42: 202–207.

25.

Porter

Cai

Gribbons

et al.

The asthma kiosk: a patient-centered technology for collaborative decision support in the emergency department. J Am Med Inform Assoc 2004; 11: 458–467.

26.

Jones

. The role of health kiosks in 2009: literature and informant review. Int J Environ Res Public Health 2009; 6: 1818–1855.

27.

Cupertino

Richter

Cox

et al.

Feasibility of a Spanish/English computerized decision aid to facilitate smoking cessation efforts in underserved communities. J Health Care Poor Underserved 2010; 21: 504–517.

28.

Holmes

Estabrooks

Davis

et al.

Effect of a grocery store intervention on sales of nutritious foods to youth and their families. J Acad Nutr Diet 2012; 112: 897–901.

29.

Joshi

Weng

Lichenstein

et al.

Prospective tracking of a pediatric emergency department e-kiosk to deliver asthma education. Health Inform J 2009; 15: 282–295.

30.

Tony

Sarah

Dhinagaran

et al.

Design, development and implementation of a touch-screen health information kiosk for patients at the outpatient waiting area in a large tertiary care hospital in India: an evaluation of user satisfaction. J Health Inform Dev Ctries 2013; 7: 8–19–8–19.

31.

Chan

Nagurka

Bentley

et al.

Medical utilization of kiosks in the delivery of patient education: a systematic review. Health Promot Perspect 2014; 4: 1–1.

32.

Lawrence

. Cashing in on check-in-as hospitals face steeper challenges in collecting for service, bringing the revenue cycle to kiosks is one answer. Healthcare Inf 2010; 18: 18–20–18–20.

33.

Deblonde

Meulemans

Callens

et al.

HIV testing in Europe: mapping policies. Health Policy 2011; 103: 101–110.