Here is my assignment 2
Hi Angelo,
A delicate subject. You have done a good job with the COM-B. And as you concluded, the CFIR seems cumbersome in this particular context and is adding less to what COM-B has already covered.
An it was useful reading your assignment in a way that it made me think that I might have missed my analysis (using the COM-B too) by including what will make the behavior stop in addition to what is driving the behavior.
Might need to revise.
It's interesting to see that there are a lot of barriers towards GC/CT screening in HIV patients on many different socio-ecological levels. I agree that structural barriers seem to be the most important ones to address, and that the COM-B model doesn't clearly distinguish between different socio-ecological levels. I have never been specifically involved in care of HIV patients, but I think when trying to close this gap of insufficient GC/CT screening there are also opportunities on the patient-level, and some focus could also be given on involvement of the patient such as educating patients about the risks of CG/CT and the benefits for screening and motivate them to address this topic at subsequent health care visits and more openly communicate potential risky behaviours. This in turn would also require provider time and appropriate interpersonal skills and knowledge of the provider as important components of the capability part of the COM-B model.
Thanks Asa, this is a really interesting area. A lot of it overlaps with older adult cancer screening, but this time with a really different population and a more involved screening test. Sounds like it involves giving urine and swabs of body cavities.
Beyond the two theories that you mention here, you might be able to borrow some ideas from the behavioral economics concepts that Elvin talked about 1st week. One would be that providers are automatically prompted to sign an order for GC/CT testing every 6 months and need to opt out if it is inappropriate for that patient. Another would be to pair GC/CT testing to another activity that happens regularly to trigger both at the same time. In colorectal cancer screening they did that with the Flu-FIT program where people coming for their Flu vaccine are also given a FIT. Are people with HIV on antiretrovirals still have relatively frequent blood draws? Maybe people in the lab could automatically do the GC/CT testing at the time of blood draws (would probably require training and a way to make it discreet). Another idea from colorectal cancer screening is automated outreach, where people are automatically mailed reminders or receive robo-calls when they are due for screening. These could be 'cues for action' that don't depend on providers remembering that someone is due for screening.
Hi Asa,
This is a great gap to focus on for these assignments. I think trying to look for literature for similar tests that use the same testing platform as the GC/CT test and see if there are similar results. If people are just turned off by the testing platform then finding ways to couple this testing with another routine test might be a good route to explore. There are many options to address this gap, better follow up with patients, performing testing at already scheduled appointments, provider pressure to get testing etc. I encourage you to delve into the literature a bit further and see if there have been more studies regarding attitudes towards this test/testing platform. Looking forward to hearing more about this gap/analysis in section.