The VHA is collaborating with other healthcare agencies to expand the capacity of the family health history (FHH) module currently available in MyHealtheVet program using the Next Generation FHH tool. The ultimate goal of our work is to examine veterans' and VHA primary care providers' acceptance and utilization of FHH information as a genomic and clinical tool. Our work will contribute to the ongoing attempts in translating genomic findings into clinical practice to improve the quality of care for veterans with or at risk of common diseases. However, several important issues need to be addressed before our proposed full study can be implemented. The objective for this pilot study is to enhance the development of the full study by testing the data collection tools, assessing the feasibility of subjects' recruitment, collecting preliminary data and determining the performance characteristics of the proposed outcome measures. This will be the first project that assesses the use of FHH as a genomic and clinical tool at the VHA. We conceptualize our investigation within the framework of the Theory of Planned Behavior (TPB). TPB posits that individuals' behaviors (using FHH information) are driven by their behavioral intentions (BI). BI is a function of: (1) Behavioral Beliefs which shapes individuals' attitude toward the behavior, (2) Normative Beliefs, which is the subjective norms surrounding the performance of the behavior, and (3) Behavioral Control which is individuals' perception of the ease with which the behavior can be performed. The proposed pilot research is an observational, prospective study that incorporates both qualitative and quantitative approaches. A total of 100 veterans visiting the primary care outpatient clinic will be invited to complete the online self-administered Next Generation FHHT and the study's surveys [e.g., veterans' FHH survey] with the help of a research coordinator, if needed. Participants will be asked to share the generated FHH information with their relatives and primary care providers. A small subset of the enrolled veterans (n=30) who have a FHH of a common chronic disease and are at moderate/high familial risk for that disease will be selected to participate in two sequential follow-up phone interviews over a period of six months. The goal of these interviews is to assess veterans' actual patterns of utilization regarding FHH information and to gain an in-depth understanding of the processes and ethical issues related to the use of FHH information. Semi-structured interviews will also be conducted with 15 primary care providers enrolled from the clinic to examine their perspective about the use of FHH as a genomic and clinical tool. Both quantitative and qualitative analyses will be employed using SAS program and Atlas. Ti Software respectively. The study's specific aims are: (1) to pilot test veterans' FHH survey to assess veterans' beliefs and attitudes regarding the utilizations of their FHH information, (2) to assess the logistics for veterans follow up semi- structured interviews and (3) to generate preliminary data on primary care providers' views regarding the use of FHH information in the clinic.
Current advances in genomics hold great promise to transform the practice of medicine by personalizing health care. Family health history (FHH) information can be incorporated as a genomic and clinical tool. The VHA is collaborating with other healthcare agencies to expand the capacity of the family health history (FHH) module available in MyHealtheVet program using the Next Generation FHH tool. This study will provide data on the performance and acceptability of an inexpensive method for FHH assessment that could be integrated into clinical practice to facilitate screening and identification of veterans at risk for common chronic diseases, so that they can be offered special preventive measures. The FHH information and screening would also enable healthcare organizations to focus resources on developing critically important health behaviors in the population at highest risk of developing chronic diseases.
