Computer-assisted Psychosocial Risk Assessment (CaPRA) for Refugee Health and Settlement

Study Overview
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Brief Summary
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The purpose of this study was to examine preliminary effect of Computer-assisted Psychosocial Risk Assessment tool (CaPRA) among Afghan refugees visiting medical professionals (family physicians or nurse practitioners) at a Community Health Center. The investigators examined the tool's acceptability among patients and its impact on patient satisfaction and patient intention to visit a psychosocial counselor as a proxy of potential to integrate medical and social care.

Detailed Description
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The recent waves of refugees to Canada belong to regions of prolonged conflict and, thus arrive in compromised state of mental, physical, and social health. This complexity asks for provision of integrated medical and social care to newly arrived refugees. With this aim, a university-community initiative developed a Computer-assisted Psychosocial Risk Assessment tool (CaPRA) in Dari/Farsi for Afghan refugees. This innovative eHealth approach is first of its kind for Canadian refugees accessing primary care. In this model of care, patients complete an interactive multi-risk iPad computer survey in their own language before seeing the provider. The computer then generates individualized recommendation sheet for patients and a risk-report for providers at the point of care. The tool was developed through a collaborative process by working with Access Alliance Multicultural Health and Community Services and advisory board with community representatives.

Official Title
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Computer-assisted Psychosocial Risk Assessment (CaPRA) for Refugee Health and Settlement - Evaluation Phase

Conditions
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Computer, Screening, Decision Support System, Primary Care, Psychosocial, Refugees

Intervention / Treatment
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* Behavioral: Computer-assisted Psychosocial Risk Assessment (CaPRA)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Afghan refugee patients Over 18 years of age Speak and read Dari /Farsi or English language Eligible for federal or provincial health care program Visiting a participating medical practitioner Exclusion Criteria: Patient visiting a provider who has not consented for the study Patient accompanied by a family member for interpretation New patients Patients unable to receive study details due to logistical issue (e.g, no private room)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention (CaPRA)<br> | Behavioral: Computer-assisted Psychosocial Risk Assessment (CaPRA)<br>* The study intervention was a touch-screen self-assessment survey which eligible patients completed on a touch-screen iPad in Dari/Farsi language while waiting to see their medical practitioner. The Computer-assisted Psychosocial Risk Assessment (CaPRA) survey had questions on psychosocial risks (e.g., alcohol, tobacco and street drug use, sexual health, personal violence, post-traumatic stress disorder, depression, and food insecurity), cardiovascular risks (e.g., physical activity, weight, diabetes, and hypertension), road and home safety, stress buffers (e.g., coping and social support) and sociodemographics. The tool generated two tailored print-outs at the point of care. The recommendation sheet for patients summarized their disclosed risks in simple Dari/Farsi language along with contacts of relevant services. The risk-report for medical practitioner summarized patients' risks with possible referrals. This was attached to the medical chart prior to the consult.<br>|
| No Intervention: Control (usual care)<br> | Behavioral: Computer-assisted Psychosocial Risk Assessment (CaPRA)<br>* The study intervention was a touch-screen self-assessment survey which eligible patients completed on a touch-screen iPad in Dari/Farsi language while waiting to see their medical practitioner. The Computer-assisted Psychosocial Risk Assessment (CaPRA) survey had questions on psychosocial risks (e.g., alcohol, tobacco and street drug use, sexual health, personal violence, post-traumatic stress disorder, depression, and food insecurity), cardiovascular risks (e.g., physical activity, weight, diabetes, and hypertension), road and home safety, stress buffers (e.g., coping and social support) and sociodemographics. The tool generated two tailored print-outs at the point of care. The recommendation sheet for patients summarized their disclosed risks in simple Dari/Farsi language along with contacts of relevant services. The risk-report for medical practitioner summarized patients' risks with possible referrals. This was attached to the medical chart prior to the consult.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient intention to visit a psychosocial counselor | Patients completed a paper-pencil Exit Survey in the intervention (CaPRA) and control (usual care) groups | July to October post-visit | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient satisfaction | Patients completed a paper-pencil Exit Survey in the intervention (CaPRA) and control (usual care) groups | July to October post-visit | 
| Patient acceptability | Patients completed a paper-pencil Exit Survey in the intervention group (CaPRA) | July to October post-visit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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pilot, randomized controlled trial, RCT, computer, screening, community heath center, psychosocial, immigrant