How CARE Works
CARE conducts a personalized motivational interview that explores the patient’s behavior, knowledge, and goals.
A patient-selected virtual counselor accompanies the patient through the interview, voicing (optional) all questions and responses and making CARE accessible to people at all levels of literacy and in the language (optional) most comfortable to them. When it comes to sensitive information, our research shows that most people are more comfortable with a CARE counselor, as they feel less judged and are more likely to disclose accurately.
CARE delivery modes
CARE lives in a secure, HIPAA-compliant cloud environment, so it’s available on virtually any Internet-connected device (computer, tablet, or mobile phone) capable of displaying a responsive web page.
Not all situations allow for Internet connections, however, so for maximum flexibility, CARE can also be run:
- On a closed local area network (LAN) that is not exposed to the Internet (such as in some hospitals).
- As a stand-alone without any network connection. In a controlled setting, patients use a specially configured tablet computer that contains the entire system. Encrypted data is then moved off of the tablet and stored on a central computer or cloud.
Personalized counseling and skills-building
CARE synthesizes a patient’s behaviors, knowledge, and goals and provides highly personalized feedback based on the patient’s particular circumstances. Patients receive praise for healthy behaviors as well as feedback on risks, with the most serious risks flagged to the patient’s attention.
Counseling messages compare, for example, a patient’s expressed goals with their reported behaviors, and highlight risks that the patient may not understand based on the knowledge assessment.
Patients can view one or more engaging skills-building videos that are appropriate both to the stage of change and the specific risks for each patient. Many videos model risk-reduction steps that meet the patient at his or her particular stage and situation. Others provide knowledge that addresses specific gaps identified as part of the synthesis feedback.
CARE supports online and in-clinic workflows. In clinical deployments, for example, CARE can handle subject recruitment and test consenting, with consent and safe-to-test confirmation provided to clinic staff. Session interrupts are supported, allowing, for instance, a patient in a clinic to interrupt a CARE session to see their clinician, and then return to complete the interrupted session, either in the clinic or later at home.
CARE offers highly personalized synthesis, feedback, and skills-building to each patient.
Synthesis messages compare a patient’s goals with their reported behaviors. The messages may highlight successful patient behaviors, or behaviors that don’t match goals. Either way, the messages are always presented in a non-judgmental way. For example:
- You said staying healthy is important to you, and you’ve made an appointment for an STD screening. Good job!
- You said it’s important to you to avoid catching a disease, but having sex without using condoms is putting you at risk for STDs.
- You said keeping on your medications is important to you, but it sounds like you’re having trouble taking them consistently.
Feedback messages identify risks and risk-reduction behaviors and rank them in order of severity. Typically, all patients first receive positive reinforcement, and then CARE displays the riskiest behaviors they’ve presented in a graphic way, using colors (red, yellow, and green) and symbols to help identify degree of risk. Identifying risks in this way cues patients on the behaviors they can alter to most greatly reduce their risk—and around which they create a plan later in the CARE session.
Skills-building videos demonstrate how a patient might address the risks that CARE has helped them identify. Videos are personalized to the patient’s circumstances, including their stage of change and state of knowledge. For example, a MSM patient with a sexual partner of unknown status might be presented with a video with advice on how to discuss getting tested with a partner.
CARE supports experimental research projects by offering multiple study arms within a single deployment. Users can be screened and directed to the appropriate arm, or randomized among two or more arms. This capability is designed to support experiments intended to refine a content protocol (since protocols can be quickly updated and deployed) or to support randomized controlled-trial projects.
CARE can track patient responses in multiple sessions over time. Data from previous visits is accessible in real time during any session. CARE can ask how previous risk-reduction plans are going, spot changes in behaviors and health status, and address previously identified risks. This powerful capability can provide a richer patient experience over time as well as support nuanced longitudinal research projects.
CARE provides flexible access to data for easy workflow integration with analytic software. In addition, CARE can provide custom reports for routine monitoring and quality control, and descriptive statistics.
CARE is fully localizable into as many languages as desired. Full export/import support of content for translation provides an extremely efficient workflow for multiple languages, and includes both audio and video. CARE has been deployed in dual English/Spanish versions among US Spanish-speaking populations, and an English/Swahili version has also been deployed in Kenya.