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Coulter RWS, Dougherty M, Clark MB, Wilson A, Miller E, Ragavan MI. Online Human-Centered Design Methods are Acceptable, Appropriate, and Feasible for Generating Adolescent Relationship Abuse Intervention Ideas With Sexual and Gender Diverse Youth. J Adolesc Health 2024; 75:656-664. [PMID: 39066750 DOI: 10.1016/j.jadohealth.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/15/2024] [Accepted: 06/02/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Sexual and gender diverse youth (SGDY) are at greater risk for adolescent relationship abuse (ARA) than cisgender heterosexual youth, but there are not enough evidence-based interventions for reducing ARA among SGDY. We piloted online human-centered design (HCD) methodology to engage SGDY in generating ARA intervention ideas. This study evaluated the acceptability, appropriateness, and feasibility of the online methods and identified SGDY-derived intervention ideas for reducing ARA. METHODS From August 2020 through March 2021, we conducted a longitudinal online HCD study with 46 SGDY (aged 14-18 years) recruited via social media from across the United States. SGDY completed HCD activities using MURAL (collaborative digital whiteboard) in four group-based sessions (1.5 hours each) and a follow-up survey with validated measures of acceptability, appropriateness, and feasibility (a priori success benchmarks: means > 3.75 on each five-point scale). RESULTS SGDY in the sample were 41% racial/ethnic minorities. SGDY rated the online HCD methods as highly acceptable, appropriate, and feasible (means ≥ 4.29). SGDY co-created a breadth of ARA intervention concepts across all social-ecological levels, including commonplace ideas (e.g., curriculum for schools) and novel ideas, such as social media-based interventions to foster healthy relationships, incentivization interventions for performing social justice work, and school plays with SGDY storylines. DISCUSSION Online HCD methods are acceptable, appropriate, and feasible for designing ARA intervention ideas. The intervention ideas generated in this study can help catalyze ARA intervention research for SGDY. Our method can be transported to other populations and health topics to help advance adolescent health and equity.
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Affiliation(s)
- Robert W S Coulter
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Michelle Dougherty
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael B Clark
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Elizabeth Miller
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maya I Ragavan
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Gender Academic Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
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Rosenbaum S, Moberg J, Chesire F, Mugisha M, Ssenyonga R, Ochieng MA, Simbi CMC, Nakyejwe E, Ngatia B, Rada G, Vásquez-Laval J, Garrido JD, Baguma G, Kuloba S, Sebukyu E, Kabanda R, Mwenyango I, Muzaale T, Nandi P, Njue J, Oyuga C, Rutiyomba F, Rugengamanzi F, Murungi J, Nsangi A, Semakula D, Kaseje M, Sewankambo N, Nyirazinyoye L, Lewin S, Oxman AD, Oxman M. Teaching critical thinking about health information and choices in secondary schools: human-centred design of digital resources. F1000Res 2024; 12:481. [PMID: 39246586 PMCID: PMC11377934 DOI: 10.12688/f1000research.132580.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2024] [Indexed: 09/10/2024] Open
Abstract
Background Learning to thinking critically about health information and choices can protect people from unnecessary suffering, harm, and resource waste. Earlier work revealed that children can learn these skills, but printing costs and curricula compatibility remain important barriers to school implementation. We aimed to develop a set of digital learning resources for students to think critically about health that were suitable for use in Kenyan, Rwandan, and Ugandan secondary schools. Methods We conducted work in two phases collaborating with teachers, students, schools, and national curriculum development offices using a human-centred design approach. First, we conducted context analyses and an overview of teaching strategies, prioritised content and collected examples. Next, we developed lessons and guidance iteratively, informed by data from user-testing, individual and group interviews, and school pilots. Results Final resources include online lesson plans, teachers' guide, and extra resources, with lesson plans in two modes, for use in a classroom equipped with a blackboard/flip-chart and a projector. The resources are accessible offline for use when electricity or Internet is lacking. Teachers preferred the projector mode, as it provided structure and a focal point for class attention. Feedback was largely positive, with teachers and students appreciating the learning and experiencing it as relevant. Four main challenges included time to teach lessons; incorrect comprehension; identifying suitable examples; and technical, logistical, and behavioural challenges with a student-computer mode that we piloted. We resolved challenges by simplifying and combining lessons; increasing opportunities for review and assessment; developing teacher training materials, creating a searchable set of examples; and deactivating the student-computer mode. Conclusion Using a human-centred design approach, we created digital resources for teaching secondary school students to think critically about health actions and for training teachers. Be smart about your health resources are open access and can be translated or adapted to other settings.
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Affiliation(s)
- Sarah Rosenbaum
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, 0213, Norway
| | - Jenny Moberg
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, 0213, Norway
| | - Faith Chesire
- Tropical Institute of Community Health and Development in Africa, Kisumu, Kenya
- Institute of Health and Society, Faculty of Medicine, Universitetet i Oslo, Oslo, Oslo, Norway
| | - Michael Mugisha
- Institute of Health and Society, Faculty of Medicine, Universitetet i Oslo, Oslo, Oslo, Norway
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Butare, Southern Province, Rwanda
| | - Ronald Ssenyonga
- Institute of Health and Society, Faculty of Medicine, Universitetet i Oslo, Oslo, Oslo, Norway
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
| | - Marlyn A Ochieng
- Tropical Institute of Community Health and Development in Africa, Kisumu, Kenya
| | - Clarisse Marie Claudine Simbi
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Butare, Southern Province, Rwanda
| | - Esther Nakyejwe
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
| | - Benson Ngatia
- Tropical Institute of Community Health and Development in Africa, Kisumu, Kenya
| | - Gabriel Rada
- Epistemonikos Foundation, Santiago, Santiago Metropolitan Region, Chile
| | | | | | - Grace Baguma
- National Curriculum Development Centre, Kampala, Uganda
| | - Sam Kuloba
- Ministry of Education and Sports, Kampala, Uganda
| | | | - Richard Kabanda
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Central Region, Uganda
- Ministry of Health, Kampala, Uganda
| | | | | | | | - Jane Njue
- Kenya Institute of Curriculum Development, Nairobi, Kenya
| | - Cyril Oyuga
- Kenya Institute of Curriculum Development, Nairobi, Kenya
| | | | | | | | - Allen Nsangi
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
| | - Daniel Semakula
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
| | - Margaret Kaseje
- Tropical Institute of Community Health and Development in Africa, Kisumu, Kenya
| | - Nelson Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Central Region, Uganda
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Butare, Southern Province, Rwanda
| | - Simon Lewin
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, 0213, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Andrew D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, 0213, Norway
| | - Matt Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, 0213, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Lyles C, Berrean B, Buenaventura A, Milter S, Hernandez DD, Sarkar U, Gutierrez C, Palmer N, Brown III W. Building a Client Resource and Communication Platform for Community-Based Organizations to Address Health and Social Needs: Co-Design Study. JMIR Hum Factors 2024; 11:e53939. [PMID: 39157908 PMCID: PMC11342060 DOI: 10.2196/53939] [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: 11/07/2023] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 08/20/2024] Open
Abstract
Background Connecting individuals to existing community resources is critical to addressing social needs and improving population health. While there is much ongoing informatics work embedding social needs screening and referrals into health care systems and their electronic health records, there has been less focus on the digital ecosystem and needs of community-based organizations (CBOs) providing or connecting individuals to these resources. Objective We used human-centered design to develop a digital platform for CBOs, focused on identification of health and social resources and communication with their clients. Methods Centered in the Develop phase of the design process, we conducted in-depth interviews in 2 phases with community-based organizational leadership and staff to create and iterate on the platform. We elicited and mapped participant feedback to theory-informed domains from the Technology Acceptance Model, such as Usefulness and Ease of Use, to build the final product and summarized all major design decisions as the platform development proceeded. Results Overall, we completed 22 interviews with 18 community-based organizational leadership and staff in 2 consecutive Develop phases. After coding of the interview transcripts, there were 4 major themes related to usability, relevance, and external factors impacting use. Specifically, CBOs expressed an interest in a customer relationship management software to manage their client interactions and communications, and they needed specific additional features to address the scope of their everyday work, namely (1) digital and SMS text messaging communication with clients and (2) easy ways to identify relevant community resources based on diverse client needs and various program eligibility criteria. Finally, clear implementation needs emerged, such as digital training and support for staff using new platforms. The final platform, titled "Mapping to Enhance the Vitality of Engaged Neighborhoods (MAVEN)," was completed in the Salesforce environment in 2022, and it included features and functions directly mapped to the design process. Conclusions Engaging community organizations in user-centered design of a health and social resource platform was essential to tapping into their deep expertise in serving local communities and neighborhoods. Design methods informed by behavioral theory can be similarly employed in other informatics research. Moving forward, much more work will be necessary to support the implementation of platforms specific to CBOs' needs, especially given the resources, training, and customization needed in these settings.
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Affiliation(s)
- Courtney Lyles
- UC Davis Center for Healthcare Policy and Research, UC Davis School of Medicine, University of California, Davis, Sacramento, CA, United States
| | - Beth Berrean
- Technology Services Unit, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ana Buenaventura
- Technology Services Unit, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Svetlana Milter
- Technology Services Unit, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Dayana Daniel Hernandez
- Technology Services Unit, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Urmimala Sarkar
- Department of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Christian Gutierrez
- Department of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - Nynikka Palmer
- Department of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
| | - William Brown III
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Hayward SE, Vanqa N, Makanda G, Tisile P, Ngwatyu L, Foster I, Mcinziba AA, Biewer A, Mbuyamba R, Galloway M, Bunyula S, van der Westhuizen HM, Friedland JS, Medina-Marino A, Viljoen L, Schoeman I, Hoddinott G, Nathavitharana RR. "As a patient I do not belong to the clinic, I belong to the community": co-developing multi-level, person-centred tuberculosis stigma interventions in Cape Town, South Africa. BMC GLOBAL AND PUBLIC HEALTH 2024; 2:55. [PMID: 39157720 PMCID: PMC11324783 DOI: 10.1186/s44263-024-00084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024]
Abstract
Background Anticipated, internal, and enacted stigma are major barriers to tuberculosis (TB) care engagement and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa. Methods Using a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n = 87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed, and then further interpreted using the socio-ecological model and behaviour change wheel framework. Results Intervention components across socio-ecological levels shared common functions linked to effective behaviour change, namely education, training, enablement, persuasion, modelling, and environmental restructuring. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal and anticipated stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended to decrease enacted stigma. Participants discussed how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers. Conclusions Decreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-led multi-level intervention components should be prioritised by TB programs, including integrated TB/HIV care services. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-024-00084-z.
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Affiliation(s)
- Sally E. Hayward
- Institute for Infection and Immunity, St George’s, University of London, London, UK
- TB Proof, Cape Town, South Africa
| | - Nosivuyile Vanqa
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | | | | | - Abenathi A. Mcinziba
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Amanda Biewer
- Beth Israel Deaconess Medical Center, Boston, MA USA
| | | | | | | | | | - Jon S. Friedland
- Institute for Infection and Immunity, St George’s, University of London, London, UK
| | - Andrew Medina-Marino
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Desmond Tutu Health Foundation, Cape Town, South Africa
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Lario Viljoen
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Graeme Hoddinott
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Ruvandhi R. Nathavitharana
- TB Proof, Cape Town, South Africa
- Beth Israel Deaconess Medical Center, Boston, MA USA
- Harvard Medical School, Boston, MA USA
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Obegu P, Nicholls K, Alberti M. Operational Mechanisms of Peer Support Groups and Support for Caregivers of People Living with Serious Mental Illness. Community Ment Health J 2024:10.1007/s10597-024-01326-y. [PMID: 39093458 DOI: 10.1007/s10597-024-01326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 07/13/2024] [Indexed: 08/04/2024]
Abstract
The challenges faced by caregivers of people living with serious mental illness in Canada are well documented in the literature including emotional distress, financial strain, social isolation, and concerns about their physical health following the impact of caregiving. Peer support programs (including peer support groups) emerged as a promising method to attempt to address these challenges. While there is evidence on the positive impacts of peer support groups in providing support for caregivers, the mechanisms by which peer support groups operate and influence support for caregivers of people living with serious mental illness are less understood. This qualitative study took on a co-designed participatory research approach. Fifteen adult caregivers of people living with serious mental illness across Canada were engaged through key informant interviews that lasted for 45 - 60 min each. A thematic analysis was carried out to help understand the operational mechanisms of peer support groups in influencing support for caregivers. The key informant interviews allowed for the identification and description of the following operational mechanisms that influenced the support caregivers received from peer support groups: (1) Group dynamics; (2) Messaging/content; (3) Equity and inclusion, (4) Group philosophy; and (5) Privacy concerns. Findings from this study showed that caregivers identified a number of operational mechanisms of peer support groups that explained how they felt supported when they participated in peer support groups. Among other operational mechanisms, group dynamics in terms of the gathering of caregivers of different age brackets and varying caregiving experience negatively influenced the peer support experience of caregivers. This pointed to the need for group dynamics that consider close age ranges and similar caregiving experience during group meetings to enhance support for caregivers. Caregivers also identified a gap in equity and inclusion in peer support groups that could have otherwise enriched their experience and enhanced the support they looked to receive from the group. Practical examples to enhance equity and inclusion include promoting active listening, using inclusive language, encouraging diverse representation and asking for feedback from peer support group members. While peer support groups in Canada exist independently of one another, it may help to consolidate evidence-based recommendations in the operational mechanisms of these groups, for the benefit of caregivers who turn to these groups for support, having been left on their own by an otherwise fractured mental health system.
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Affiliation(s)
- Pamela Obegu
- Canadian Institute for Advancements in Mental Health, Toronto, Canada.
| | - Kayla Nicholls
- Canadian Institute for Advancements in Mental Health, Toronto, Canada
| | - Mary Alberti
- Canadian Institute for Advancements in Mental Health, Toronto, Canada
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Haq ZU, Naeem A, Zaeem D, Sohail M, Pervaiz NUA. Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study. JMIRX MED 2024; 5:e48213. [PMID: 39087559 PMCID: PMC11300676 DOI: 10.2196/48213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/12/2024] [Accepted: 04/29/2024] [Indexed: 08/02/2024]
Abstract
Background Primary health care (PHC) is the backbone of universal health coverage, with community health workers (CHWs) being one of its critical pillars in lower-middle-income countries. Most CHW functions require them to be an efficient communicator, but their program development has been deficient in this area. Can IT provide some solutions? Moreover, can some IT-based CHW-delivered innovations help mothers and children in areas not covered by PHC services? We explored these questions during the development and feasibility testing of a digital application designed to improve the communication capacity of CHWs in two underserved areas of Islamabad. Objective This study aims to explore the perceptions, practices, and related gaps about mother and child health, and child development in an underserved area; develop and deploy a behavior change communication program to address the gaps; and assess the feasibility of the program. Methods We carried out a mixed methods study with three steps. First, we conducted 13 in-depth interviews and two focus group discussions with stakeholders to explore the issues faced by mothers living in these underserved areas. To address these barriers, we developed Sehat Ghar, a video-based health education application to demonstrate practices mothers and families needed to adopt. Second, we trained 10 volunteer CHWs from the same community to deliver health education using the application and assessed their pre-post knowledge and skills. Third, these CHWs visited pregnant and lactating mothers in the community with random observation of their work by a supporting supervisor. Results Initial exploration revealed a need for health-related knowledge among mothers and suboptimal utilization of public health care. Sehat Ghar used behavior change techniques, including knowledge transfer, enhancing mothers' self-efficacy, and improving family involvement in mother and child care. Volunteer CHWs were identified from the community, who after the training, showed a significant improvement in mean knowledge score (before: mean 8.00, SD 1.49; after: mean 11.40, SD 1.43; P<.001) about health. During supportive supervision, these CHWs were rated as excellent in their interaction with mothers and excellent or very good in using the application. The CHW and her community reported their satisfaction with the application and wanted its delivery regularly. Conclusions Sehat Ghar is a simple, easy-to-use digital application for CHWs and is acceptable to the community. Mothers appreciate the content and presentation and are ready to incorporate its messages into their daily practices. The real-world effectiveness of the innovation tested on 250 mother-infant pairs will be important for its proof of effectiveness. With its usefulness and adaptability, and the rapidly spreading use of mobile phones and internet technology, this cost-effective innovation can help in delivering health communications at a large scale in a minimum amount of time.
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Affiliation(s)
| | | | | | - Mohina Sohail
- Alliance for Behavioural Communication & Development, Islamabad, Pakistan
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Baumann SE, Rabin MA, Devkota B, Hawk M, Upadhyaya K, Shrestha GR, Joseph B, Burke JG. Centering Communities in Global Health: Using Human-Centered Design to Facilitate Collaboration and Intervention Development. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241264331. [PMID: 39044545 DOI: 10.1177/2752535x241264331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Utilizing iterative and collaborative tools, Human-centered Design (HCD) facilitates the creation of tailored solutions for multifaceted issues by fostering empathy and a deep understanding of human behaviors. This paper presents insights gleaned from employing HCD tools to center communities in global health intervention development. PURPOSE The study team collaborated with community members in Dailekh, Nepal to co-design interventions to address harms associated with menstrual seclusion, known as chhaupadi. RESEARCH DESIGN AND STUDY SAMPLE A Community Design Team, comprising 10 women representing various castes and ages convened for a four-day intervention co-design workshop in the community. A Community Validation Team, comprising 12 individuals from diverse occupational and caste backgrounds provided feedback on the interventions. Additionally, six village leaders participated in Key Informant Interviews to garner additional insights. DATA COLLECTION In the study's initial "discovery" phase, the Community Design Team employed HCD tools to generate a nuanced understanding of the context, stakeholders, and community experiences. Subsequently, in the second "design" phase, the Community Design Team crafted interventions to address harms associated with chhaupadi. RESULTS Invaluable lessons gained from this study underscore the necessity of crafting contextually suitable tools, checklists, and prompts for participants, allocating sufficient staff, time, and resources, and adapting to participants' literacy levels and engagement preferences, whether through group or individual activities. CONCLUSIONS Reflecting on these insights, our experience suggests HCD offers promising tools to authentically and equitably involve participants with diverse backgrounds in articulating their own ideas for community-based solutions in Nepal. Health practitioners, researchers, and intervention development experts are encouraged to consider adopting HCD methodologies to prioritize community voices in devising solutions for complex health challenges.
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Affiliation(s)
- Sara E Baumann
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Megan A Rabin
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bhimsen Devkota
- Faculty of Health Education, Tribhuvan University, Kirtipur, Nepal
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Brigit Joseph
- Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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8
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Romero V, Donaldson H. Human-centred design thinking and public health education: A scoping review. Health Promot J Austr 2024; 35:688-700. [PMID: 37643841 DOI: 10.1002/hpja.802] [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: 06/15/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
ISSUE ADDRESSED Human-centred design thinking (HCDT) is gaining traction to develop appropriate public health interventions. The HCDT process helps frame problems with intention and encourages experimentation through collaboration. Public health graduates need an expanded toolkit to solve both the complex known problems of today, and the adaptability to solve the unknown problems of tomorrow. But how is the health promotion workforce being prepared with this innovation capability? This scoping review aims to provide a pedagogical understanding of teaching HCDT in public health education. METHODS The Arksey & O'Malley framework is used to structure this review. Peer-reviewed articles written from 2000 to 2023 across eight databases were analysed. The data extracted included: author/year, setting, aim/purpose, participants, HCDT framework, HCDT methods, outcomes and challenges. RESULTS Nine relevant publications were included from a total of 208 records. The first reported use of HCDT in public health and health promotion teaching was in 2015. Teaching inspiration drew from established HCDT frameworks: d.school and IDEO which promote the iterative process of empathy/inspiration, ideation and testing/implementation. CONCLUSIONS HCDT has been used for both designing public health curricula and for teaching students to apply it in their practice. First, HCDT methods can be used to problem-solve teaching and learning issues such as creating inviting learning environments and designing an HCDT unit. Second, the teaching of HCDT can prepare and equip the public health workforce to solve problems requiring tailored solutions from an empathetic and iterative stance working as a team. The teaching and practice of HCDT exemplifies the process of social innovation in health promotion. SO WHAT?: As an emerging field, future studies and applications should include clarifying and evaluating the HCDT stages used. More publications will enable a fuller understanding and potentially advocate the necessity of teaching and learning HCDT in public health and health promotion.
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Affiliation(s)
- Vivian Romero
- Central Queensland University, Melbourne, Victoria, Australia
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Yu K, Jiang H, Liu M, Wu S, Jordan-Marsh M, Chi I. Chinese Immigrant Caregivers: Understanding Their Unmet Needs and the Co-Design of an mHealth App. Can J Aging 2024:1-8. [PMID: 38757195 DOI: 10.1017/s0714980824000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Immigrant caregivers support the aging population, yet their own needs are often neglected. Mobile technology-facilitated interventions can promote caregiver health by providing easy access to self-care materials. OBJECTIVE This study employed a design thinking framework to examine Chinese immigrant caregivers' (CICs) unmet self-care needs and co-design an app for promoting self-care with CICs. METHODS Nineteen semi-structured interviews were conducted in conceptual design and prototype co-design phases. FINDINGS Participants reported unmet self-care needs influenced by psychological and social barriers, immigrant status, and caregiving tasks. They expressed the need to learn to keep healthy boundaries with the care recipient and respond to emergencies. Gaining knowledge was the main benefit that drew CICs' interest in using the self-care app. However, potential barriers to use included issues of curriculum design, technology anxiety, limited free time, and caregiving burdens. DISCUSSION The co-design process appears to be beneficial in having participants voice both barriers and preferences.
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Affiliation(s)
- Kexin Yu
- NIA-Layton Aging and Alzheimer's Disease Center, and Oregon Center for Aging & Technology, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
| | - Haojun Jiang
- Tourism and Social Administration College, Nanjing Xiaozhuang University, Nanjing, China
| | - Mandong Liu
- Research Institute of Social Development, Southwestern University of Finance and Economics, Sichuan, China
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
- Daniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Maryalice Jordan-Marsh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA, USA
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Turuba R, Katan C, Marchand K, Brasset C, Ewert A, Tallon C, Fairbank J, Mathias S, Barbic S. Weaving community-based participatory research and co-design to improve opioid use treatments and services for youth, caregivers, and service providers. PLoS One 2024; 19:e0297532. [PMID: 38635804 PMCID: PMC11025903 DOI: 10.1371/journal.pone.0297532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/30/2023] [Indexed: 04/20/2024] Open
Abstract
Integrating the voices of service users and providers in the design and delivery of health services increases the acceptability, relevance, and effectiveness of services. Such efforts are particularly important for youth opioid use treatments and services, which have failed to consider the unique needs of youth and families. Applying community-based participatory research (CBPR) and co-design can facilitate this process by contextualizing service user experiences at individual and community levels and supporting the collaborative design of innovative solutions for improving care. However, few studies demonstrate how to effectively integrate these methods and engage underserved populations in co-design. As such, this manuscript describes how our team wove CBPR and co-design methods to develop solutions for improving youth opioid use treatments and services in Canada. As per CBPR methods, national, provincial, and community partnerships were established to inform and support the project's activities. These partnerships were integral for recruiting service users (i.e., youth and caregivers) and service providers to co-design prototypes and support local testing and implementation. Co-design methods enabled understanding of the needs and experiences of youth, caregivers, and service providers, resulting in meaningful community-specific innovations. We used several engagement methods during the co-design process, including regular working group meetings, small group discussions, individual interviews and consultations, and feedback grids. Challenges involved the time commitment and resources needed for co-design, which were exacerbated by the COVID-19 pandemic and limited our ability to engage a diverse sample of youth and caregivers in the process. Strengths of the study included youth and caregiver involvement in the co-design process, which centered around their lived experiences; the therapeutic aspect of the process for participants; and the development of innovations that were accepted by design partners.
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Affiliation(s)
- Roxanne Turuba
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Kirsten Marchand
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | | | - Alayna Ewert
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Corinne Tallon
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Steve Mathias
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
- Providence Research, Vancouver, British Columbia, Canada
| | - Skye Barbic
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Providence Research, Vancouver, British Columbia, Canada
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11
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Tegbe M, Moon K, Nawaz S. Re-envisioning contributory health schemes to achieve equity in the design of financial protection mechanisms in low- and middle-income countries. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae044. [PMID: 38756182 PMCID: PMC11057020 DOI: 10.1093/haschl/qxae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/18/2024]
Abstract
Universal health coverage has emerged as a global health priority, requiring that financing strategies that ensure low-income and medically and financially at-risk individuals can access health services without the threat of financial catastrophe. Contributory financing schemes and social health insurance (SHI) schemes, in particular, predominate in low- and middle-income countries (LMICs), despite evidence that suggests the most vulnerable remain excluded from such schemes. In this commentary, we discuss the need to re-envision schemes to prioritize equity, offering 3 concrete recommendations: adopt participatory designs for the co-design of schemes with beneficiaries, establish linkages between contributory financial protection schemes with economic empowerment initiatives, and prioritize the needs and preferences of beneficiaries over political expediency. Co-design alone does not necessarily translate into more equitable schemes, underscoring the need for greater monitoring and evaluation of these schemes that consider differential impacts across contexts and subgroups. In doing so, SHI schemes can be both attractive and accessible to populations that have long been excluded from financial protections in LMICs, acting as 1 channel in a broader financing strategy to achieve universal health coverage.
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Affiliation(s)
- Muyiwa Tegbe
- Primary Health Care Program, PATH, Seattle, WA 98121, United States
| | - Kyle Moon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Saira Nawaz
- Primary Health Care Program, PATH, Seattle, WA 98121, United States
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12
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Tieosapjaroen W, Chen E, Ritchwood T, Li C, Conklin JL, Babatunde AO, Ongkeko AM, Nwaozuru U, Tucker JD, Castillo Carandang NT, Ong JJ. Designathons in health research: a global systematic review. BMJ Glob Health 2024; 9:e013961. [PMID: 38453248 PMCID: PMC10921519 DOI: 10.1136/bmjgh-2023-013961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION A designathon is a three-stage participatory activity informed by design thinking. There is a growing literature on designathons in health. This study synthesised designathons' effectiveness and implementation-related factors to address health challenges. METHODS We searched Cochrane Library, Embase, PubMed, Scopus and the ClinicalTrials.gov registry for articles containing primary data on designathons for health from their dates of inception to 29 November 2022. We retrieved additional studies from citation searching and a complementary open call. We synthesised data on designathons' effectiveness (ie, engagement, outputs and implementation), required resources and implementation-related factors (ie, resources, facilitators, barriers, strengths and limitations). We assessed the risk of bias using a checklist adapted from Joanna Briggs Institute Critical Appraisal tools. RESULTS In total, 4973 citations were identified, and 42 studies were included. In total, 26 studies (62%) were from high-income countries. The median number of total participants was 49, divided into a median of 8 teams. The duration of the intensive collaboration phase ranged from 3 hours to 7 days. Common evaluation criteria were feasibility, innovation and impact. Idea and prototype outputs included mobile phone applications, educational programmes and medical devices. Interventions developed from a designathon was estimated to be highly cost-effective. The most common facilitators were interdisciplinary participants and high-quality mentorship. The most common barriers were suboptimal execution of the events, difficulties in balancing interdisciplinary participants across teams and limited support for participants along the process. There were limited data on required resources and further implementation of solutions after designathons. CONCLUSION Given designathons' adaptability in terms of budget, mode of delivery, type of output and involvement of diverse participants, including end users, designathons can be implemented in a wide range of contexts to address various health issues. PROSPERO REGISTRATION NUMBER CRD42023389685.
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Affiliation(s)
- Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth Chen
- Department of Health Behavior, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tiarney Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chunyan Li
- Tokyo College, The University of Tokyo, Tokyo, Japan
| | - Jamie L Conklin
- Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Arturo M Ongkeko
- National Institutes of Health, University of the Philippines Manila, Manila, The Philippines
- Foundation for the Advancement of Clinical Epidemiology Inc, Manila, The Philippines
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Nina T Castillo Carandang
- Foundation for the Advancement of Clinical Epidemiology Inc, Manila, The Philippines
- Department of Clinical Epidemiology, University of the Philippines Manila, Manila, The Philippines
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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13
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Kelley JC, Tsai JHC. Protecting Outdoor Workers From Climate Change Impacts Through Interdisciplinary Collaboration. Workplace Health Saf 2024; 72:119. [PMID: 38149642 DOI: 10.1177/21650799231221136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
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Tshuma N, Elakpa DN, Moyo C, Soboyisi M, Moyo S, Mpofu S, Chadyiwa M, Malahlela M, Tiba C, Mnkandla D, Ndhlovu TM, Moruthoane T, Mphuthi DD, Mtapuri O. The Transformative Impact of Community-Led Monitoring in the South African Health System: A Comprehensive Analysis. Int J Public Health 2024; 69:1606591. [PMID: 38420516 PMCID: PMC10899425 DOI: 10.3389/ijph.2024.1606591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Objectives: Community-led monitoring (CLM) is an emerging approach that empowers local communities to actively participate in data collection and decision-making processes within the health system. The research aimed to explore stakeholder perceptions of CLM data and establish a CLM Data Value Chain, covering data collection and its impact. Methods: Qualitative data were collected from stakeholders engaged in health programs in South Africa. Data analysis involved a collaborative workshop that integrated elements of affinity diagramming, thematic analysis, and the systematic coding process outlined in Giorgi's method. The workshop fostered joint identification, co-creation of knowledge, and collaborative analysis in developing the data value chain. Results: The findings showed that CLM data enabled community-level analysis, fostering program advocacy and local collaboration. It enhanced program redesign, operational efficiency, and rapid response capabilities. Context-specific solutions emerged through the CLM Data Value Chain, promoting sustainable and efficient program implementation. Conclusion: CLM is a powerful tool for improving program implementation, quality, and advocacy in South African healthcare. It strengthens accountability, trust, and transparency by involving local communities in data-driven decision-making. CLM addresses context-specific challenges and tailors interventions to local needs.
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Affiliation(s)
| | - Daniel Ngbede Elakpa
- The Best Health Solutions, Johannesburg, South Africa
- Center for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clinton Moyo
- The Best Health Solutions, Johannesburg, South Africa
| | - Melikhaya Soboyisi
- Networking HIV and AIDS Community of Southern Africa (NACOSA), Gauteng, South Africa
| | - Sehlule Moyo
- The Best Health Solutions, Johannesburg, South Africa
| | | | - Martha Chadyiwa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | | | | | - David Mnkandla
- Networking HIV and AIDS Community of Southern Africa (NACOSA), Gauteng, South Africa
| | | | | | - David D. Mphuthi
- College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Oliver Mtapuri
- School of Built Environment and Development Studies, College of Humanities, University of KwaZulu-Natal, Durban, South Africa
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15
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Hayward SE, Vanqa N, Makanda G, Tisile P, Ngwatyu L, Foster I, Mcinziba A, Biewer A, Mbuyamba R, Galloway M, Bunyula S, Westhuizen HM, Friedland JS, Marino-Medina A, Viljoen L, Schoeman I, Hoddinott G, Nathavitharana RR. "As a patient I do not belong to the clinic, I belong to the community." Co-developing a multi-level, person-centred tuberculosis stigma intervention in Cape Town, South Africa. RESEARCH SQUARE 2024:rs.3.rs-3921970. [PMID: 38405783 PMCID: PMC10889064 DOI: 10.21203/rs.3.rs-3921970/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Anticipated, internal, and enacted stigma are major barriers to TB care engagement, and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa. Methods Using a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n=87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed and then further interpreted using the socio-ecological model. Results Intervention components across socio-ecological levels shared common behaviour change strategies, namely education, empowerment, engagement, and innovation. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended. Consideration of how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested to decrease anticipated and enacted stigma. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers. Conclusions Decreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-informed intervention components should be prioritised by TB programs, including integrated TB/HIV care services.
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Affiliation(s)
| | | | | | | | | | | | | | - Amanda Biewer
- Beth Israel Deaconess Medical Center, Harvard Medical School
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Aflatoony L, Hepburn K, Perkins MM. From Empathy to Action: Design Thinking as a Catalyst for Community-Based Participatory Research in Dementia Caregiving. DESIGN FOR HEALTH (ABINGDON, ENGLAND) 2024; 8:24-45. [PMID: 39036349 PMCID: PMC11257414 DOI: 10.1080/24735132.2024.2307225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/11/2024] [Indexed: 07/23/2024]
Abstract
This article delves into the understudied realm of investigating the potential benefits of integrating design thinking into community-based participatory research within the context of culturally diverse dementia caregivers. Following the Double-Diamond process model, we conducted a series of workshops with 15 family caregivers of dementia patients from three distinct communities (multi-racial, Black, and Latino ethnicity) to gain insights into their daily experiences and co-create interventions that could address their pressing challenges. The research question for this study aimed to explore the potential benefits of design thinking in community-based research on dementia caregiving. Our findings contribute to the health design community by demonstrating the potential of design thinking to 1) uncover common and distinct challenges in diverse communities, 2) translate findings into actionable solutions, and 3) design tailored interventions that are responsive to the context-specific needs of the community. Our study leads us to conclude that the integration of design thinking as a catalyst in community-based participatory research has the potential to amplify the identification of nuanced and previously unexamined challenges through empathetic exploration, and to propose innovative interventions that are more amenable to uptake and acceptance within the community.
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Affiliation(s)
- Leila Aflatoony
- Georgia Institute of Technology, Industrial Design, Atlanta, USA
| | - Kenneth Hepburn
- Emory University Woodruff Health Sciences Center, Nell Hodgson Woodruff School of Nursing, Atlanta, USA
| | - Molly M. Perkins
- Emory University School of Medicine, Division of Geriatric Medicine and Gerontology, Atlanta, USA
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17
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Straand IJ, Følstad A, Bjørnestad JR. Exploring a Gaming-Based Intervention for Unemployed Young Adults: Thematic Analysis. JMIR Hum Factors 2024; 11:e44423. [PMID: 38236624 PMCID: PMC10835587 DOI: 10.2196/44423] [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: 11/18/2022] [Revised: 09/02/2023] [Accepted: 11/20/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Promoting positive psychologies that promote resilience such as a growth mindset could be beneficial for young, unemployed adults, as many lack the self-esteem and self-efficacy to cope with job search adversity. These young people may be reached at scale through the web-based delivery of self-administered positive psychology interventions. However, past studies report unsatisfying user experiences and a lack of user engagement. A gaming-based experience could be an approach to overcoming these challenges. OBJECTIVE Our research objective was to explore how young, unemployed adults experience a positive psychology intervention designed as a game to extract learning and principles for future intervention research and development. METHODS To respond to the research question, a team of researchers at the University of Stavanger worked with designers and developers to conceptualize and build a gaming-based intervention. Feedback from the users was collected through formative usability testing with 18 young adults in the target group. Retrospectively, recordings and notes were transcribed and subjected to thematic analysis to extract learnings for the purposes of this paper. RESULTS A total of 3 themes were identified that pinpoint what we consider to be key priorities for future gaming interventions for unemployed young adults: adaptation to user preferences (eg, need for responding to user preferences), empathic player interaction (eg, need for responsiveness to user inputs and a diverse set of interaction modes), and sensemaking of experience and context (eg, need for explicit presentation of game objectives and need for management of user expectations related to genre). CONCLUSIONS Feedback from end users in usability-testing sessions was vital to understanding user preferences and needs, as well as to inform ongoing intervention design and development. Our study also shows that game design could make interventions more entertaining and engaging but may distort the intervention if the game narrative is not properly aligned with the intervention intent and objectives. By contrast, a lack of adaptation to user needs may cause a less motivating user experience. Thus, we propose a structured approach to promote alignment between user preferences and needs, intervention objectives, and gameplay.
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Affiliation(s)
| | - Asbjørn Følstad
- Department of Sustainable Communication Technologies, SINTEF Digital, Oslo, Norway
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18
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Stransky ML, Bremer-Kamens M, Bair-Merritt M, Howard C, Brooks C, Meill A, Morris A, Sheldrick RC. Conceptualizations of health, ability to act upon those definitions and desire for supports among families from historically marginalized communities. Child Care Health Dev 2024; 50:e13214. [PMID: 38062906 DOI: 10.1111/cch.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/25/2024]
Abstract
Respect for parents' values and clinician-parent collaboration is less common among families from historically marginalized communities. We investigated how parents from marginalized communities operationalize health and their preferences for paediatric primary care. We recruited families who spoke English, Haitian Creole or Spanish with at least one child younger than 6 years old. Staff queried families' values and life experiences, perspectives on health and healthcare, social supports and resources. Fourteen interviews with the parents of 26 children were thematically analysed. Interviews revealed the following four themes: (1) parents' definitions of 'health' extend beyond physical health; (2) families' ability to actuate health definitions is complicated by poverty's impact on agency; (3) parents engage in ongoing problem recognition and identify solutions, but enacting solutions can be derailed by barriers and (4) parents want support from professionals and peers who acknowledged the hard work of parenting. Eliciting parents' multidimensional conceptualizations of health can support families' goal achievement and concern identification in the context of isolation, limited agency and few resources. Efforts to improve family centred care and reduce disparities in paediatric primary care must be responsive to the strengths, challenges, resources and priorities of marginalized families.
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Affiliation(s)
- Michelle L Stransky
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Miriam Bremer-Kamens
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
| | - Megan Bair-Merritt
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
- Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | | | | | - Anita Morris
- Center for the Urban Child and Healthy Family, Boston Medical Center, Boston, MA, USA
| | - R Christopher Sheldrick
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Salib Y, Amodei J, Sanchez C, Castillo Smyntek XA, Lien M, Liu S, Acharya G, Kihumbu B, Mishra P, Chaves-Gnecco D, Timsina K, Diaz J, Henry C, Mickievicz E, Mwaliya A, Ho K, Sidani J, Ragavan MI. The COVID-19 vaccination experience of non-English speaking immigrant and refugee communities of color: A community co-created study. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:177-188. [PMID: 36283968 PMCID: PMC9597283 DOI: 10.1177/2752535x221133140] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this community-partnered study we conducted focus groups with non-English speaking immigrant and refugee communities of color in 4 languages to understand their perspectives on COVID-19 vaccines, barriers to accessing vaccines, and recommendations for healthcare providers. We used a mixed deductive-inductive thematic analysis approach and human centered design to guide data analysis. 66 individuals participated; 85% were vaccinated. The vaccination experience was often positive; however, participants described language inaccessibility, often relying on family members for interpretation. Community-based organizations played a role in connecting participants to vaccines. Unvaccinated participants expressed fear of side effects and belief in natural immunity. Participants shared recommendations to providers around increasing vaccine access, improving language accessibility, and building trust. Results from our study show numerous barriers immigrant and refugee communities of color faced getting their COVID-19 vaccine, but also highlights opportunities to engage with community partners. Future implications for research, policy, and practice are described.
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Affiliation(s)
- Yesmina Salib
- Jewish Family Community Services, Pittsburgh, PA, USA
| | - Joseph Amodei
- Division of Immersive Media, Chatham University, Pittsburgh, PA, USA
| | | | | | - Marian Lien
- OCA Asian Pacific American Advocates--Pittsburgh Chapter, Pittsburgh, PA, USA
| | | | - Geeta Acharya
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Pralad Mishra
- Jewish Family Community Services, Pittsburgh, PA, USA
| | - Diego Chaves-Gnecco
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Pittsburgh, PA, USA
| | - Khara Timsina
- Bhutanese Community Association of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Erin Mickievicz
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Pittsburgh, PA, USA
| | - Aweys Mwaliya
- Somali Bantu Community Association of Pittsburgh, Pittsburgh, PA, USA
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jaime Sidani
- Department of Behavioral and Community Health Sciences, University of PittsburghSchool of Public Health, Pittsburgh, PA, USA
| | - Maya I Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Pittsburgh, PA, USA
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Chavez-Rimache L, Ugarte-Gil C, Brunette MJ. The community as an active part in the implementation of interventions for the prevention and care of tuberculosis: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001482. [PMID: 38100540 PMCID: PMC10723726 DOI: 10.1371/journal.pgph.0001482] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 10/19/2023] [Indexed: 12/17/2023]
Abstract
Interventions involving direct community stakeholders include a variety of approaches in which members take an active role in improving their health. We evaluated studies in which the community has actively participated to strengthen tuberculosis prevention and care programs. A literature search was performed in Pubmed, Scopus, ERIC, Global Index Medicus, Scielo, Cochrane Library, LILACS, Google Scholar, speciality journals, and other bibliographic references. The primary question for this review was: ¿what is known about tuberculosis control interventions and programs in which the community has been an active part?. Two reviewers performed the search, screening, and selection of studies independently. In cases of discrepancies over the eligibility of an article, it was resolved by consensus. 130 studies were selected, of which 68.47% (n = 89/130) were published after 2010. The studies were conducted in Africa (44.62%), the Americas (22.31%) and Southeast Asia (19.23%). It was found that 20% (n = 26/130) of the studies evaluated the participation of the community in the detection/active search of cases, 20.77% (n = 27/130) in the promotion/prevention of tuberculosis; 23.07% (n = 30/130) in identifying barriers to treatment, 46.15% (n = 60/130) in supervision during treatment and 3.08% (n = 4/130) in social support for patient. Community participation not only strengthens the capacities of health systems for the prevention and care of tuberculosis, but also allows a better understanding of the disease from the perspective of the patient and the affected community by identifying barriers and difficulties through of the tuberculosis care cascade. Engaging key community stakeholders in co-creating solutions offers a critical pathway for local governments to eradicate TB.
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Affiliation(s)
- Lesly Chavez-Rimache
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Perú
| | - César Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Perú
- School of Medicine, Universidad Peruana Cayetano Heredia, San Martín de Porres, Perú
| | - Maria J. Brunette
- School of Medicine, Universidad Peruana Cayetano Heredia, San Martín de Porres, Perú
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States of America
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Dumitriu D, Lavallée A, Riggs JL, Frosch CA, Barker TV, Best DL, Blasingame B, Bushar J, Charlot-Swilley D, Erickson E, Finkel MA, Fortune B, Gillen L, Martinez M, Ramachandran U, Sanders LM, Willis DW, Shearman N. Advancing early relational health: a collaborative exploration of a research agenda. Front Pediatr 2023; 11:1259022. [PMID: 38143537 PMCID: PMC10748603 DOI: 10.3389/fped.2023.1259022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023] Open
Abstract
Here, we introduce the Early Relational Health (ERH) Learning Community's bold, large-scale, collaborative, data-driven and practice-informed research agenda focused on furthering our mechanistic understanding of ERH and identifying feasible and effective practices for making ERH promotion a routine and integrated component of pediatric primary care. The ERH Learning Community, formed by a team of parent/caregiver leaders, pediatric care clinicians, researchers, and early childhood development specialists, is a workgroup of Nurture Connection-a hub geared toward promoting ERH, i.e., the positive and nurturing relationship between young children and their parent(s)/caregiver(s), in families and communities nationwide. In response to the current child mental health crisis and the American Academy of Pediatrics (AAP) policy statement promoting ERH, the ERH Learning Community held an in-person meeting at the AAP national headquarters in December 2022 where members collaboratively designed an integrated research agenda to advance ERH. This agenda weaves together community partners, clinicians, and academics, melding the principles of participatory engagement and human-centered design, such as early engagement, co-design, iterative feedback, and cultural humility. Here, we present gaps in the ERH literature that prompted this initiative and the co-design activity that led to this novel and iterative community-focused research agenda, with parents/caregivers at the core, and in close collaboration with pediatric clinicians for real-world promotion of ERH in the pediatric primary care setting.
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Affiliation(s)
- Dani Dumitriu
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, United States
- Division of Developmental Neuroscience, Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Andréane Lavallée
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, United States
| | - Jessica L. Riggs
- Department of Psychiatry, The University of Michigan, Ann Arbor, MI, United States
| | - Cynthia A. Frosch
- Department of Human Development and Family Science, Auburn University, Auburn, AL, United States
| | - Tyson V. Barker
- Science and Innovation Strategy, Institute for Child Success, Greenville, SC, United States
| | - Debra L. Best
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, Duke University School of Medicine, Durham, NC, United States
| | | | - Jessica Bushar
- HealthySteps, ZERO TO THREE, Washington, DC, United States
| | | | - Elizabeth Erickson
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, Duke University School of Medicine, Durham, NC, United States
| | - Morgan A. Finkel
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, United States
| | - Bryn Fortune
- Fortune Consulting, Early Relational Health-Family Network Collaborative, Royal Oak, MI, United States
| | - Leah Gillen
- Department of Research and Innovation, Reach out and Read, Boston, MA, United States
| | - Marty Martinez
- Chief Executive Officer, Reach Out and Read, Boston, MA, United States
| | - Usha Ramachandran
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, United States
| | - Lee M. Sanders
- Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - David W. Willis
- Center for the Study of Social Policy, Washington, DC, United States
| | - Nikki Shearman
- Department of Research and Innovation, Reach out and Read, Boston, MA, United States
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Pike JM, Haberlin-Pittz KM, Alharbi BS, Perkins SM, Hannon TS. A co-designed, community-based intensive health behavior intervention promotes participation and engagement in youth with risk factors for type 2 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1264312. [PMID: 38108040 PMCID: PMC10722280 DOI: 10.3389/fcdhc.2023.1264312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/31/2023] [Indexed: 12/19/2023]
Abstract
Background Obesity among youth (children and adolescents) is associated with increased risk for youth-onset type 2 diabetes. Lifestyle change can delay or prevent the development of type 2 diabetes, yet real-world implementation of health behavior recommendations is challenging. We previously engaged youth with risk factors for type 2 diabetes, their caregivers, and professionals in a human-centered design study to co-design a lifestyle change program. Here we report the outcomes for this 16-week co-designed lifestyle change program for youth at risk for T2D and their caregivers. Research design and methods This single-arm family-based cohort study included youth aged 7-18 years, with BMI ≥85th percentile (overweight or obese) and at least one additional risk factor for type 2 diabetes, and their caregivers. Clinical (BMI, HbA1c), self-reported physical activity, and quality of life outcomes were evaluated at baseline (B), post-intervention (M4), and 1 year (M12) following the intervention. Results Seventy-eight youth (mean age 12.4 ± 2.7y, 67% female, 37.8% white) and 65 caregivers were included in the data analysis. Youth baseline BMI z-scores (2.26 ± 0.47) and HbA1c (5.3 ± 0.3) were unchanged at follow up time points [BMI z-scores M4 (2.25 ± 0.52), M12 (2.16 ± 0.58), p-value 0.46], [HbA1c M4 (5.3 ± 0.3), M12 (5.2 ± 0.3), p-value (0.04)]. Youth reported increased physical activity at M4 (p = 0.004), but not at M12. Youth quality of life scores increased at M12 (p=0.01). Families who attended at least one session (n=41) attended an average of 9 out of 16 sessions, and 37 percent of families attended 13 or more sessions. Conclusion A co-designed, community-based lifestyle intervention promotes increased physical activity, improved quality of life, maintenance of BMI z-scores and HbA1c, and engagement in youth with risk factors for T2D.
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Affiliation(s)
- Julie M. Pike
- Department of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Pediatric Endocrinology, Riley Children’s Health, Indiana University Health, Indianapolis, IN, United States
| | - Kathryn M. Haberlin-Pittz
- Department of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Pediatric Endocrinology, Riley Children’s Health, Indiana University Health, Indianapolis, IN, United States
| | - Basmah S. Alharbi
- Department of Biostatistics and Health Data Science, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States
| | - Susan M. Perkins
- Department of Biostatistics and Health Data Science, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tamara S. Hannon
- Department of Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
- Department of Pediatric Endocrinology, Riley Children’s Health, Indiana University Health, Indianapolis, IN, United States
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Leos C, Chen E, Jagannathan V. Using Human-Centered Design Strategies to Identify Unmet Adolescent Sexual Health Wants and Needs. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:174-184. [PMID: 37351667 PMCID: PMC10764404 DOI: 10.1007/s11121-023-01559-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
This paper describes a human-centered design approach to investigate unmet adolescent sexual health wants and needs among youth of color in low-income and rural communities in Texas, North Carolina, and Connecticut (n = 149). The approach involved gathering qualitative data through in-depth interviews and other human-centered design activities between April 2016 and August 2016. Data were analyzed using thematic content analysis after each round of data collection. Themes were triangulated across multiple data sources to identify key insights. Results highlighted several important unmet wants and needs. Participants shared that schools were not the preferred place to learn about sexual health and healthy relationships, due to uncomfortable and sometimes even hostile environments. When discussing the potential to use internet- and technology-based sexual health resources, participants expressed concerns over privacy, safety, and credibility of information available. Similarly, participants preferred mobile apps over websites due to the privacy of the experience. Most importantly, key emotions impacting adolescents' access to and use of sexual health resources were identified. Results indicated a preference for consuming story-based information in a text message format that described diverse experiences related to sexual health topics. Together, these findings led to the development of an innovative, mobile health intervention for adolescents, the Real Talk mobile app. This human-centered approach can support researchers and practitioners in strengthening intervention development efforts to improve the reach, adoption, and implementation of sexual health interventions.
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Affiliation(s)
| | - Elizabeth Chen
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
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Schwab J, Wachinger J, Munana R, Nabiryo M, Sekitoleko I, Cazier J, Ingenhoff R, Favaretti C, Subramonia Pillai V, Weswa I, Wafula J, Emmrich JV, Bärnighausen T, Knauf F, Knauss S, Nalwadda CK, Sudharsanan N, Kalyesubula R, McMahon SA. Design Research to Embed mHealth into a Community-Led Blood Pressure Management System in Uganda: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46614. [PMID: 38032702 PMCID: PMC10722357 DOI: 10.2196/46614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Uncontrolled hypertension is a leading risk factor for cardiovascular diseases. In Uganda, such diseases account for approximately 10% of all deaths, with 1 in 5 adults having hypertension (>90% of the hypertensive cases are uncontrolled). Although basic health care in the country is available free of cost at government facilities, regularly accessing medication to control hypertension is difficult because supply chain challenges impede availability. Clients therefore frequently suspend treatment or buy medication individually at private facilities or pharmacies (incurring significant costs). In recent years, mobile health (mHealth) interventions have shown increasing potential in addressing health system challenges in sub-Saharan Africa, but the acceptability, feasibility, and uptake conditions of mobile money approaches to chronic disease management remain understudied. OBJECTIVE This study aims to design and pilot-test a mobile money-based intervention to increase the availability of antihypertensive medication and lower clients' out-of-pocket payments. We will build on existing local approaches and assess the acceptability, feasibility, and uptake of the designed intervention. Furthermore, rather than entering the study setting with a ready-made intervention, this research will place emphasis on gathering applied ethnographic insights early, which can then inform the parameters of the intervention prototype and concurrent trial. METHODS We will conduct a mixed methods study following a human-centered design approach. We will begin by conducting extensive qualitative research with a range of stakeholders (clients; health care providers; religious, cultural, and community leaders; academics; and policy makers at district and national levels) on their perceptions of hypertension management, money-saving systems, and mobile money in the context of health care. Our results will inform the design, iterative adaptation, and implementation of an mHealth-facilitated pooled financing intervention prototype. At study conclusion, the finalized prototype will be evaluated quantitatively via a randomized controlled trial. RESULTS As of August 2023, qualitative data collection, which started in November 2022, is ongoing, with data analysis of the first qualitative interviews underway to inform platform and implementation design. Recruitment for the quantitative part of this study began in August 2023. CONCLUSIONS Our results aim to inform the ongoing discourse on novel and sustainable pathways to facilitate access to medication for the management of hypertension in resource-constrained settings. TRIAL REGISTRATION German registry of clinical trials DRKS00030922; https://drks.de/search/en/trial/DRKS00030922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46614.
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Affiliation(s)
- Josephine Schwab
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Richard Munana
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | - Maxencia Nabiryo
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Sekitoleko
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | | | - Rebecca Ingenhoff
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Caterina Favaretti
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Vasanthi Subramonia Pillai
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | - John Wafula
- African Community Center for Social Sustainability, Nakaseke District, Uganda
| | - Julius Valentin Emmrich
- mTOMADY gGmbh, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, United States
| | - Samuel Knauss
- mTOMADY gGmbh, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christine K Nalwadda
- Department of Community Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke District, Uganda
- Department of Physiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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Castle N, Kunwar S, Khanal L, Oot L, Elkes K, Shrestha S, Joshi A, Rai P, Bhattarai S, Karmacharya BM. Using the Journey to Health and Immunization (JTHI) Framework to Engage Stakeholders in Identifying Behavioral and Social Drivers of Routine Immunization in Nepal. Vaccines (Basel) 2023; 11:1709. [PMID: 38006041 PMCID: PMC10675610 DOI: 10.3390/vaccines11111709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
Although the Government of Nepal has achieved high and sustained childhood vaccination coverage, reaching under-immunized and zero-dose children requires different approaches. Behavioral science offers promise in better understanding the drivers of vaccination and development of more effective programs; however, the application of behavioral science to immunization programs in Nepal is nascent. Through the Behavioral Science Immunization Network, JSI, UNICEF Nepal, and Dhulikhel Hospital-Kathmandu University School of Medical Sciences established a Behavioral Science Center to engage a diverse group of stakeholders in increasing the capacity of practitioners to use behavioral science in immunization programming. As a result of the engagement during formative research, government stakeholders requested and applied tools from behavioral science to solve different immunization challenges. Of particular value was the use of the Journey to Health and Immunization framework, which helped stakeholders identify behavioral and social drivers of zero-dose communities in Kathmandu. Our experience in Nepal demonstrates that there is strong demand for approaches and tools from behavioral science to use in relation to immunization and that this type of engagement model is effective for generating demand for and strengthening capacity to use behavioral science approaches.
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Affiliation(s)
- Nicole Castle
- JSI Research & Training Institute, Inc., 2733 Crystal Drive, 4th Floor, Arlington, VA 22202, USA; (L.O.); (K.E.)
| | - Surakshya Kunwar
- Department of Public Health, Dhulikhel Hospital-Kathmandu University School of Medical Sciences, Dhulikhel 45200, Nepal; (A.J.); (P.R.); (B.M.K.)
| | | | - Lisa Oot
- JSI Research & Training Institute, Inc., 2733 Crystal Drive, 4th Floor, Arlington, VA 22202, USA; (L.O.); (K.E.)
| | - Katharine Elkes
- JSI Research & Training Institute, Inc., 2733 Crystal Drive, 4th Floor, Arlington, VA 22202, USA; (L.O.); (K.E.)
| | - Swechhya Shrestha
- UNICEF Nepal, UN House, Pulchowk, Kathmandu P.O. Box 1187, Nepal; (S.S.); (S.B.)
| | - Anjali Joshi
- Department of Public Health, Dhulikhel Hospital-Kathmandu University School of Medical Sciences, Dhulikhel 45200, Nepal; (A.J.); (P.R.); (B.M.K.)
| | - Prasanna Rai
- Department of Public Health, Dhulikhel Hospital-Kathmandu University School of Medical Sciences, Dhulikhel 45200, Nepal; (A.J.); (P.R.); (B.M.K.)
| | - Sanju Bhattarai
- UNICEF Nepal, UN House, Pulchowk, Kathmandu P.O. Box 1187, Nepal; (S.S.); (S.B.)
| | - Biraj Man Karmacharya
- Department of Public Health, Dhulikhel Hospital-Kathmandu University School of Medical Sciences, Dhulikhel 45200, Nepal; (A.J.); (P.R.); (B.M.K.)
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Diaz-Martinez J, Kallus L, Levine HM, Lavernia F, Pierre AJ, Mancilla J, Barthe A, Duran C, Kotzker W, Wagner E, Hospital MM. Community-Engaged Research (CEnR) to Address Gaps in Chronic Kidney Disease Education among Underserved Latines-The CARE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7026. [PMID: 37947582 PMCID: PMC10649949 DOI: 10.3390/ijerph20217026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Ensuring equitable chronic kidney disease (CKD) education for Latine patients with low health literacy and low English proficiency stands as a critical challenge, and the "Caridad Awareness and Education" (CARE) initiative represents our ongoing effort to address this imperative issue. In collaboration with twenty-three patients living with CKD, diabetes and/or hypertension and twelve trained Community Health Workers (CHWs) from diverse Latine subgroups, we conducted a research initiative funded by the National Kidney Foundation. Our primary objective was to co-design and test culturally tailored patient education materials (PEMs) for underserved Latine adults at risk for or diagnosed with CKD. We effectively integrated Community-Engaged Research (CEnR) principles with a Human-Centered Design (HCD) approach to create a range of CKD-PEM prototypes in Spanish. Patient preferences for printed educational materials were clear. They favored printed materials that incorporated visual content with concise text over digital, email, texts, or online resources and personalized phone outreach and the involvement of CHWs. Additionally, patients identified their unwavering commitment to their families as a forceful motivator for caring for their kidney health. Currently, a culturally and linguistically tailored CKD flipchart for one-on-one education, led by CHWs, is undergoing a pilot testing phase involving a sample of one hundred Latine patients at risk for or diagnosed with CKD. This innovative approach signifies a commitment to amplifying the insights and expertise of the Latine community afflicted by kidney health disparities, effectively embracing a CEnR to forge meaningful and impactful CKD-PEMs.
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Affiliation(s)
- Janet Diaz-Martinez
- Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA; (E.W.); (M.M.H.)
- Robert Stempel College of Public Health and School of Social Work, Florida International University, Miami, FL 33199, USA
| | - Laura Kallus
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | | | - Frank Lavernia
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Aydevis Jean Pierre
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Jessica Mancilla
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Ale Barthe
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Carlos Duran
- Florida Kidney Physicians, Boca Raton, FL 33431, USA; (C.D.); (W.K.)
| | - Wayne Kotzker
- Florida Kidney Physicians, Boca Raton, FL 33431, USA; (C.D.); (W.K.)
| | - Eric Wagner
- Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA; (E.W.); (M.M.H.)
- Robert Stempel College of Public Health and School of Social Work, Florida International University, Miami, FL 33199, USA
| | - Michelle M. Hospital
- Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA; (E.W.); (M.M.H.)
- Robert Stempel College of Public Health and School of Social Work, Florida International University, Miami, FL 33199, USA
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Fabian KE, Foster KT, Chwastiak L, Turner M, Wagenaar BH. Adapting a transdiagnostic digital mental health intervention for use among immigrant and refugee youth in Seattle: a human-centered design approach. Transl Behav Med 2023; 13:867-875. [PMID: 37418614 PMCID: PMC11009687 DOI: 10.1093/tbm/ibad041] [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] [Indexed: 07/09/2023] Open
Abstract
Digital mental health interventions show promise in addressing mental health needs, especially among youth and marginalized communities. This study adapted the World Health Organization -developed STARS (Sustainable Technology for Adolescents to Reduce Stress) digital mental health intervention for use among youth and young adults aged 14-25 from immigrant and refugee communities in Seattle, Washington. Human-centered design methods centered around qualitative semi-structured interviews were used to contextually and culturally adapt the intervention and prioritize the needs and preferences of the intended end user. Intervention prototypes were modified and then presented to the target groups in iterative cycles until saturation was achieved. Qualitative interviews occurred in three iterations of five participants each. Modifications were documented according to the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) implementation science framework. Modifications aligned with the FRAME process elements: (a) tailoring/refining, which included adapting language to less resemble digital phishing scams; (b) changes in packaging or materials, which included naming the chatbot and adopting a corresponding avatar; (c) adding/removing, which included changing existing emojis and adding additional media types including graphics interchange format images, pictures, and voice memos; (d) shortening/condensing, which included shortening the length of individual text sections as well as deleting redundant language; (e) lengthening/extending, which included allowing the user to choose to receive content catered to teenagers or to adults; and (f) loosening structure, including giving users options to skip parts of modules or to engage with additional material. The modified STARS intervention shows promise for engagement with immigrant and refugee youth in Seattle and can be examined for clinical effectiveness. Adaptations increased the relevance of content to the intended end user, expanded options for personalization and customization of the user experience, and utilized language that was age appropriate, engaging, and did not invoke feelings of stigma or distrust. Adaptations of digital mental health interventions should focus on modifications that maximize acceptability and appropriateness to intended audiences.
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Affiliation(s)
- Katrin E Fabian
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Katherine T Foster
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Morgan Turner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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28
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Hopkins KL, Lepage C, Cook W, Thomson A, Abeyesekera S, Knobler S, Boehman N, Thompson B, Waiswa P, Ssanyu JN, Kabwijamu L, Wamalwa B, Aura C, Rukundo JC, Cook J. Co-Designing a Mobile-Based Game to Improve Misinformation Resistance and Vaccine Knowledge in Uganda, Kenya, and Rwanda. JOURNAL OF HEALTH COMMUNICATION 2023; 28:49-60. [PMID: 38146161 DOI: 10.1080/10810730.2023.2231377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Misinformation can decrease public confidence in vaccines, and reduce vaccination intent and uptake. One strategy for countering these negative impacts comes from inoculation theory. Similar to biological vaccination, inoculation theory posits that exposure to a weakened form of misinformation can develop cognitive immunity, reducing the likelihood of being misled. Online games offer an interactive, technology-driven, and scalable solution using an active form of inoculation that engages and incentivizes players to build resilience against misinformation. We document the development of the critical thinking game Cranky Uncle Vaccine. The game applies research findings from inoculation theory, critical thinking, humor in science communication, and serious games. The game content was iterated through a series of co-design workshops in Kampala (Uganda), Kitale (Kenya), and Kigali (Rwanda). Workshop participants offered feedback on cartoon character design, gameplay experience, and the game's content, helping to make the game more culturally relevant and avoid unintended consequences in East African countries. Our co-design methodology offers an approach for further adaptation of the Cranky Uncle Vaccine game to other regions, as well as a template for developing locally relevant interventions to counter future infodemics.
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Affiliation(s)
- Kathryn L Hopkins
- Vaccine Acceptance & Demand Initiative, Global Immunization, Sabin Vaccine Institute, Washington DC, USA
| | | | | | - Angus Thomson
- Irimi Company, Lyon, France
- School of Liberal Arts, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | | | - Stacey Knobler
- Vaccine Acceptance & Demand Initiative, Global Immunization, Sabin Vaccine Institute, Washington DC, USA
| | - Nicholas Boehman
- Vaccine Acceptance & Demand Initiative, Global Immunization, Sabin Vaccine Institute, Washington DC, USA
| | - Brianna Thompson
- Vaccine Acceptance & Demand Initiative, Global Immunization, Sabin Vaccine Institute, Washington DC, USA
| | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Lydia Kabwijamu
- School of Public Health, Makerere University, Kampala, Uganda
| | - Benson Wamalwa
- Department of Chemistry, University of Nairobi, Nairobi, Kenya
| | - Caroline Aura
- Department of Chemistry, University of Nairobi, Nairobi, Kenya
| | | | - John Cook
- Melbourne Centre for Behaviour Change, University of Melbourne, Melbourne, VIC, Australia
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Griffin AC, Perez T, Avoundjian T, Becker W, Midboe AM. A Tool to Identify and Engage Patients on Risky Opioid Regimens. Appl Clin Inform 2023; 14:1018-1026. [PMID: 38151042 PMCID: PMC10752654 DOI: 10.1055/s-0043-1777126] [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: 07/17/2023] [Accepted: 10/30/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Concerns around opioid safety for patients living with chronic pain have led to a growing number of collaborative and multimodal pain care initiatives. A major challenge in these efforts has been identifying and engaging patients on high-risk opioid regimens in a timely manner. OBJECTIVES In this clinical informatics case report, we describe the development and implementation of a web-based tool to support providers as they implement an integrated pain support clinical initiative at primary care clinics across three health care systems. METHODS The tool identifies patients on risky opioid medication regimens and generates autopopulated patient outreach letters. It contains three core functions that: (1) identify patients prescribed high-dose opioids or coprescribed opioids and benzodiazepines, (2) generate automated letters for patients with an upcoming primary care appointment, and (3) allow clinic staff to write back to a database to track outreach and referrals. Qualitative stakeholder feedback was gathered through interviews and user testing to assess perceived usefulness and ease of use of the tool. RESULTS Over a 24-month period, the tool identified 1,125 patients prescribed risky medication regimens and generated 1,315 total letters as some patients became reeligible. Stakeholder feedback revealed that the tool was useful to quickly find patients on risky medication regimens and efficient in generating prepopulated letters that could be mailed in large batches. Additional feedback led to iterative refinements and improved system capabilities that varied across clinics. CONCLUSION Deploying clinical informatics tools that prioritize, engage, and track high-risk patient populations supports reduction of risky medication regimens. Such tools can reduce workload burden on busy primary care staff, particularly during implementation studies, and enhance patient-centered care through the use of direct-to-consumer outreach.
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Affiliation(s)
- Ashley C. Griffin
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States
- Stanford University School of Medicine, Stanford, California, United States
| | - Taryn Perez
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States
| | - Tigran Avoundjian
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States
| | - William Becker
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States
- Yale School of Medicine, New Haven, Connecticut, United States
| | - Amanda M. Midboe
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States
- Division of Health Policy and Management, University of California Davis—School of Medicine, Davis, CA, USA
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Litke SG, Resnikoff A, Anil A, Montgomery M, Matta R, Huh-Yoo J, Daly BP. Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity. JMIR Ment Health 2023; 10:e46949. [PMID: 37610818 PMCID: PMC10467602 DOI: 10.2196/46949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths. OBJECTIVE This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)? METHODS An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app-based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions. RESULTS The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies. CONCLUSIONS Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process.
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Affiliation(s)
- Shannon Grace Litke
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Annie Resnikoff
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Ashley Anil
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Meredith Montgomery
- Department of Information Science, Drexel University, Philadelphia, PA, United States
| | - Rishabh Matta
- Department of Information Science, Drexel University, Philadelphia, PA, United States
| | - Jina Huh-Yoo
- Department of Information Science, Drexel University, Philadelphia, PA, United States
| | - Brian P Daly
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
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Hartmann M, Roberts ST, Triplett N, Tenza S, Maboa O, Mampuru L, Mayisela N, Mbewe D, Tolley EE, Reddy K, Palanee-Phillips T, Montgomery ET. Development of a relationship counselling website to identify and mitigate risk of intimate partner violence in the context of women's PrEP use. PLOS DIGITAL HEALTH 2023; 2:e0000329. [PMID: 37578954 PMCID: PMC10424861 DOI: 10.1371/journal.pdig.0000329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 07/18/2023] [Indexed: 08/16/2023]
Abstract
Discreet, accessible interventions are urgently needed to mitigate the risk of intimate-partner violence (IPV) and other relationship barriers that women encounter to using HIV prevention methods such as pre-exposure prophylaxis (PrEP). We adapted a counsellor-administered intervention, CHARISMA, into a mobile-optimized website to enhance accessibility and reduce human resources required for HIV prevention and relationship counseling. Using human-centered design and participatory methods, CHARISMA was adapted through workshops with former CHARISMA in-person intervention participants (n = 14; ages 18-45) and web development 'sprints' combined with cognitive interviews (n = 24). 'CHARISMA mobile' was then beta-tested with 81 women naïve to the in-person intervention. In beta-testing, participants used a 'think aloud' process to provide feedback on ease of use and rated design, functionality, comprehension, confidentiality, safety, and usefulness on a scale of 1 to 5 via a survey. Data were conducted in four rounds, interspersed with rapid assessment according to go/no-go criteria, and website adaptations. The updated website was pilot tested for 'real-world' feasibility and acceptability among 159 women using their own smartphones at a location of their choice. Feedback was measured via surveys and website analytics. Workshops and cognitive interviews generated insights on technology use, contextual adaptations, and confidentiality, which were integrated into the beta version. The beta version met all 'go' criteria and was further adapted for pilot testing. In pilot testing, users found the website was useful (mean rating 4.54 out of 5), safe (4.5 out of 5), and had few concerns about confidentiality (1.75, representing low concern). On average, users rated the website more than 4 stars out of 5. Beta and pilot-testing suggested the smartphone-optimized website was well-accepted, relevant, engaging, feasible to administer, discreet and safe. Results contributed to a refined website, suitable for adaptations to other contexts and further evaluation where outcomes related to PrEP use and relationships should be assessed.
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Affiliation(s)
- Miriam Hartmann
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Sarah T. Roberts
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
| | - Noah Triplett
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
| | - Siyanda Tenza
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Onthatile Maboa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lydia Mampuru
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nonkululeko Mayisela
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dorica Mbewe
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- University of Washington, Department of Epidemiology; School of Public Health, Seattle, United States of America
| | - Elizabeth T. Montgomery
- Women’s Global Health Imperative, RTI International, Berkeley, California, United States of America
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Khalil GE, Kim J, McLean D, Ramirez E, Zhao B, Salloum RG. Identifying adolescents' gaming preferences for a tobacco prevention social game: A qualitative study. PLoS One 2023; 18:e0289319. [PMID: 37506112 PMCID: PMC10381079 DOI: 10.1371/journal.pone.0289319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Considering the dangers of adolescent tobacco use, the successful design of behavioral programs is crucial for tobacco prevention. According to preliminary research, social game interventions can improve adolescent tobacco outcomes. The current qualitative study aims to (1) uncover the gaming elements that adolescents deem important for a positive learning experience, and (2) confirm these gaming elements with adolescents who are presented with a tobacco prevention game concept that applies these elements. METHODS Findings from this study are drawn from two phases. Phase 1 involved in-person focus group discussions (n = 15) and Phase 2 included three online focus groups and a paired interview with another set of adolescents (n = 15). The study was conducted under a project that aimed to design and test a social game-based tobacco prevention program for adolescents (Storm-Heroes). With open coding and thematic analysis, two research team members identified repeated topics and relevant quotes to organize them into themes. The themes evolved as new content was identified during the process. This process was repeated until thematic saturation was reached. RESULTS Thematic analysis across Phase 1 and Phase 2 revealed four major themes: 1) Balance during gaming challenges, 2) Healthy social interaction, 3) Performance and creative freedom, and 4) Fictional world and game mechanics for tobacco prevention. CONCLUSION This study identified specific intervention features that best fit the needs of adolescents in the context of a social game for tobacco prevention. For future research, we will use a participatory approach to allow adolescents to take part in the design process, improve Storm-Heroes, and develop health promotional messages that can be incorporated into the program. Ultimately, a board game for tobacco prevention is expected to bring adolescents together to create lasting memories that nudge them away from tobacco use and the harm it can cause.
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Affiliation(s)
- Georges Elias Khalil
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, United States of America
| | - Jeanie Kim
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - David McLean
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, United States of America
| | - Erica Ramirez
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, United States of America
| | - Bairu Zhao
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, United States of America
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, United States of America
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Walker AF, Graham S, Maple-Brown L, Egede LE, Campbell JA, Walker RJ, Wade AN, Mbanya JC, Long JA, Yajnik C, Thomas N, Ebekozien O, Odugbesan O, DiMeglio LA, Agarwal S. Interventions to address global inequity in diabetes: international progress. Lancet 2023; 402:250-264. [PMID: 37356448 PMCID: PMC10726974 DOI: 10.1016/s0140-6736(23)00914-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
Diabetes is a serious chronic disease with high associated burden and disproportionate costs to communities based on socioeconomic, gender, racial, and ethnic status. Addressing the complex challenges of global inequity in diabetes will require intentional efforts to focus on broader social contexts and systems that supersede individual-level interventions. We codify and highlight best practice approaches to achieve equity in diabetes care and outcomes on a global scale. We outline action plans to target diabetes equity on the basis of the recommendations established by The Lancet Commission on Diabetes, organising interventions by their effect on changing the ecosystem, building capacity, or improving the clinical practice environment. We present international examples of how to address diabetes inequity in the real world to show that approaches addressing the individual within a larger social context, in addition to addressing structural inequity, hold the greatest promise for creating sustainable and equitable change that curbs the global diabetes crisis.
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Affiliation(s)
- Ashby F Walker
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia
| | - Leonard E Egede
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Claude Mbanya
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Judith A Long
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | | | | | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
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Nelson-Peterman J, Sibeko L, Mouth R, Cordeiro LS. Building on Community Research Partnerships and Training Students in a Multi-Phase Community-Based Participatory Research Study With Young Women of Cambodian Heritage in Massachusetts. Health Promot Pract 2023; 24:669-681. [PMID: 36415160 DOI: 10.1177/15248399221135116] [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] [Indexed: 07/20/2023]
Abstract
Refugees bring significant economic and cultural benefits to communities and yet face elevated risk of chronic disease and barriers to good health in the U.S. Community-based participatory research (CBPR) can benefit refugee communities and provide training/mentoring opportunities for students. The Cambodian Women's Health Study was a four-phase, multi-year CBPR university-community collaboration with the Massachusetts Cambodian community that focused on health, nutrition, pregnancy, and food security among primarily young women of Cambodian heritage ages 15-30 years old. Phase 1 was a focus group discussion (FGD, n = 4) and cross-sectional survey (n = 56) with pregnant women. Phase 2 was a cross-sectional survey (n = 107) with nonpregnant women. Phase 3 was a series of FGD (seven FGD, n = 38) with women. Phase 4 was a student-led translational nutrition intervention (three classes) with women (n = 11) and men (n = 10). The study design included compensation and support for the community partner and included structured mentoring of students (six graduates, eight undergraduates) in CBPR methods, adult learning, and cultural humility. Benefits to the community agency included enhanced research capacity, including supervising student research assistants, and robust compensation. Benefits to students included intensive mentoring and training. Successes included cost-effectiveness and strong recruitment and experiences with participants. Challenges included issues with student-led recruitment and organization that required additional mentoring and reflection. To work toward socially just and equitable research and interventions, CBPR collaborative efforts should include intentional meaningful compensation and community capacity-building as well as structured mentoring and training for student researchers and should build on existing work and relationships within communities.
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Miller SJ, Sly JR, Alcaraz KI, Ashing K, Christy SM, Gonzalez B, Lu Q, Newton RL, Redmond M, Shen M, Thomas-Purcell K, Yi J, Veinot T, Meade CD. Equity and behavioral digital health interventions: Strategies to improve benefit and reach. Transl Behav Med 2023; 13:400-405. [PMID: 36940409 PMCID: PMC10255755 DOI: 10.1093/tbm/ibad010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND Behavioral digital health interventions (e.g., mobile apps, websites, wearables) have been applied widely to improve health outcomes. However, many groups (e.g., people with low income levels, people who are geographically isolated, older adults) may face obstacles to technology access and use. In addition, research has found that biases and stereotypes can be embedded within digital health interventions. As such, behavioral digital health interventions that intend to improve overall population health may unintentionally widen health-related inequities. PURPOSE This commentary offers guidance and strategies to mitigate these risks when using technology as a means for delivering a behavioral health intervention. METHODS A collaborative working group from Society of Behavioral Medicine's Health Equity Special Interest Group developed a framework to center equity in the development, testing and dissemination of behavioral digital health interventions. RESULTS We introduce Partner, Identify, Demonstrate, Access, Report (PIDAR), a 5-point framework to avoid the creation, perpetuation, and/or widening of health inequities in behavioral digital health work. CONCLUSIONS It is critically important to prioritize equity when conducting digital health research. The PIDAR framework can serve as a guide for behavioral scientists, clinicians and developers.
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Affiliation(s)
- Sarah J Miller
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamilia R Sly
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kassandra I Alcaraz
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | | | - Shannon M Christy
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Brian Gonzalez
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Qian Lu
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert L Newton
- Population and Public Health, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Michelle Redmond
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Megan Shen
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Kamilah Thomas-Purcell
- Nova Southeastern University, College of Healthcare Sciences, Department of Health Science, Ft. Lauderdale, FL, USA
| | - Jean Yi
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Tiffany Veinot
- School of Information and School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Cathy D Meade
- Department of Health Outcomes and Behavior, Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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Rodriguez NM, Burleson G, Linnes JC, Sienko KH. Thinking Beyond the Device: An Overview of Human- and Equity-Centered Approaches for Health Technology Design. Annu Rev Biomed Eng 2023; 25:257-280. [PMID: 37068765 PMCID: PMC10640794 DOI: 10.1146/annurev-bioeng-081922-024834] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
A shift in the traditional technocentric view of medical device design to a human-centered one is needed to bridge existing translational gaps and improve health equity. To ensure the successful and equitable adoption of health technology innovations, engineers must think beyond the device and the direct end user and must seek a more holistic understanding of broader stakeholder needs and the intended context of use early in a design process. The objectives of this review article are (a) to provide rationale for the need to incorporate meaningful stakeholder analysis and contextual investigation in health technology development and biomedical engineering pedagogy, (b) to review existing frameworks and human- and equity-centered approaches to stakeholder engagement and contextual investigation for improved adoption of innovative technologies, and (c) to present case studyexamples of medical device design that apply these approaches to bridge the gaps between biomedical engineers and the contexts for which they are designing.
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Affiliation(s)
- Natalia M Rodriguez
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, Indiana, USA;
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Grace Burleson
- Design Science, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Jacqueline C Linnes
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, Indiana, USA;
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Kathleen H Sienko
- Design Science, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
- Department of Mechanical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Gariboldi MI, Chen M, Wei Y, Xu S, Galea G, Lee S. Towards digital healthy ageing: the case of Agatha and priorities moving forward. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 35:100649. [PMID: 37424690 PMCID: PMC10326683 DOI: 10.1016/j.lanwpc.2022.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/19/2022] [Accepted: 11/04/2022] [Indexed: 02/09/2023]
Abstract
Digital tools have an important role to play in meeting the health demands of ageing societies. However, current technological design paradigms often marginalize older people. We adopted a lean, user-centred approach to prototype the Avatar for Global Access to Technology for Healthy Ageing (Agatha), an interactive one-stop shop for healthy ageing promotion. Building on this experience, we present a vision for an integrated approach to "digital healthy ageing". Older people consulted predominantly associated "healthy ageing" with disease avoidance. Digital healthy ageing should take a more holistic approach, covering self-care, prevention, and active ageing. It should also consider social determinants of health in old age, including access to information and digital health literacy, as they interact with poverty, education, access to health services and other structural factors. We use this framework to map out key areas of innovation and explore policy priorities and opportunities for innovation practitioners.
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Affiliation(s)
- Maria Isabella Gariboldi
- Healthy Ageing Unit, Division of Healthy Environments and Populations, World Health Organization (WHO), Western Pacific Regional Office (WPRO), 669 Ermita Manila 1000, Metro Manila, Philippines
| | - Mengji Chen
- Innovation and Research Unit, Division of Data, Strategy and Innovation, World Health Organization (WHO), Western Pacific Regional Office (WPRO), 669 Ermita Manila 1000, Metro Manila, Philippines
| | - Yuxin Wei
- Healthy Ageing Unit, Division of Healthy Environments and Populations, World Health Organization (WHO), Western Pacific Regional Office (WPRO), 669 Ermita Manila 1000, Metro Manila, Philippines
| | - Shan Xu
- WHO Collaborating Centre for Digital Health China Academy of Information and Communications Technology (CAICT), 52 Hua Yuan Bei Road, Haidian District Beijing, 100191, PR China
- Shanghai Institute of Major Infectious Disease and Biosafety, Fudan University, 220 Handan Road. Shanghai, 200433, China
| | - Gauden Galea
- WHO Representative Office in China, 401 Dongwai Diplomatic Building 23, Dongzhimenwai Dajie Chaoyang District Beijing, 100600, PR China
| | - Siwon Lee
- Healthy Ageing Unit, Division of Healthy Environments and Populations, World Health Organization (WHO), Western Pacific Regional Office (WPRO), 669 Ermita Manila 1000, Metro Manila, Philippines
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Molony SL, Fazio S, Sanchez R, Montminy J, Rulison M, McGuire RD, Feinn R, Jeon S, Montesano R, Prophater L, VanHaitsma K, Zimmerman S. Applying person-centered research ethics in the design of dementia-specific measures. J Aging Stud 2023; 65:101139. [PMID: 37268373 PMCID: PMC10259161 DOI: 10.1016/j.jaging.2023.101139] [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: 08/12/2022] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 06/04/2023]
Abstract
There is an emerging call for new strengths-based measures to guide research, care, and support for persons living with Alzheimer's disease and related dementias. Person-centered interventions have demonstrated a positive impact in global quality of life, but many promising approaches lack strengths-based measures with sufficient sensitivity to document relevant outcomes. Human centered design is an innovative method for person-centered instrument development. This paper describes a research process using Human Centered Design and highlights ethical principles considered during the translation of the design process to experiential world of Alzheimer's disease and related dementia. Including persons living with dementia and care partners as members of the design team offers new insights, while requiring focused attention on inclusivity, transparency, and person-centered ethics.
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Affiliation(s)
- Sheila L Molony
- Quinnipiac University School of Nursing, 275 Mt. Carmel Ave, Hamden, CT 06518, United States of America.
| | - Sam Fazio
- Quality Care & Psychosocial Research, Alzheimer's Association, United States of America.
| | | | - Joe Montminy
- Alzheimer's Association, United States of America
| | - Maureen Rulison
- Certified Montessori Dementia Care Professional, Caregiver Support & Resources
| | | | - Richard Feinn
- Medical Sciences, Quinnipiac University, United States of America.
| | - Sangchoon Jeon
- Research Scientist in Nursing, Yale School of Nursing, United States of America.
| | | | - Lorna Prophater
- Quality Care & Psychosocial Research at Alzheimer's Association, United States of America.
| | - Kimberly VanHaitsma
- Ross and Carol Nese College of Nursing; Program for Person-Centered Living Systems of Care, Penn State University, United States of America.
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and the School of Social Work, The University of North Carolina at Chapel Hill, United States of America.
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Sbaffi L, Zamani E, Kalua K. Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach. J Med Internet Res 2023; 25:e45440. [PMID: 37166971 DOI: 10.2196/45440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries. OBJECTIVE This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera. METHODS We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers. RESULTS The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities. CONCLUSIONS This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers' role.
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Affiliation(s)
- Laura Sbaffi
- Information School, University of Sheffield, Sheffield, United Kingdom
| | - Efpraxia Zamani
- Information School, University of Sheffield, Sheffield, United Kingdom
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
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Fry M, Maxwell K, Eisenhauer E, Julius S, Kiessling B, Matsler M, Ollove M, Romanoski S. Centering equity in the development of a community resilience planning resource. CLIMATE RISK MANAGEMENT 2023; 40:1-11. [PMID: 38361534 PMCID: PMC10866210 DOI: 10.1016/j.crm.2023.100520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Building community resilience requires centering equity in resilience planning processes. Tools and resources for strengthening community resilience need to address equity in both their content and the process for using them. This is especially so for communities living in proximity to contaminated lands that face compounding hazards (i.e., environmental, disaster, and climate-related); legacies of institutional or structural disenfranchisement; challenges with inclusion of minority populations in planning; and constraints on doing data-intensive planning and management in under-resourced and underserved jurisdictions. A research team from the U.S. Environmental Protection Agency is developing a new resource, the Equitable Resilience Builder, which will serve communities with intersecting social and environmental vulnerabilities, in pursuit of creating resilience plans and developing the intra-community connections to implement them. This article details how the team used human-centered design to develop the Equitable Resilience Builder. Our objective in doing so is to share the evolution of equity in the project and demonstrate key inflection points in the discovery, synthesis, and ideation phases of human-centered design. The team was able to expand their understanding of what it means to undertake resilience planning in an equitable way during engagements with state, local, tribal agencies, foundations, non-governmental organizations, and academia and through participatory workshops. It developed design principles for how the tool might use storytelling and other techniques to address emotions and trauma, ensure local voices are heard, and encourage relationship building. This article offers lessons learned for others seeking to address resilience and equity in climate risk management, particularly when working with communities in proximity to contaminated lands.
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Affiliation(s)
- Meridith Fry
- US Environmental Protection Agency Office of Research and Development, 1200 Pennsylvania Ave, NW, Washington, DC 20460, USA
| | - Keely Maxwell
- US Environmental Protection Agency Office of Research and Development, 1200 Pennsylvania Ave, NW, Washington, DC 20460, USA
| | - Emily Eisenhauer
- US Environmental Protection Agency Office of Research and Development, 1200 Pennsylvania Ave, NW, Washington, DC 20460, USA
| | - Susan Julius
- US Environmental Protection Agency Office of Research and Development, 1200 Pennsylvania Ave, NW, Washington, DC 20460, USA
| | - Brittany Kiessling
- US Environmental Protection Agency Office of Research and Development, 109 TW Alexander Dr, Durham, NC 27709, USA
| | - Marissa Matsler
- Oak Ridge Institute for Science and Education Research Participant at the US Environmental Protection Agency Office of Research and Development, Corvallis, OR 97333, USA
| | - Margaret Ollove
- The Lab at the US Office of Personnel Management, 1900 E Street NW, Washington, DC 20415, USA
| | - Sara Romanoski
- The Lab at the US Office of Personnel Management, 1900 E Street NW, Washington, DC 20415, USA
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Antoniadou V, Hadjipanayis A. Co-constructing effective collective intelligence networks in rare diseases: a mixed method approach to identify the parameters that matter for patients, professionals and policy-makers, piloted in Cyprus. Orphanet J Rare Dis 2023; 18:97. [PMID: 37118739 PMCID: PMC10142407 DOI: 10.1186/s13023-023-02672-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/11/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Rare diseases are a particular field of public health that is characterized by scattered, often insufficient knowledge and infrastructure. The scarcity of specialized knowledge often forces clinicians and patients to an incomplete picture of the diseases and their associated risks. Effective person-centred networks appear promising for solving such real world and life-defining problems by purposely sourcing expert knowledge that is geographically-dispersed. The design and implementation of the RARE-e-CONNECT network technology is described. The project was funded to create collaborative spaces for the development of international partnerships in Cyprus' healthcare, promoting the dissemination of expert knowledge on rare diseases while saving resources through teleconsultation. Parameters that matter for patients, providers and policy-makers through the RARE-e-CONNECT experience were evaluated through a participatory mixed-method approach, consisting of (1) a needs assessment survey with 27 patients/families and 26 healthcare professionals at the two referral hospitals for the diagnosis and management of rare diseases in Cyprus; (2) interviews with 40 patients, families and patient representatives, as well as 37 clinicians and laboratory scientists, including national ERN coordinators/members; (3) activity metrics from 210 healthcare professionals and 251 patients/families/patient representatives who participated on the platform at the time of the research. RESULTS Our results indicate usage and intention by both healthcare professionals and patients/families to openly provide decentralized specialized information for raising suspicion amongst clinicians to facilitate the necessary referrals, as well as peer to peer psychosocial support to help cope with the everyday challenges of living with the disease. User behavior was largely affected by the prevailing social norm favoring individual practice, as well as missing policies for telemedicine and shared care. This article discusses how telehealth is inextricably linked to social, cultural, organizational, technological and policy factors affecting uptake. CONCLUSIONS We argue that collective intelligence tools need to be formally considered and work hand in hand with national and European policies/regulatory frameworks to promote proactiveness amongst the healthcare community with regard to the timely diagnosis of rare diseases and the facilitation of patients' pathway to specialists. Collaborative channels between countries need to be established to source collective intelligence on complex cases and save resources through teleconsultation/telementoring.
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Affiliation(s)
| | - Adamos Hadjipanayis
- Medical School, European University Cyprus, Karyatidon 42, Larnaca, 6042, Cyprus
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Chen E, Bishop J, Guge Cozon L, Hernandez E, Sadeghzadeh C, Bradley M, Dearth-Wesley T, De Marco M. Integrating Human-Centered Design Methods Into a Health Promotion Project: Supplemental Nutrition Assistance Program Education Case Study for Intervention Design. JMIR Form Res 2023; 7:e37515. [PMID: 37083485 PMCID: PMC10163394 DOI: 10.2196/37515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/30/2022] [Accepted: 10/16/2022] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Human-centered design, or design thinking, offers an extensive toolkit of methods and strategies for user-centered engagement that lends itself well to intervention development and implementation. These methods can be applied to the fields of public health and medicine to design interventions that may be more feasible and viable in real-world contexts than those developed with different methods. OBJECTIVE The design team aimed to develop approaches to building food skills among caregivers of children aged 0-5 years who are eligible for a federal food assistance program while they were in the grocery store. METHODS They applied 3 specific human-centered design methods-Extremes and Mainstreams, Journey Mapping, and Co-Creation Sessions-to collaboratively develop intervention approaches to enhance Supplemental Nutrition Assistance Program Education (SNAP-Ed) reach and impact across food retail settings. Extremes and Mainstreams is a specific kind of purposive sampling that selects individuals based on characteristics beyond demographics. Journey Mapping is a visual tool that asks individuals to identify key moments and decision points during an experience. Co-Creation Sessions are choreographed opportunities for individuals to explicitly contribute to the design of a solution alongside research or design team members. RESULTS Ten caregivers with diverse lived experiences were selected to participate in remote design thinking workshops and create individual journey maps to depict their grocery store experiences. Common happy points and pain points were identified. Nine stakeholders, including caregivers, SNAP-Ed staff, and grocery store dieticians, cocreated 2 potential intervention approaches informed by caregivers' experiences and needs: a rewards program and a meal box option. CONCLUSIONS These 3 human-centered design methods led to a meaningful co-design process where proposed interventions aligned with caregivers' wants and needs. This case study provides other public health practitioners with specific examples of how to use these methods in program development and stakeholder engagement as well as lessons learned when adapting these methods to remote settings.
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Affiliation(s)
- Elizabeth Chen
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jared Bishop
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lindsay Guge Cozon
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eduardo Hernandez
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Claire Sadeghzadeh
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Tracy Dearth-Wesley
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Molly De Marco
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Hong YA, Shen K, Han HR, Ta Park V, Bagchi P, Lu HK, Chen H, Wang JHY. A WeChat-based Intervention, Wellness Enhancement for Caregivers (WECARE), for Chinese American Dementia Caregivers: Pilot Assessment of Feasibility, Acceptability, and Preliminary Efficacy. JMIR Aging 2023; 6:e42972. [PMID: 37018042 PMCID: PMC10131589 DOI: 10.2196/42972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Chinese American family caregivers of persons with dementia experience high rates of psychosocial distress and adverse health outcomes. Due to their immigrant and minority status, they face substantial obstacles to care and support, including stigma and misperception of dementia, limited knowledge and use of welfare and services, and poor social support. Few interventions have been developed or tested for this vulnerable population. OBJECTIVE This study aims to pilot-test the Wellness Enhancement for Caregivers (WECARE) intervention, a culturally tailored program delivered via WeChat, a social media app highly popular in the Chinese population. The 7-week WECARE was designed specifically for Chinese American dementia caregivers to improve their caregiving skills, reduce stress, and enhance psychosocial well-being. Feasibility, acceptability, and preliminary efficacy of the WECARE were assessed in this pilot. METHODS A total of 24 Chinese American family caregivers of persons with dementia were recruited for a pre-post 1-arm trial of the WECARE. By subscribing to the WECARE official account, participants received interactive multimedia programs on their WeChat account multiple times a week for 7 weeks. A backend database automatically delivered program components and tracked user activities. Three online group meetings were organized to facilitate social networking. Participants completed a baseline and a follow-up survey. Feasibility was assessed by the follow-up rate and curriculum completion rate; acceptability was assessed by user satisfaction and perceived usefulness of the program; and efficacy was assessed with pre-post differences in 2 primary outcomes of depressive symptoms and caregiving burden. RESULTS The intervention was completed by 23 participants with a retention rate of 96%. Most of them (n=20, 83%) were older than 50 years and the majority (n=17, 71%) were female. The backend database revealed that the mean curriculum completion rate was 67%. Participants also reported high rates of user satisfaction and perceived usefulness of the intervention and high ratings of weekly programs. The intervention led to significant improvement in participants' psychosocial health outcomes; their depressive symptoms reduced from 5.74 to 3.35 with an effect size of -0.89 and caregiving burden decreased from 25.78 to 21.96 with an effect size of -0.48. CONCLUSIONS This pilot study suggests that WeChat-based WECARE intervention was feasible and acceptable; it also demonstrated initial efficacy in improving psychosocial well-being in Chinese American dementia caregivers. Further research with a control group is needed to assess its efficacy and effectiveness. The study highlights the need for more culturally appropriate mobile health interventions for Chinese American family caregivers of persons with dementia.
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Affiliation(s)
- Y Alicia Hong
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, United States
| | - Kang Shen
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, United States
| | - Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Van Ta Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Pramita Bagchi
- Department of Statistics, George Mason University, Fairfax, VA, United States
| | - Huixing Kate Lu
- Chinese Culture and Community Service Center, Inc, Gaithersburg, MD, United States
| | - Hsiaoyin Chen
- Chinese Culture and Community Service Center, Inc, Gaithersburg, MD, United States
| | - Judy Huei-Yu Wang
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States
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Mak WWS, Ng SM, Leung FHT. A Web-Based Stratified Stepped Care Platform for Mental Well-being (TourHeart+): User-Centered Research and Design. JMIR Form Res 2023; 7:e38504. [PMID: 36947112 PMCID: PMC10131708 DOI: 10.2196/38504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Internet-based mental health interventions have been demonstrated to be effective in alleviating psychological distress and promoting mental well-being. However, real-world uptake and engagement of such interventions have been low. Rather than being stand-alone interventions, situating internet-based interventions under a stratified stepped care system can support users to continue with mental health practice and monitor their mental health status for timely services that are commensurate with their needs. A user-centered approach should be used in the development of such web-based platforms to understand the facilitators and barriers in user engagement to enhance platform uptake, usability, and adherence so it can support the users' continued adoption and practice of self-care for their mental health. OBJECTIVE The aim of this study was to describe the design process taken to develop a web-based stratified stepped care mental health platform, TourHeart+, using a user-centered approach that gathers target users' perceptions on mental self-care and feedback on the platform design and incorporates them into the design. METHODS The process involved a design workshop with the interdisciplinary development team, user interviews, and 2 usability testing sessions on the flow of registration and mental health assessment and the web-based self-help interventions of the platform. The data collected were summarized as descriptive statistics if appropriate and insights are extracted inductively. Qualitative data were extracted using a thematic coding approach. RESULTS In the design workshop, the team generated empathy maps and point-of-view statements related to the possible mental health needs of target users. Four user personas and related processes in the mental health self-care journey were developed based on user interviews. Design considerations were derived based on the insights drawn from the personas and mental health self-care journey. Survey results from 104 users during usability testing showed that the overall experience during registration and mental health assessment was friendly, and they felt cared for, although no statistically significant differences on preference ratings were found between using a web-based questionnaire tool and through an interactive chatbot, except that chatbot format was deemed more interesting. Facilitators of and barriers to registering the platform and completing the mental health assessment were identified through user feedback during simulation with mock-ups. In the usability testing for guided self-help interventions, users expressed pain points in course adherence, and corresponding amendments were made in the flow and design of the web-based courses. CONCLUSIONS The design process and findings presented in the study are important in developing a user-centric platform to optimize users' acceptance and usability of a web-based stratified stepped care platform with guided self-help interventions for mental well-being. Accounting for users' perceptions and needs toward mental health self-care and their experiences in the design process can enhance the usability of an evidence-based mental health platform on the web.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sin Man Ng
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Florence H T Leung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
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Shaikh Y, Jeelani M, Gibbons MC, Livingston D, Williams DR, Wijesinghe S, Patterson J, Russell S. Centering and collaborating with community knowledge systems: piloting a novel participatory modeling approach. Int J Equity Health 2023; 22:45. [PMID: 36915080 PMCID: PMC10010640 DOI: 10.1186/s12939-023-01839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Systems science approaches like simulation modeling can offer an opportunity for community voice to shape policies. In the episteme of many communities there are elders, leaders, and researchers who are seen as bearers of historic knowledge and can contextualize and interpret contemporary research using knowledge systems of the community. There is a need for a systematic methodology to collaborate with community Knowledge Bearers and Knowledge Interpreters. In this paper we report the results of piloting a systematic methodology for collaborating with a community Knowledge-Bearer and Knowledge-Interpreter to develop a conceptual model revealing the local-level influences and architecture of systems shaping community realities. The use case for this pilot is 'persistent poverty' in the United States, specifically within the inner-city African American community in Baltimore City. METHODS This pilot of a participatory modeling approach was conducted over a span of 7 sessions and included the following steps, each with an associated script: Step 1: Knowledge-Bearer and Knowledge-Interpreter recruitment Step 2: Relationship building Step 3: Session introduction, Vignette development & enrichment Step 4: Vignette analysis & constructing architecture of systems map Step 5: Augmenting architecture of systems map RESULTS: Each step of the participatory modeling approach resulted in artifacts that were valuable for both the communities and the research effort. Vignette construction resulted in narratives representing a spectrum of lived experiences, trajectories, and outcomes within a community. The collaborative analysis of vignettes yielded the Architecture of Systemic Factors map, that revealed how factors inter-relate to form a system in which lived experience of poverty occurs. A literature search provided an opportunity for the community to contextualize existing research about them using realities of lived experience. CONCLUSION This methodology showed that a community Knowledge Bearer can function as communicators and interpreters of their community's knowledge base, can develop coherent narratives of lived experiences within which research and knowledge is contextualized, and can collaboratively construct conceptual mappings necessary for simulation modeling. This participatory modeling approach showed that even if there already exists a vast body of research about a community, collaborating with community gives context to that research and brings together disparate findings within narratives of lived experience.
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Affiliation(s)
- Yahya Shaikh
- The MITRE Corp, 2275 Rolling Run Dr, Windsor Mill, Woodlawn, MD, 21244, USA.
| | - Muzamillah Jeelani
- International Islamic University of Malaysia, Jalan Gombak, 53100, Kuala Lumpur, Selangor, Malaysia
| | | | | | | | | | | | - Sybil Russell
- The MITRE Corp, 2275 Rolling Run Dr, Windsor Mill, Woodlawn, MD, 21244, USA
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Munro S, Di Meglio G, Williams A, Barbic SP, Begun S, Black A, Carson A, Fortin M, Jacob K, Khan Z, Martin-Misener R, Meherali S, Paller V, Seiyad H, Vallée CA, Wahl K, Norman WV. Can youth-engaged research facilitate equitable access to contraception in Canada? The qualitative study protocol for the Ask Us project. BMJ Open 2023; 13:e070904. [PMID: 36863736 PMCID: PMC9990688 DOI: 10.1136/bmjopen-2022-070904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/06/2023] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION There is little to no evidence in Canada on the barriers that youth face when accessing contraception. We seek to identify the contraception access, experiences, beliefs, attitudes, knowledge, and needs of youth in Canada, from the perspectives of youth and youth service providers. METHODS AND ANALYSIS This prospective, mixed-methods, integrated knowledge mobilisation study, the Ask Us project, will involve a national sample of youth, healthcare and social service providers, and policy makers recruited via a novel relational mapping and outreach approach led by youth. Phase I will centre the voices of youth and their service providers through in-depth one-on-one interviews. We will explore the factors influencing youth access to contraception, theoretically guided by Levesque's Access to Care framework. Phase II will focus on the cocreation and evaluation of knowledge translation products (youth stories) with youth, service providers, and policy makers. ETHICS AND DISSEMINATION Ethical approval was received from the University of British Columbia's Research Ethics Board (H21-01091). Full open-access publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to youth and service providers through social media, newsletters, and communities of practice, and to policy makers through invited evidence briefs and face-to-face presentations.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Giuseppina Di Meglio
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada
| | - Aleyah Williams
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Skye Pamela Barbic
- Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Black
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea Carson
- Research, Innovation, and Discovery, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Michelle Fortin
- Options for Sexual Health, Vancouver, British Columbia, Canada
| | - Kaiya Jacob
- Youth Partner, Vancouver, British Columbia, Canada
| | - Zeba Khan
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Victoria Paller
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Carol-Anne Vallée
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Wahl
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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Morse B, Allen M, Schilling LM, Soares A, DeSanto K, Holliman BD, Lee RS, Kwan BM. Community Engagement in Research and Design of a Transgender Health Information Resource. Appl Clin Inform 2023; 14:263-272. [PMID: 37019175 PMCID: PMC10076103 DOI: 10.1055/s-0043-1763290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Access to credible and relevant health care information is an unmet need for the transgender and gender-diverse (TGD) community. This paper describes the community engagement methods and resulting community priorities as part of a codesign process for the development of a Transgender Health Information Resource (TGHIR) application. METHODS A lesbian, gay, bisexual, transgender, and queer advocacy organization and an academic health sciences team partnered to establish a community advisory board (CAB) of TGD individuals, parents of TGD individuals, and clinicians with expertise in transgender health to inform the project. The analytic-deliberative model and group facilitation strategies based on Liberating Structures guided procedures. Affinity grouping was used to synthesize insights from CAB meeting notes regarding roles and perspectives on the design of the TGHIR application. We used the Patient Engagement in Research Scale (PEIRS) to evaluate CAB members' experience with the project. RESULTS The CAB emphasized the importance of designing the application with and for the TGD community, including prioritizing intersectionality and diversity. CAB engagement processes benefited from setting clear expectations, staying focused on goals, synchronous and asynchronous work, and appreciating CAB member expertise. TGHIR application scope and priorities included a single source to access relevant, credible health information, the ability to use the app discreetly, and preserving privacy (i.e., safe use). An out-of-scope CAB need was the ability to identify both culturally and clinically competent TGD health care providers. PEIRS results showed CAB members experienced moderate to high levels of meaningful engagement (M[standard deviation] = 84.7[12] out of 100). CONCLUSION A CAB model was useful for informing TGHIR application priority features. In-person and virtual methods were useful for engagement. The CAB continues to be engaged in application development, dissemination, and evaluation. The TGHIR application may complement, but will not replace, the need for both culturally and clinically competent health care for TGD people.
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Affiliation(s)
- Brad Morse
- Division of General Internal Medicine, Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | | | - Lisa M Schilling
- Division of General Internal Medicine, Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Andrey Soares
- Division of General Internal Medicine, Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Kristen DeSanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Brooke Dorsey Holliman
- Department of Family Medicine, Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Rita S Lee
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Bethany M Kwan
- Department of Emergency Medicine, Adult and Child Center for Outcomes Research and Delivery Science, Data Science to Patient Value Initiative, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
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Bazzano AN, Noel LA, Patel T, Dominique CC, Haywood C, Moore S, Mantsios A, Davis PA. Improving the Engagement of Underrepresented People in Health Research Through Equity-Centered Design Thinking: Qualitative Study and Process Evaluation for the Development of the Grounding Health Research in Design Toolkit. JMIR Form Res 2023; 7:e43101. [PMID: 36649162 PMCID: PMC10015353 DOI: 10.2196/43101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/27/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Health inequalities are rooted in historically unjust differences in economic opportunities, environment, access to health care services, and other social determinants. Owing to these health inequalities, the COVID-19 pandemic has disproportionately affected underserved populations, notably people of color, incarcerated and formerly incarcerated individuals, and those unable to physically distance themselves from others. However, people most strongly impacted by health disparities, and the pandemic, are not frequently engaged in research, either as researchers or as participants, resulting in slow progress toward improving health equity. Establishing ways to foster the engagement of historically excluded people is crucial to improving health equity through patient-centered health research. OBJECTIVE This study aimed to assess the use of equity-centered design thinking (EDT) for engaging community members in research prioritization related to COVID-19. The co-design methods and subsequent production of a toolkit that can be used for engagement were assessed through process evaluation and qualitative methods. METHODS Process evaluation and qualitative inquiry, using reflexive thematic analysis, were undertaken to examine the use of EDT. Patient community members and stakeholders remotely partnered with design and health researchers in a year-long digital process to cocreate capacity-building tools for setting agenda for research regarding the impact of COVID-19 on health outcomes. Through a series of 3 workshops, 5 community partners engaged in EDT activities to identify critical challenges for the health and well-being of their communities. The subsequent tools were tested with 10 health researchers who provided critical input over the course of 2 workshops. Interviews with co-designers, project materials, and feedback sessions were used in the process evaluation and finalization of an equity-centered toolkit for community engagement in research. Data from the co-design process, meetings, workshops, and interviews were analyzed using reflexive thematic analysis to identify salient themes. RESULTS Process evaluation illustrated how the EDT co-design process offered an approach to engage patient partners and community stakeholders in health-related research around COVID-19. The participants expressed satisfaction with design thinking approaches, including creative activities and iterative co-design, as a means of working together. Thematic analysis identified 3 key themes: the value of authentic partnerships, building trust and empathy through design, and fostering candid dialogue around health and social issues impacting historically underrepresented and underinvested communities. CONCLUSIONS The project addressed the need to test EDT strategies for fostering inclusive community engagement in health research agenda setting and provided an alternative to traditional top-down models. Despite the increasing use of human-centered design in health, few projects explicitly include equity in design thinking approaches. The use of methods and tools to intentionally engage underrepresented stakeholders in the process of research agenda setting and equitably sharing power between researchers and community members may improve health research, ultimately improving health equity.
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Affiliation(s)
- Alessandra N Bazzano
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Lesley-Ann Noel
- College of Design, North Carolina State University, Raleigh, NC, United States
| | - Tejal Patel
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | | | - Catherine Haywood
- Louisiana Community Health Outreach Network, New Orleans, LA, United States
| | - Shenitta Moore
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Andrea Mantsios
- Public Health Innovation & Action, New York, NY, United States
| | - Patricia A Davis
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
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Chavez-Rimache L, Ugarte-Gil C, Brunette MJ. The community as an active part in the implementation of interventions for the prevention and control of tuberculosis: a scoping review. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.10.22283706. [PMID: 36711680 PMCID: PMC9882411 DOI: 10.1101/2023.01.10.22283706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Interventions involving direct community stakeholders include a variety of approaches in which members take an active role in improving their health. We evaluated studies in which the community has actively participated to strengthen tuberculosis prevention and control programs. A literature search was performed in Pubmed, Scopus, ERIC, Global Index Medicus, Scielo, Cochrane Library, LILACS, Google Scholar, speciality journals, and other bibliographic references. The primary question for this review was: what is known about tuberculosis control interventions and programs in which the community has been an active part?. Two reviewers performed the search, screening and selection of studies independently. In cases of discrepancies over the eligibility of an article, it was resolved by consensus. 130 studies were selected, of which 68.47% (n=89/130) were published after 2010. The studies were conducted in Africa (44.62%), the Americas (22.31%) and Southeast Asia (19.23%). It was found that 20% (n=26/130) of the studies evaluated the participation of the community in the detection/active search of cases, 20.77% (n=27/130) in the promotion/prevention of tuberculosis; 23.07% (n=30/130) in identifying barriers to treatment, 46.15% (n=60/130) in supervision during treatment and 3.08% (n=4/130) in social support for patient. Community participation not only strengthens the capacities of health systems for the prevention and control of tuberculosis, but also allows a better understanding of the disease from the perspective of the patient and the affected community by identifying barriers and difficulties through of the tuberculosis care cascade. Engaging key community stakeholders in co-creating solutions offers a critical pathway for local governments to eradicate TB.
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Affiliation(s)
- Lesly Chavez-Rimache
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Perú
| | - César Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Perú
- School of Medicine, Universidad Peruana Cayetano Heredia, Perú
| | - Maria J Brunette
- School of Medicine, Universidad Peruana Cayetano Heredia, Perú
- School of Health & Rehabilitation Sciences, College of Medicine. The Ohio State University, United States of America
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50
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Turin TC, Lasker MAA, Rahman N, Rumana N, Chowdhury N. 'Engagement and involvement matrix': a co-creation blueprint for inclusive community engaged research and knowledge mobilisation. Evid Based Nurs 2023; 26:4-9. [PMID: 36396428 DOI: 10.1136/ebnurs-2022-103644] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Nafiza Rahman
- Community Based Citizen Researcher, Calgary, Alberta, Canada
| | - Nahid Rumana
- Sleep Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Nashit Chowdhury
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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