Implementation of an Online Family Health History Tool using Research Assistants in Rural North Carolina

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Introduction: Chronic diseases have been increasing globally for decades, while the leading chronic diseases worldwide are cancer, cardiovascular disease (CVD), chronic respiratory disease, and diabetes.1 Behavioral risk factors of chronic diseases that can be modified include physical activity, diet, alcohol consumption and tobacco use.3 4 Several guidelines for screening and prevention recommend that family health history (FHH) is collected by primary care providers for disease risk stratification and management.6 7 MeTree, developed in 2014, is a computerized, patient-facing program that collects information about family health history and generates decision support for providers and patients.6 15 There are several potential barriers to implementation of an online FHH software tool including health literacy, computer skills, and behavioral components. This study collects FHH information through MeTree in a rural population in North Carolina through a unique implementation process using research assistants to manually and verbally assist participants. The aims of this study are to characterize the quality of pedigrees collected and to estimate familial disease aggregation among the families of participants.

Methods: This study enrolled 44 participants from an ongoing study conducted by collaborators from Duke University Health System, Duke Clinical Research Institute,

University of North Carolina Pembroke, and Southeastern Regional Medical Center. To collect FHH information, participants constructed family pedigree in MeTree, one family member at a time with the help of one study research assistant. Once participants created a full family pedigree, an individual risk assessment was generated by MeTree.

Results: More than half of the participants were female (n= 30, 68.2%). The ethnic group that composed the largest part of our study population were Lumbee Indians (n=23, 52.3%) followed by White/Caucasians (n=13, 29.5%) and African Americans (n=7, 15.9%). For quality, the average score across all pedigrees was higher than 65% for all seven components of the criteria. The total number of diseases present among all participants and relatives in the study was 930 (Table 3). Cancer was present in 81.8% of pedigrees and made up 12.2% of all reported diseases. Twenty-five percent of all pedigrees had at least one family member that was diagnosed with lung cancer. Diabetes was also frequently reported and was observed in 75% of all pedigrees. Kidney Disease was reported in at least one or more relatives in 52.3% of pedigrees.

Conclusions: Using a patient-facing online Health Information Technology tool such as MeTree could potentially lead to better health outcomes due to risk assessment and individually-targeted prevention strategies. MeTree may be an important tool to use to address the large burden of chronic diseases in this region.






Wittmer, Ashley Nicole (2018). Implementation of an Online Family Health History Tool using Research Assistants in Rural North Carolina. Master's thesis, Duke University. Retrieved from


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