Information Visualizations to Facilitate HIV-related Patient-provider Communication in New York City (Info Viz: HIV-NYC)
Phase: NA
Conditions: Health Communication
Sponsor: Columbia University

 
 
 
 
 
 
Official Title: Information Visualizations to Facilitate HIV-related Patient-provider 
Communication in New York City (Info Viz: HIV-NYC) 
Unique Protocol ID: AAAS4611 
Registration Identifier: NCT04102540 
                             Document Date: September 18, 2019 

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Protocol: Information visualizations to facilitate clinician-patient communication in HIV care in 
New York City: Info Viz HIV - NYC 
 
Study Purpose and Rationale  
 
Latinos are the largest and fastest growing minority group in the US,1,2 and they are disproportionately 
affected by HIV.3-6 In 2014, almost 25% of new cases of HIV infections were among Latinos although 
they only represent 17% of the US population.7 Additionally, Latinos have a faster rate of progression 
from HIV to AIDS, higher rates of HIV-related deaths, and marked delay in the diagnosis of 
infections.3,4,8 Approximately 42% of HIV diagnoses among Latinos in the US are in persons born 
abroad.9 In absolute numbers, new HIV diagnoses among foreign-born individuals in the US were the 
highest among Caribbean-born persons, which may partially be attributed to high rates of bidirectional 
travel.10-12 It is, therefore, critical that HIV prevention and treatment activities incorporate factors 
associated with Latino immigrant and transnational groups.13,14 In Washington Heights, New York City, 
understanding these factors related with bi-directional travel to the Dominican Republic is warranted, as 
the Latino population of Washington Heights is largely comprised of Dominicans.15  
 
Many factors contribute to the health disparities experienced by Latinos, of which low health literacy 
and literacy in general are potential contributors.16-19 Health literacy, or “the degree to which individuals 
have the capacity to obtain, process, and understand basic health information and services needed to 
make appropriate health decisions,”20 is an established concern affecting vulnerable communities 
globally.21 Not surprisingly, Spanish-speaking, less educated, and/or foreign-born Latinos have lower 
health literacy than those born in the US.20 Low health literacy can lead to worse health outcomes, less 
use of services, and poorer knowledge of illness.22,23 Also, patients with limited health literacy are likely 
to have low numeracy which affects interpretations of medication quantities, time between doses, and 
time between appointments, among other quantitative knowledge relating to effective management of 
HIV.24,25  
 
Infographics are emerging technologies to help teach complex health concepts to patients with low 
health literacy. When effectively designed, infographics (information visualizations) contain a depth and 
breadth of information and lead to improved understanding of concepts.26-28 By carefully selecting the 
design and included content, simple images can convey large amounts of information in a visually 
appealing and comprehensible way.29-31 Methodically constructed infographics have been shown to 
improve communication about health behaviors and health risks and minimize comprehension 
differences between individuals with high and low health literacy.27,32 They can also help improve 
information exchange amidst culture and language differences by using images familiar to patients to 
explain complicated processes33 as well as augment attention span and recall of learned material.31,34,35 
Furthermore, rigorously designed and evaluated infographics can help mitigate health disparities by 
helping clinicians provide the information that people need for effective health management in an 
understandable way.27,28,33  
 
During preliminary studies, we developed a set of infographics designed to facilitate HIV-related 
clinician-patient communication during clinic visits (AAAR3300). Initial infographics were designed by 
persons living with HIV (PLWH) in the Dominican Republic and are now being tested for feasibility 
and usability amongst a cohort in the DR (AAAR9023). In this study, we propose to assess the 
feasibility of using the infographic intervention in a clinic that specializes in HIV care in Washington 

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Heights to improve clinical communication and subsequently, patient outcomes. Additionally, we will 
collect information about acculturation and bi-directional travel to more thoroughly assess how these 
factors relate to HIV infection among Hispanic/Latino populations living in the US. 
 
The purpose of this study is, therefore, to complete the following research aims: 
 
Aim 1. Establish potential differences in clinic messaging and cultural perceptions of infographics in 
New York and refine infographics for cultural and clinical relevance to a New York based clinic 
setting 
 
Aim 2. Explore the feasibility and usability of the infographics that were designed during preliminary 
studies to facilitate HIV-related communication at The Comprehensive Health Program of NewYork-
Presbyterian/Columbia (NYP-CHP) in New York City.  
 
Aim 3. Pilot test measures to assess treatment outcomes within patients who self-identify as 
Hispanic/Latino at a health care clinic in New York and estimate measurement parameters for future 
efficacy testing (means and standard deviations).  
 
Aim 4. Measure level of acculturation and rates of bi-directional travel in this study population. 
 
Aim 5. Generate an explanatory model of HIV infection among patients in this clinical context and 
explore how it may be used to guide HIV-related communication using infographics. 
 
 
Study Design 
 
To complete the study aims, a mixed methods study will be conducted. The components of this study 
include: 
 
1) One design session with health care providers at CHP-NYP 
 
2) A single group pretest/posttest study design will be used to pilot test the infographic intervention 
 
3) In-depth interviews with two stakeholders  
 
a. Patient participants who receive the intervention 
 
c. Members of the clinical team at CHP-NYP 
 
An initial design session will be conducted to learn how to adapt infographics that were designed in the 
DR to be useful and relevant in a clinical setting in New York City. Changes will be incorporated into 
the designs and then the intervention will take place over the subsequent 8 months. During the 
intervention, patient participants will receive information using the infographics during study visits, 
which will take place after their normal visits to CHP-NYP. Baseline data will be collected from patient 
participants at enrollment and at 3- and 6-month follow up visits. In-depth interviews will be completed 
with a selection of patient participants to develop an explanatory model of HIV infection and HIV-
related communication using infographics. Individual interviews will also be conducted with additional 
members of the CHP-NYP clinical team to explore factors related to intervention implementation. 

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Statistical Procedures 
 
1) Design session with health care providers (N ≤ 10) 
 
The audio recording of the design session with health care providers will be transcribed and analyzed 
with conventional content analysis to extract key points and recommended changes to infographic 
designs (Aim 1). 
 
2) Single group pretest-posttest study design (N = 30) 
 
Descriptive statistics (means, standard deviations) will be calculated for all participant demographics. 
Responses to open-ended questions in baseline and follow up questionnaires will be grouped according 
to meaning and then, needed changes in infographic design or clinical processes will be determined 
(Aim 2). Scores on the acculturation scale will be calculated according to published recommendations 
(Aim 4).36,37  Mean scores and standard deviations will be calculated for each additional scale included 
in the follow up assessments and the change in mean scores between baseline and follow-up assessments 
determined (Aim 3). To take into account sex as a biological variable (NOT-OD-15-102), mean scores 
between male and female participants will be compared. Cronbach’s alpha will be used to compare the 
reliability of measures with reported values and to support the assertion that these tools can be used 
within this population. Data collected will also be used to estimate parameters for use in determining 
effect sizes, which will be corrected for the bias inherent in small samples,38 and reported as relative 
risks for categorical outcomes and as Cohen’s D for continuous outcomes which will enable a more 
precise power calculation for subsequent study phases (Aim 3).  
 
3.a.) Individual interviews with patient study participants (N ≤ 25) 
 
We will conduct semi-structured individual interviews using an iterative interview guide (see attached 
interview guide) developed following the recommendations of Kallio 2016 which includes 1) internal 
testing by the research team; 2) expert assessment by specialists outside the research team; and 3) field-
testing with the potential study participants.39 Depending on when saturation is reached, up to 30 in-
depth interviews will be conducted with participants who are enrolled in the study. 
The guide includes open-ended questions and probes designed to generate an explanatory model of 
participants’ experience living with HIV and communicating about it in a clinical setting.40,41 
Recruitment for in-depth interviews will continue until we have reached data saturation, when no new 
information is gleaned from the most recent interviews.42 Analysis of transcripts from in-depth 
interviews (Aim 5) will be guided by a qualitative descriptive (QD) methodology and will include 
conventional QD content analysis methods such as inductive line-by-line latent coding. An iterative 
content analysis method will then be used to generate codes and extract meaning from each question.43-45 
A coding guide will be developed by one member of the research team after initial review of a subset of 
transcripts. Other team members will then review and refine the coding guide. Then, two members of 
the research team will code each transcript and discrepancies will be resolved by discussion until 
consensus is achieved. Analyses will be conducted in Spanish then translated to English for final 
dissemination. NVivo will be used to support data management and Gioia’s methodology to ensure rigor 
in qualitative research will be followed.46  
 
 

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3.b.) Individual interviews with members of the clinic team (N ≤ 10) 
 
Audio recordings of these interviews will also be transcribed and main points regarding changes to the 
study and clinical utility of infographics in this setting will be extracted. 
 
Privacy and Data Security 
 
Provide a description of how the confidentiality of study data will be ensured, addressing concerns or 
protections that specifically relate to the data storage elements identified above (e.g. hard copy, 
electronic, system, and/or endpoint 
 
All data collected will be coded to ensure confidentiality. Data from baseline and follow up assessments 
will be collected in Columbia University’s REDCap survey management system then downloaded and 
stored on Columbia University Servers. Audio recordings of intervention visits and in-depth interviews 
will be transcribed then saved on Columbia University Servers. Only members of the research team will 
have access to the list that matches codes with participants. That list will be stored in password protected 
Columbia University Servers. Audio Recordings will be transcribed by a secure transcription service 
outside of Columbia. Audio recordings will be destroyed as soon as data analysis is complete and the 
associated manuscript is accepted for publication. 
 
Provide a description of the protections in place to safeguard participants' privacy while information 
is being collected: 
 
Data will be collected in a private interview setting to maintain participant comfort and confidentiality. 
All collected data will be coded. Only the study team will have access to the file which can link 
participants to their study data. It will be password protected on Columbia University Servers. 
 
Procedures 
 
Samantha Stonbraker, a Columbia Researcher, will be responsible for overseeing all study related 
procedures, data analysis, and final dissemination. 
 
Study Setting 
 
All study activities will take place at The Comprehensive Health Program of NewYork-
Presbyterian/Columbia (NYP-CHP). This is a Ryan White funded, bilingual, patient-centered medical 
home that emphasizes sexual health, hepatitis management, and HIV care. It primarily serves Upper 
Manhattan and the South Bronx where residents are disproportionately affected by HIV. NYP-CHP’s 
large multidisciplinary team provides HIV care to a population of more than 2,300 children, adolescents, 
and adults through more than 16,000 visits per year. 
 
Design Session 
 
Members of the clinic team at NYP-CHP will be asked if they are interested in participating in the study. 
Interested participants will all meet and provide verbal informed consent to participate in the study. 
During the design session, each infographic (n=15) will be shown to the group and the necessary 

5 
 
changes that need to be made to each will be solicited. The session will be audio recorded and later 
transcribed for analysis. 
 
Infographic intervention 
 
Study team members who will administer the intervention will have a training regarding how guide 
patient education with infographics using the adherence counseling format that is used at CHP-NYP and 
will review principal components of intervention fidelity, including how to maintain it.47,48 During the 
intervention period, after normal clinic visits, study team members will guide education using the 
laminated, paper-based set of infographics developed in preliminary studies. Infographics will be 
available in both English and in Spanish and will provide a visual representation of the pertinent 
information to be included in clinical conversations. Intervention fidelity will be verified by audio 
recording up to one-half of total intervention visits with patient permission as is detailed in the informed 
consent document. Members of the study team will listen to audio recordings to confirm the other team 
member is using infographics during visits as specified in the intervention training, that both study team 
members are using them in the same way, and that they are delivering the intervention consistently 
across visits. Study team members will complete a second training session after the baseline visits to 
revisit main points that need to be addressed while administering the intervention and address any 
concerns that arise during the initial intervention visits. Patient participants will be asked about study 
team members use of infographics during follow up assessments. 
 
Participant eligibility will be verified by clinic staff through electronic health records during team hudles 
that take place in the mornings on study days. A list of eligible participants will be provided to the health 
care providers who are seeing patients that day. The provider will then assess potential participant 
interest using the attached recruitment script and refer those who are interested in participating to an on-
site study team member. That team member will then further introduce the study and then if a participant 
is interested, complete the informed consent process.  
 
After completing informed consent, patient participants will complete a baseline assessment using 
REDcap on an encrypted tablet with the help of a study team member prior to intervention 
administration (Table 1). Patient participants will then receive the intervention during study visits, which 
will take place after participants’ normally scheduled appointments at baseline, 3- and 6-month visits. 
They will complete a follow up assessment at their visits closest to 3- and 6-months following their 
baseline visit. Study team members will extract information from patient medical records (CD4 count, 
viral load, current ART etc.) at each data collection time point. Patient participants will receive reminder 
phone calls prior to each of their study visits using the attached reminder phone call script. Time 
intervals were selected as CD4 count and viral load may change as early as three months after ART 
initiation.49-51 Study team members will time how long it takes to administer the intervention.  
 
Following their six-month study visit, participants will be asked to participant in an in-depth interview. 
At the end of the study, additional members of the clinical team will be interviewed to assess feasiblity 
of infographic use in this clinical setting.  
 
 
 
 

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Table 1. Summary of research activities  
Date(s) 
Study point 
Participants 
Activities 
July 2019 
Design Session 
• Members of clinical 
team 
• Two hour design session 
September 
2019 
Study team 
member training 
• Study team members • Two-hour training on how to 
use infographics 
September/ 
October 2019 
Enrollment 
• Patients 
• Study team 
 
• Health literacy assessment 
• Baseline assessment  
• Exposure to intervention 
• CD4 & viral load extracted 
December 
2019/  
January 2020 
3-month visits 
• Patients 
• Study team 
 
• Exposure to intervention 
• Follow up assessment 
• CD4 & viral load extracted 
March/April 
2020 
6-month visits 
• Patients 
• Study team 
• Exposure to intervention 
• Follow up assessment 
• CD4 & viral load extracted 
March –  
May  
In-depth 
interviews 
• Patients 
• Follow up assessment 
• CD4 & viral load extracted 
April/May 
In-depth 
interviews 
• Members of the 
clinical team 
• Individual interviews with team 
members 
 
Measures  
 
Outcome selection was guided by a conceptual model to theoretically guide communication studies.52,53 
This model illustrates pathways through which clinician-patient communication may influence health 
outcomes in the short (proximal), medium (intermediate), and long-term. Primary outcomes of CD4 
count and viral load will be collected from patient medical records at each study visit. Measures of 
information recall/comprehension, satisfaction with care,54 self-efficacy to manage HIV,55 adherence,56 
health related quality of life,57 and health status (self-reported status and CD4 count and viral load) will 
all be included in the baseline and follow up assessments.  
 
Baseline assessments will collect demographic information, assess level of acculturation,37 evaluate 
health literacy level,58 and contain a measure for each outcome. 
 
Follow up assessments for PLWH will include the outcome measures as well as open-ended questions 
exploring the usability of infographics, satisfaction with designs and recommendations for improvement. 
Open-ended questions regarding interventionists’ communication strategies and intervention delivery 
will be included to assess providers’ communication variability. 
 
In-depth interviews with PLWH. To describe PLWH’s perceptions of HIV-related communication in a 
clinical setting and how it may be influenced by infographic use, directed content analysis guided by 

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McGuire’s Classic Input-Output Framework for Constructing Persuasive Messages will be used.59 In-
depth interviews will be conducted using a semi-structured interview guide in a private setting by a 
study team member and will be audio-recorded and transcribed. 
 
In-depth interviews with clinical care team. To learn more about how this intervention was accepted 
and feasible at the clinic as a whole, interviews will be conducted with additional members of the 
clinical care team. Participants will complete a semi-structured interview containing questions on the 
following aspects of feasibility: acceptability, demand, implementation, practicality, adaptation, 
integration, expansion, and limited-efficacy testing60 and questions elucidating feedback on infographic 
design and suggestions regarding their effective incorporation into clinical visits.  
Each session will be audio recorded, later transcribed, and then analyzed to identify key features of the 
study that worked and what didn’t work in order to better inform future efforts. 
 
Recruitment and Consent 
 
Describe plans for screening and/or determining eligibility of prospective subjects 
 
Patient participant eligibility will be confirmed by staff at CHP-NYP through the EHR. A list of eligible 
participants will be provided to the health care providers seeing patients on study days. During clinic 
visits, providers will review the study with eligible participants using the recruitment script and if they 
show interest in the study, will refer potential participants to speak to a study team member who will 
provide more information about the study, complete the informed consent process, and administer the 
intervention. 
 
Eligible design session participants are staff at CHP-NYP that are involved in any patient education 
activities. Eligible members of the clinical care team who will complete individual interviews will be 
anyone who was involved with, or had knowledge of, the intervention and its use at CHP-NYP. Design 
session participants and clinic care team members will be identified by members of the research team 
who are affiliated with CHP-NYP. 
 
Participants from the design session may also participate as care team members who complete individual 
interviews.  
 
Describe how participants will be recruited 
 
Patient participants 
Using the attached recruitment script, health care providers will introduce the study to eligible patient 
participants and if they are interested, the providers will refer them to speak with an on-site researcher 
immediately following their clinic appointment. The on-site researcher will further introduce the study 
to participants in their primary language (English or Spanish) and answer any questions the person has, 
then continue with informed consent if the individual indicates interest in study participation.  
 
Health care provider participants 
After being selected by CHP-NYP affiliated study team members, potential participants for the design 
session, and members of the clinical care team who will complete individual interviews will be recruited 
by the study team members who will provide more information about the study and enroll participants. 

8 
 
To avoid coercion, all potential participants will be reminded that their participation in this research is 
completely voluntary, that they don’t have to participate if they don’t want to, and that there will not be 
any adverse effects to them if they choose not to participate. 
 
Describe how participants' written consent will be obtained 
 
Written informed consent of patients will be completed by an on-site study team member in a private 
space. The process will begin with a succinct summary of the research study. The complete informed 
consent form will be read to participants and comprehension of procedures will be verified by short 
questions in the consent forms. Additionally, participants will be provided the opportunity to discuss any 
of the information and will be encouraged to ask questions prior to signing the form. They will then be 
asked to confirm that they were provided sufficient information about the study and then they will be 
asked to sign the form. A signed copy of the informed consent form will be stored in a locked file 
cabinet in a locked office in the School of Nursing. Participants will be given a copy of the informed 
consent form for their records.  
 
Verbal informed consent will be obtained for the design session and for the individual interviews with 
members of the clinical team. 
 
Research Aims and Abstracts 
 
Research Question(s)/Hypothesis(es) 
 
Research Question 1: What are some of the cultural and practical differences between the way health 
information is provided to persons living with HIV in a health care clinic in the United States vs. in the 
Dominican Republic? 
 
Research Question 2: To what extent are the infographics designed during preliminary studies a 
feasible and useful method to facilitate HIV-related clinician-patient communication amongst 
Hispanic/Latino persons living with HIV in New York City? 
 
Research Question 3: How efficacious are these measures (described in the procedures section) to 
assess treatment outcomes among this population and what are their measurement parameters (means 
and standard deviations) in this population?  
 
Research Question 4: What are PLWH’s perceptions of HIV-related communication including 
infographic use during a clinical visit with a healthcare provider? 
 
Scientific Abstract 
 
Latinos are the largest and fastest growing minority group in the United States (US) and they are 
disproportionately affected by HIV. In 2014, almost 25% of new cases of HIV infections were among 
Latinos although they only represent 17% of the US population. Many factors contribute to the health 
disparities experienced by Latinos, of which low health literacy and literacy in general are potential 
contributors. Health literacy, or “the degree to which individuals have the capacity to obtain, process, 
and understand basic health information and services needed to make appropriate health decisions,” is 

9 
 
an established concern affecting vulnerable communities globally. Low health literacy can lead to worse 
health outcomes, less use of services, and poorer knowledge of illness. Not surprisingly, Spanish-
speaking, less educated, and/or foreign-born Latinos have lower health literacy than those born in the 
US.  
 
Infographics are technologies designed to help teach complex health concepts to patients with low health 
literacy. When effectively designed, infographics (information visualizations) contain a depth and 
breadth of information and lead to improved understanding of concepts. Additionally, infographics can 
also help improve information exchange amidst culture and language differences by using images 
familiar to patients to explain complicated processes as well as augment attention span and recall of 
learned material. During preliminary studies, we developed a set of infographics designed to facilitate 
HIV-related clinician-patient communication during clinic visits (AAAR3300). Initial infographics were 
designed by persons living with HIV (PLWH) in the Dominican Republic and are now being tested for 
feasibility and usability amongst a cohort in the DR (AAAR9023). In this study, we propose to assess 
the feasibility of using infographics to improve patient outcomes at a clinic that specializes in HIV care 
in Washington Heights. Additionally, we will collect information about acculturation and bi-directional 
travel to more thoroughly assess how these factors relate to HIV infection among Hispanic/Latino 
populations living in the US. 
 
Lay Abstract 
 
Latinos are the largest and fastest growing minority group in the United States (US). Unfortunately, they 
have higher rates of HIV than their peers in other ethnic groups. Many things lead to this health 
disparity. One potential cause is low health literacy and/or literacy in general. Health literacy, is defined 
as “the degree to which individuals have the capacity to obtain, process, and understand basic health 
information and services needed to make appropriate health decisions.” It is a large concern that affects 
vulnerable communities globally. Low health literacy can lead to worse health outcomes, less use of 
services, and poorer knowledge of illness. Spanish-speaking, less educated, and/or Latinos not born in 
the US have lower health literacy than those born in the US.  
 
Infographics are tools that can help teach complex topics to patients with low health literacy. Well-
designed infographics are images that combine symbols and text that aid in education. They can also 
lead to improved understanding of concepts and can improve communication when there are culture and 
language differences. This has been shown to help people pay attention for longer amounts of time and 
remember more of what they learn. In early work, we developed a set of infographics to support HIV-
related clinician-patient communication in a clinical setting (AAAR3300). These infographics were 
designed by persons living with HIV (PLWH) in the Dominican Republic and are now being tested to 
see if they are useful during clinic visits in the DR (AAAR9023). In this study, we propose to test these 
infographics to see if they can improve patient’s health in a US-based clinic that specializes in HIV care.  
 
Risks, Benefits, and Monitoring 
 
Potential Risks  
 
One potential risk to participants directly related to their participation in this protocol is possible loss of 
confidentiality. However, all the data safety and monitoring procedures in this protocol will be strictly 

10 
 
adhered to in order to avoid any loss of confidentiality. An additional risk is that participants might feel 
uncomfortable if they are unable to answer some of the questions in the surveys. Prior to beginning data 
collection, all participants will be reminded they do not have to answer any question that makes them 
feel uncomfortable and that they may withdraw from the study at any point without any consequences 
whatsoever. During the study visits, a study team member will also be available in order to provide any 
help that does not lead participants to the correct answer. During in-depth interviews participants may 
feel discomfort discussing their HIV status. Prior to interviews, participants will be reminded that they 
do not have to answer any question that makes them feel uncomfortable and that they are free to leave 
the interview at any time without any consequences whatsoever.  
 
Additionally, all study team members will be trained to identify signs of suicidal ideation and 
depression. Should they notice any of these signs while they are completing a study visit, or if 
participants are showing signs of discomfort, the study visit will be stopped immediately, and the 
participant will be referred to an appropriate mental health professional. 
 
Potential Benefits 
 
This study does not have any direct benefit to participants. However, participants are more likely to 
benefit from the health education provided because of the intervention. Additionally, by participating in 
this research, they will be able to actively contribute to improving the health care services that they and 
their peers receive. 
 
Alternatives 
 
This study does not present greater than minimal risks to participants. An alternative is to not participate 
in this research. 
 
Data and Safety Monitoring 
 
The safety of this study’s data will be regularly monitored by the study team. Any breaches of the study 
protocol will be submitted to the IRB immediately. 
 
Subjects 
 
Inclusion Criteria 
 
Adults (≥ 18 years of age) living with HIV, who self-identify as Hispanic/Latino, are English or Spanish 
Speaking, a new patient or a patient with a detectable viral load and plan to receive care at the NYP-
CHP during the study period will be eligible for inclusion.  
 
Exclusion are current pregnancy or inability to provide informed consent. 
 
Study population characteristics 
 
Study participants will be adults (≥ 18 years of age) living with HIV, who self-identify as 
Hispanic/Latino, are English or Spanish Speaking, with a detectable viral load and plan to receive care at 

11 
 
the NYP-CHP during the study period. Participants are likely to be economically and educationally 
disadvantaged and non-English speaking. 
 
Subject population justification  
 
PLWH at NYP-CHP are likely to have lower levels of education and low health literacy and adherence 
to antiretroviral medications is a perpetual concern. Although a vulnerable population because they are 
living with a stigmatized health condition and are economically and educationally disadvantaged, their 
participation in this research is justified because it enables them to help design a tool and intervention 
that may help them to better manage their condition and improve the clinic services that they and their 
peers receive. Furthermore, if the target population of interventions is not included in the research 
design and evaluation phases, interventions may be ineffective and misguided. 
 
Describe and justify reimbursement/compensation 
 
Participants will receive $25 in the form of a paycard for each of their study visits (three visits total). 
Participants who participate in the in-depth interviews will also receive a $25 pay card for that visit. 
Providers involved in the intervention will be provided refreshments the two trainings on how to 
administer the intervention as well as during the semi-structured interview that they will complete at the 
end of the study. 
 
 
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