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Campbell E, Bear Don’t Walk OJ, Fraser H, Gichoya J, Wagholikar KB, Kanter AS, Holl F, Craig S. Principles and implementation strategies for equitable and representative academic partnerships in global health informatics research. J Am Med Inform Assoc 2025; 32:958-963. [PMID: 39946172 PMCID: PMC12012363 DOI: 10.1093/jamia/ocaf015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 11/26/2024] [Accepted: 01/15/2025] [Indexed: 04/23/2025] Open
Abstract
OBJECTIVE Developing equitable, sustainable informatics solutions is key to scalability and long-term success for projects in the global health informatics (GHI) domain. This paper presents key strategies for incorporating principles of health equity in the GHI project lifecycle. MATERIALS AND METHODS The American Medical Informatics Association (AMIA) GHI Working Group organized a collaborative workshop at the 2023 AMIA Annual Symposium that included the presentation of five case studies of how principles of health equity have been incorporated into projects situated in low-and-middle-income countries and with Indigenous communities in the U.S. and best practices for operationalizing these principles into other informatics projects. RESULTS We present five principles: (1) Inclusion and Participation in Ethical, Sustainable Collaborations; (2) Engaging Community-Based Participatory Research Approaches; (3) Stakeholder Engagement; (4) Scalability and Sustainability; (5) Representation in Knowledge Creation, along with strategies that informatics researchers may use to incorporate these principles into their work. DISCUSSION Presented case studies and subsequent focus groups yielded key concepts and strategies to promote health equity that may be operationalized across GHI projects. CONCLUSION Equitable, sustainable, and scalable GHI projects require intentional integration of community and stakeholder perspectives in project development, implementation, and knowledge creation processes.
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Affiliation(s)
- Elizabeth Campbell
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Center for Outbreak Response Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21202, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Oliver J Bear Don’t Walk
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, United States
| | - Hamish Fraser
- Brown Center for Biomedical Informatics, Brown University, Providence, RI 02912, United States
| | - Judy Gichoya
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, United States
| | | | - Andrew S Kanter
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Felix Holl
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm 89231, Germany
- Leibniz Science Campus Digital Public Health, Bremen, Germany
| | - Sansanee Craig
- Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, United States
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Bear Don't Walk OJ, Paullada A, Everhart A, Casanova-Perez R, Cohen T, Veinot T. Opportunities for incorporating intersectionality into biomedical informatics. J Biomed Inform 2024; 154:104653. [PMID: 38734158 PMCID: PMC11146624 DOI: 10.1016/j.jbi.2024.104653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 04/06/2024] [Accepted: 05/08/2024] [Indexed: 05/13/2024]
Abstract
Many approaches in biomedical informatics (BMI) rely on the ability to define, gather, and manipulate biomedical data to support health through a cyclical research-practice lifecycle. Researchers within this field are often fortunate to work closely with healthcare and public health systems to influence data generation and capture and have access to a vast amount of biomedical data. Many informaticists also have the expertise to engage with stakeholders, develop new methods and applications, and influence policy. However, research and policy that explicitly seeks to address the systemic drivers of health would more effectively support health. Intersectionality is a theoretical framework that can facilitate such research. It holds that individual human experiences reflect larger socio-structural level systems of privilege and oppression, and cannot be truly understood if these systems are examined in isolation. Intersectionality explicitly accounts for the interrelated nature of systems of privilege and oppression, providing a lens through which to examine and challenge inequities. In this paper, we propose intersectionality as an intervention into how we conduct BMI research. We begin by discussing intersectionality's history and core principles as they apply to BMI. We then elaborate on the potential for intersectionality to stimulate BMI research. Specifically, we posit that our efforts in BMI to improve health should address intersectionality's five key considerations: (1) systems of privilege and oppression that shape health; (2) the interrelated nature of upstream health drivers; (3) the nuances of health outcomes within groups; (4) the problematic and power-laden nature of categories that we assign to people in research and in society; and (5) research to inform and support social change.
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Affiliation(s)
- Oliver J Bear Don't Walk
- Department of Biomedical Informatics and Medical Education, University of Washington, United States.
| | - Amandalynne Paullada
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Avery Everhart
- Department of Geography, Faculty of Arts, University of British Columbia, Canada
| | - Reggie Casanova-Perez
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, United States
| | - Tiffany Veinot
- School of Information and School of Public Health, University of Michigan, United States
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Antonio MG, Veinot TC. From illness management to quality of life: rethinking consumer health informatics opportunities for progressive, potentially fatal illnesses. J Am Med Inform Assoc 2024; 31:674-691. [PMID: 38134954 PMCID: PMC10873853 DOI: 10.1093/jamia/ocad234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Investigate how people with chronic obstructive pulmonary disease (COPD)-an example of a progressive, potentially fatal illness-are using digital technologies (DTs) to address illness experiences, outcomes and social connectedness. MATERIALS AND METHODS A transformative mixed methods study was conducted in Canada with people with COPD (n = 77) or with a progressive lung condition (n = 6). Stage-1 interviews (n = 7) informed the stage-2 survey. Survey responses (n = 80) facilitated the identification of participants for stage-3 interviews (n = 13). The interviews were thematically analyzed. Descriptive statistics were calculated for the survey. The integrative mixed method analysis involved mixing between and across the stages. RESULTS Most COPD participants (87.0%) used DTs. However, few participants frequently used DTs to self-manage COPD. People used DTs to seek online information about COPD symptoms and treatments, but lacked tailored information about illness progression. Few expressed interest in using DTs for self- monitoring and tracking. The regular use of DTs for intergenerational connections may facilitate leaving a legacy and passing on traditions and memories. Use of DTs for leisure activities provided opportunities for connecting socially and for respite, reminiscing, distraction and spontaneity. DISCUSSION AND CONCLUSION We advocate reconceptualizing consumer health technologies to prioritize quality of life for people with a progressive, potentially fatal illness. "Quality of life informatics" should focus on reducing stigma regarding illness and disability and taboo towards death, improving access to palliative care resources and encouraging experiences to support social, emotional and mental health. For DTs to support people with fatal, progressive illnesses, we must expand informatics strategies to quality of life.
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Affiliation(s)
- Marcy G Antonio
- School of Information, University of Michigan, Ann Arbor, MI 48109, United States
- School of Health Information Science, University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - Tiffany C Veinot
- School of Information, University of Michigan, Ann Arbor, MI 48109, United States
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
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Yang C, Coney L, Mohanraj D, Casanova-Perez R, Bascom E, Efrem N, Garcia JT, Sabin J, Pratt W, Weibel N, Hartzler AL. Imagining Improved Interactions: Patients' Designs To Address Implicit Bias. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:774-783. [PMID: 38222327 PMCID: PMC10785874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Implicit biases may negatively influence healthcare providers' behaviors toward patients from historically marginalized communities, impacting providers' communication style, clinical decision-making, and delivery of quality care. Existing interventions to mitigate negative experiences of implicit biases are primarily designed to increase recognition and management of stereotypes and prejudices through provider-facing tools and resources. However, there is a gap in understanding and designing interventions from patient perspectives. We conducted seven participatory co-design workshops with 32 Black, Indigenous, People of Color (BIPOC), Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+), and Queer, Transgender, Black, Indigenous, People of Color (QTBIPOC) individuals to design patient-centered interventions that help them address and recover from provider implicit biases in primary care. Participants designed four types of solutions: accountability measures, real-time correction, patient enablement tools, and provider resources. These informatics interventions extend the research on implicit biases in healthcare through inclusion of valuable, firsthand patient perspectives and experiences.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nadir Weibel
- University of California San Diego, San Diego, CA
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Platt J, Nong P, Merid B, Raj M, Cope E, Kardia S, Creary M. Applying anti-racist approaches to informatics: a new lens on traditional frames. J Am Med Inform Assoc 2023; 30:1747-1753. [PMID: 37403330 PMCID: PMC10531112 DOI: 10.1093/jamia/ocad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023] Open
Abstract
Health organizations and systems rely on increasingly sophisticated informatics infrastructure. Without anti-racist expertise, the field risks reifying and entrenching racism in information systems. We consider ways the informatics field can recognize institutional, systemic, and structural racism and propose the use of the Public Health Critical Race Praxis (PHCRP) to mitigate and dismantle racism in digital forms. We enumerate guiding questions for stakeholders along with a PHCRP-Informatics framework. By focusing on (1) critical self-reflection, (2) following the expertise of well-established scholars of racism, (3) centering the voices of affected individuals and communities, and (4) critically evaluating practice resulting from informatics systems, stakeholders can work to minimize the impacts of racism. Informatics, informed and guided by this proposed framework, will help realize the vision of health systems that are more fair, just, and equitable.
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Affiliation(s)
- Jodyn Platt
- Department of Learning Health Sciences, University of Michigan Medical School, 300 North Ingalls, Suite 1161, Ann Arbor, Michigan, USA
| | - Paige Nong
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Beza Merid
- School for the Future of Innovation in Society, Arizona State University, Tempe, Arizona, USA
| | - Minakshi Raj
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana Champaign, Champaign, Illinois, USA
| | | | - Sharon Kardia
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Melissa Creary
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Abstract
OBJECTIVES Through a scoping review, we examine in this survey what ways health equity has been promoted in clinical research informatics with patient implications and especially published in the year of 2021 (and some in 2022). METHOD A scoping review was conducted guided by using methods described in the Joanna Briggs Institute Manual. The review process consisted of five stages: 1) development of aim and research question, 2) literature search, 3) literature screening and selection, 4) data extraction, and 5) accumulate and report results. RESULTS From the 478 identified papers in 2021 on the topic of clinical research informatics with focus on health equity as a patient implication, 8 papers met our inclusion criteria. All included papers focused on artificial intelligence (AI) technology. The papers addressed health equity in clinical research informatics either through the exposure of inequity in AI-based solutions or using AI as a tool for promoting health equity in the delivery of healthcare services. While algorithmic bias poses a risk to health equity within AI-based solutions, AI has also uncovered inequity in traditional treatment and demonstrated effective complements and alternatives that promotes health equity. CONCLUSIONS Clinical research informatics with implications for patients still face challenges of ethical nature and clinical value. However, used prudently-for the right purpose in the right context-clinical research informatics could bring powerful tools in advancing health equity in patient care.
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