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Hémono R, Gatare E, Kayitesi L, Packel L, Hunter LA, Kunesh J, Mwali MM, Bertozzi S, Sayinzoga F, Mugisha M, Hope R, McCoy SI. CyberRwanda's Pathway to Impact: Results From a Cluster-Randomized Trial of Adolescent Family Planning Knowledge, Beliefs, Self-Efficacy, and Behavior. J Adolesc Health 2024; 74:1239-1248. [PMID: 38506778 DOI: 10.1016/j.jadohealth.2024.01.035] [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: 06/14/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE CyberRwanda is a digital health intervention designed to increase knowledge of family planning and reproductive health (FP/RH) and access to youth-friendly services in Rwanda. METHODS Sixty schools in eight districts were randomized 1:1:1 to one of two CyberRwanda implementation models-self-service (tablet-only) or facilitated (tablet, activity booklet, peer facilitators)-or to control. Students aged 12-19 years were randomly selected to participate. Baseline and 12-month midline surveys assessed intermediate (secondary) outcomes of FP/RH and HIV knowledge, attitudes/beliefs, self-efficacy, and behavior. Prevalence differences (PDs) were estimated using generalized linear mixed models. RESULTS There were 5,767 midline participants (51% female, mean/median age: 16 years, 29.9% sexually active). Those in CyberRwanda schools had higher knowledge of emergency contraception (57.3% vs. 47.5%, PD: 0.09, 95% confidence interval [CI]: 0.05-0.13); greater confidence in providing consent (73.3% vs. 68.1%, PD: 0.05, 95% CI: 0.01-0.08), negotiating partner's contraceptive use (88.3% vs. 85.0%, PD: 0.03, 95% CI: 0.01-0.06), and accessing/using contraceptive services (95.6% vs. 91.8%, PD: 0.03, 95% CI: 0.02-0.05); and more favorable views on FP/RH services (54.5% vs. 48.5%, PD: 0.06, 95% CI: 0.02-0.11) and condoms (76.9% vs. 71.3%, PD: 0.06, 95% CI: 0.03-0.08) compared to control. No significant differences in HIV/fertility knowledge, confidence in accessing HIV testing, or condom use were observed. DISCUSSION CyberRwanda increased FP/RH knowledge, supportive attitudes/beliefs, self-efficacy, and behavior at 12 months. The 24-month endline analysis will reveal whether CyberRwanda's benefits on intermediate outcomes result in changes to the primary outcomes, including contraception use and childbearing.
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Affiliation(s)
- Rebecca Hémono
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California.
| | | | | | - Laura Packel
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California
| | - Lauren A Hunter
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California
| | - Jacqueline Kunesh
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California
| | | | - Stefano Bertozzi
- Division of Health Policy and Management, University of California, Berkeley, School of Public Health, Berkeley, California
| | | | - Michael Mugisha
- University of Rwanda, College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
| | - Rebecca Hope
- Youth Development Labs (YLabs), Berkeley, California
| | - Sandra I McCoy
- Division of Epidemiology, University of California, Berkeley, School of Public Health, Berkeley, California
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Ilhan EI, Jola LN, van der Zalm MM, Bernstein M, Goussard P, Redfern A, Hesseling AC, Hoddinott G, McCollum ED, King C. Designing a Smartphone-Based Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative Analysis of Human-Centered Design Workshops With Health Care Workers. JMIR Hum Factors 2024; 11:e54983. [PMID: 38825834 PMCID: PMC11154651 DOI: 10.2196/54983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/23/2024] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Background Pulse oximeters noninvasively measure blood oxygen levels, but these devices have rarely been designed for low-resource settings and are inconsistently available at outpatient clinics. Objective The Phefumla project aims to develop and validate a pediatric smartphone-based pulse oximeter designed specifically for this context. We present the process of human-centered oximeter design with health care workers in South Africa. Methods We purposively sampled 19 health care workers from 5 clinics in Khayelitsha, Cape Town. Using a human-centered design approach, we conducted participatory workshops with four activities with health care workers: (1) they received 3D-printed prototypes of potential oximeter designs to provide feedback; (2) we demonstrated on dolls how they would use the novel oximeter; (3) they used pile sorting to rank design features and suggest additional features they desired; and (4) they designed their preferred user interface using a whiteboard, marker, and magnetized features that could be repositioned. We audio recorded the workshops, photographed outputs, and took detailed field notes. Analysis involved iterative review of these data to describe preferences, identify key design updates, and provide modifications. Results Participants expressed a positive sentiment toward the idea of a smartphone pulse oximeter and suggested that a pediatric device would address an important gap in outpatient care. Specifically, participants expressed a preference for the prototype that they felt enabled more diversity in the way it could be used. There was a strong tendency to prioritize pragmatic design features, such as robustness, which was largely dictated by health care worker context. They also added features that would allow the oximeter device to serve other clinical functions in addition to oxygen saturation measurement, such as temperature and respiratory rate measurements. Conclusions Our end user-centered rapid participatory approach led to tangible design changes and prompted design discussions that the team had not previously considered. Overall, health care workers prioritized pragmatism for pediatric pulse oximeter device design.
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Affiliation(s)
- Elif I Ilhan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lucia N Jola
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Andrew Redfern
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Eric D McCollum
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Global Program for Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Elkins C, Kokera S, Vumbugwa P, Gavhera J, West KM, Wilson K, Makunike-Chikwinya B, Masimba L, Holec M, Barnhart S, Matinu S, Wassuna B, Feldacker C. "Endless opportunities": A qualitative exploration of facilitators and barriers to scale-up of two-way texting follow-up after voluntary medical male circumcision in Zimbabwe. PLoS One 2024; 19:e0296570. [PMID: 38728277 PMCID: PMC11086850 DOI: 10.1371/journal.pone.0296570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
In Zimbabwe, the ZAZIC consortium employs two-way, text-based (2wT) follow-up to strengthen post-operative care for voluntary medical male circumcision (VMMC). 2wT scaled nationally with evidence of client support and strengthened follow-up. However, 2wT uptake among healthcare providers remains suboptimal. Understanding the gap between mobile health (mHealth) potential for innovation expansion and scale-up realization is critical for 2wT and other mHealth innovations. Therefore, we conducted an exploratory qualitative study with the objective of identifying 2wT program strengths, challenges, and suggestions for scale up as part of routine VMMC services. A total of 16 in-depth interviews (IDIs) with diverse 2wT stakeholders were conducted, including nurses, monitoring & evaluation teams, and technology partners-a combination of perspectives that provide new insights. We used both inductive and deductive coding for thematic analysis. Among 2wT drivers of expansion success, interviewees noted: 2wT care benefits for clients; effective hands-on 2wT training; ease of app use for providers; 2wT saved time and money; and 2wT strengthened client/provider interaction. For 2wT scale-up challenges, staff shortages; network infrastructure constraints; client costs; duplication of paper and electronic reporting; and complexity of digital tools integration. To improve 2wT robustness, respondents suggested: more staff training to offset turnover; making 2wT free for clients; using 2wT to replace paper VMMC reporting; integrating with routine VMMC reporting systems; and expanding 2wT to other health areas. High stakeholder participation in app design, implementation strengthening, and evaluation were appreciated. Several 2wT improvements stemmed from this study, including enrollment of multiple people on one number to account for phone sharing; 2wT inclusion of minors ages 15+; clients provided with $1 to offset SMS costs; and reduced SMS messages to clients. Continued 2wT mentoring for staff, harmonization of 2wT with Ministry e-health data systems, and increased awareness of 2wT's client and provider benefits will help ensure successful 2wT scale-up.
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Affiliation(s)
- Chelsea Elkins
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Sandra Kokera
- Zimbabwe Technical Training and Education Centre for Health (Zim-TTECH), Harare, Zimbabwe
| | - Phiona Vumbugwa
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Zimbabwe Technical Training and Education Centre for Health (Zim-TTECH), Harare, Zimbabwe
| | - Jacqueline Gavhera
- Zimbabwe Technical Training and Education Centre for Health (Zim-TTECH), Harare, Zimbabwe
| | - Kathleen M. West
- Health Systems & Population Health, University of Washington, Seattle, Washington, United States of America
| | - Katherine Wilson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
| | | | - Lewis Masimba
- Zimbabwe Technical Training and Education Centre for Health (Zim-TTECH), Harare, Zimbabwe
| | - Marrianne Holec
- Department of Global Health, International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
| | - Scott Barnhart
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Sulemana Matinu
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Caryl Feldacker
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, International Training and Education Center for Health, University of Washington, Seattle, Washington, United States of America
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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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Baumann SE, Leeson L, Raonivololona M, Burke JG. Exploring the multi-level impacts of a youth-led comprehensive sexuality education model in Madagascar using Human-centered Design methods. PLoS One 2024; 19:e0297106. [PMID: 38598416 PMCID: PMC11006148 DOI: 10.1371/journal.pone.0297106] [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: 08/29/2022] [Accepted: 12/24/2023] [Indexed: 04/12/2024] Open
Abstract
Comprehensive sexuality education (CSE) is recognized as a critical tool for addressing sexuality and reproductive health challenges among adolescents. However, little is known about the broader impacts of CSE on populations beyond adolescents, such as schools, families, and communities. This study explores multi-level impacts of an innovative CSE program in Madagascar, which employs young adult CSE educators to teach a three-year curriculum in government middle schools across the country. The two-phased study embraced a participatory approach and qualitative Human-centered Design (HCD) methods. In phase 1, 90 school principals and administrators representing 45 schools participated in HCD workshops, which were held in six regional cities. Phase 2 took place one year later, which included 50 principals from partner schools, and focused on expanding and validating findings from phase 1. From the perspective of school principals and administrators, the results indicate several areas in which CSE programming is having spill-over effects, beyond direct adolescent student sexuality knowledge and behaviors. In the case of this youth-led model in Madagascar, the program has impacted the lives of students (e.g., increased academic motivation and confidence), their parents (e.g., strengthened family relationships and increased parental involvement in schools), their schools (e.g., increased perceived value of schools and teacher effectiveness), their communities (e.g., increased community connections), and impacted broader structural issues (e.g., improved equity and access to resources such as menstrual pads). While not all impacts of the CSE program were perceived as positive, the findings uncovered opportunities for targeting investments and refining CSE programming to maximize positive impacts at family, school, and community levels.
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Affiliation(s)
- Sara E. Baumann
- University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA, United States of America
| | | | | | - Jessica G. Burke
- University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA, United States of America
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Sethuraman S, Peeran SW, Ramalingam K, Alzaroug Jaber A. Awareness Levels About Specialty Services Offered by the Faculty of Dentistry in Sebha, Libya. Cureus 2024; 16:e58557. [PMID: 38765436 PMCID: PMC11102078 DOI: 10.7759/cureus.58557] [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: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Assessment of awareness levels about any hospital is critical to judge its current standings and plan for future development. Limited literature is available about dental health in Libya. AIM This study aimed to study the awareness and perception of the various specialty services offered by the Faculty of Dentistry (SDC), Sebha University for their quality and preference. MATERIALS AND METHODS It was a performance monitoring research, and the data was collected by interview using a standardized questionnaire. Non-probability judgmental sampling was used. The offered services included all specialties in dentistry and oral cancer screening. Information relating to the awareness and perception of SDC specialty services was collected with few agree/disagree questions from 450 subjects. Data was collected, tabulated, and analyzed with descriptive statistics using SPSS v23.0 (IBM, Armonk, NY, USA). RESULTS About 22.7% (n=102) were in the 45-54 years age group. Self-employed (n=108, 24%) and professional (n=108, 24%) were noted in occupation. Forty-eight (n=216) were graduates. Three hundred twenty-eight respondents (72.9%) were aware about the dental services. Four hundred twenty-eight respondents (95.1%) have visited SDC. Three hundred six respondents (68%) were satisfied, and 66 respondents (14.7%) were very much satisfied. Dental health checkups were predominantly known to the respondents (n=302, 67%). For all the other specialties, the awareness level was low. CONCLUSION The identification of weak areas is crucial for the future planning and development of oral health care rendered by SDC.
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Affiliation(s)
- Sathya Sethuraman
- Dentistry and Physiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | | | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Aesa Alzaroug Jaber
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Sebha University, Sebha, LBY
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Ajman University, Ajman, ARE
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Mensah-Gourmel J, Bourgain M, Kandalaft C, Chatelin A, Tissier O, Letellier G, Gorter JW, Brochard S, Pons C. Starting from the needs: what are the appropriate sources to co-create innovative solutions for persons with disabilities? Disabil Rehabil Assist Technol 2024; 19:623-632. [PMID: 36036377 DOI: 10.1080/17483107.2022.2114554] [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: 09/01/2021] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Technical solutions could facilitate activities and participation in individuals with disabilities. For the development of solutions, hackathons are a method of interdisciplinary collaboration. For hackathon, the definition of pain points that require solutions is crucial. We aimed to determine engineers' preferences and expectations regarding pain point qualities. METHODS We used a collaborative approach involving individuals with disability, families, and healthcare professionals to determine pain points for use by engineering students during a disability Hackathon. A pain point bank was built using 3 upstream sources: a survey (350 responses, 20 pain points selected), interviews (8 children, 13 pain points), and a multidisciplinary workshop based on design thinking methods (45 people, 32 pain points). A fourth source was 20 adults with disabilities present during the Hackathon. Engineering students rated pain point qualities from each source in a questionnaire that included closed questions relating to predefined criteria: achievability, specificity, relevance and attractiveness and open questions to collect non-predefined quality criteria. RESULTS Pain points from the workshop were most frequently used (48%); followed by on-site discussions with mentors (43%), the survey (38%), and interviews (31%). On-site discussions received the highest quality ratings followed by the workshop, survey, and interviews. Three quality criteria emerged from the responses to open questions: "representative", "empathy", and "real-need". CONCLUSIONS To be actionable by engineers, pain points must relate to real needs, be achievable, specific, relevant and attractive but also representative and arouse empathy. We devised a checklist of qualities along with a toolbox of methods to achieve each. Implications For RehabilitationThe first step of the development of technical solutions for children and individuals with disabilities is the identification of their needs and their adequate formulation to be submitted to technical solutions providers.Daily life needs of individuals with disability were gathered for an engineering hackathon and proposed as pain points to 400 engineering students.To facilitate the development of solutions by engineers, pain points must relate to real needs, be specific, relevant, achievable and attractive; be representative and arouse empathy; a toolbox of needs collection methods is proposed to achieve each of those qualities.Discussions with individuals with disability and health professionals should be provided.
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Affiliation(s)
- Johanne Mensah-Gourmel
- PMR Department, CHRU Brest, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Université Bretagne Occidentale, Brest, France
| | - Maxime Bourgain
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Université Sorbonne Paris Nord, Paris, France
- EPF Graduate School of Engineering, Cachan, France
| | | | | | | | - Guy Letellier
- Pediatric Rehabilitation Hospital, ESEAN-APF, Nantes, France
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Canada
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Sylvain Brochard
- PMR Department, CHRU Brest, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Université Bretagne Occidentale, Brest, France
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
| | - Christelle Pons
- PMR Department, CHRU Brest, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Université Bretagne Occidentale, Brest, France
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Canada
- Pediatric Rehabilitation Department, Fondation Ildys, Brest, France
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Elhaddad M, Hamam S. AI-Driven Clinical Decision Support Systems: An Ongoing Pursuit of Potential. Cureus 2024; 16:e57728. [PMID: 38711724 PMCID: PMC11073764 DOI: 10.7759/cureus.57728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 05/08/2024] Open
Abstract
Clinical Decision Support Systems (CDSS) are essential tools in contemporary healthcare, enhancing clinicians' decisions and patient outcomes. The integration of artificial intelligence (AI) is now revolutionizing CDSS even further. This review delves into AI technologies transforming CDSS, their applications in healthcare decision-making, associated challenges, and the potential trajectory toward fully realizing AI-CDSS's potential. The review begins by laying the groundwork with a definition of CDSS and its function within the healthcare field. It then highlights the increasingly significant role that AI is playing in enhancing CDSS effectiveness and efficiency, underlining its evolving prominence in shaping healthcare practices. It examines the integration of AI technologies into CDSS, including machine learning algorithms like neural networks and decision trees, natural language processing, and deep learning. It also addresses the challenges associated with AI integration, such as interpretability and bias. We then shift to AI applications within CDSS, with real-life examples of AI-driven diagnostics, personalized treatment recommendations, risk prediction, early intervention, and AI-assisted clinical documentation. The review emphasizes user-centered design in AI-CDSS integration, addressing usability, trust, workflow, and ethical and legal considerations. It acknowledges prevailing obstacles and suggests strategies for successful AI-CDSS adoption, highlighting the need for workflow alignment and interdisciplinary collaboration. The review concludes by summarizing key findings, underscoring AI's transformative potential in CDSS, and advocating for continued research and innovation. It emphasizes the need for collaborative efforts to realize a future where AI-powered CDSS optimizes healthcare delivery and improves patient outcomes.
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Affiliation(s)
- Malek Elhaddad
- Medicine, The Hospital for Sick Children, Toronto, CAN
- Medicine, Upper Canada College, Toronto, CAN
| | - Sara Hamam
- Ophthalmology, Queen Elizabeth University Hospital, Glasgow, GBR
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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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10
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Pozzar RA, Tulsky JA, Berry DL, Batista J, Yackel HD, Phan H, Wright AA. Developing a Collaborative Agenda-Setting Intervention (CASI) to promote patient-centered communication in ovarian cancer care: A design thinking approach. PATIENT EDUCATION AND COUNSELING 2024; 120:108099. [PMID: 38086227 DOI: 10.1016/j.pec.2023.108099] [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: 07/20/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVES Patient-centered communication (PCC) occurs when clinicians respond to patients' needs, preferences, and concerns. While PCC is associated with better health-related quality of life in patients with cancer, patients with ovarian cancer have reported unmet communication needs. We used design thinking to develop an intervention to promote PCC in ovarian cancer care. METHODS Following the steps of design thinking, we empathized with stakeholders by reviewing the literature, then created stakeholder and journey maps to define the design challenge. To ideate solutions, we developed a challenge map. Finally, we developed wireframe prototypes and tested them with stakeholders. RESULTS Empathizing revealed that misaligned visit priorities precipitated suboptimal communication. Defining the design challenge and ideating solutions highlighted the need to normalize preference assessments, promote communication self-efficacy, and enhance visit efficiency. The Collaborative Agenda-Setting Intervention (CASI) elicits patients' needs and preferences and delivers communication guidance at the point of care. Stakeholders approved of the prototype. CONCLUSION Design thinking provided a systematic approach to empathizing with stakeholders, identifying challenges, and innovating solutions. PRACTICE IMPLICATIONS To our knowledge, the CASI is the first intervention to set the visit agenda and support communication from within the electronic health record. Future research will assess its usability and acceptability.
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Affiliation(s)
- Rachel A Pozzar
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA.
| | - James A Tulsky
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
| | - Donna L Berry
- University of Washington, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Jeidy Batista
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | | | - Hang Phan
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - Alexi A Wright
- Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA
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11
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Avery ML, Arena JL, Benson ND, Ray NA, Leary M. Using design research and human-centered design to address growing pains in a busy, urban emergency department: a faculty, clinician, and student collaboration between nursing, design, and medicine. Int J Emerg Med 2024; 17:17. [PMID: 38317078 PMCID: PMC10840182 DOI: 10.1186/s12245-024-00586-5] [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: 09/29/2023] [Accepted: 01/12/2024] [Indexed: 02/07/2024] Open
Abstract
In 2021, a large urban university-based hospital transitioned to a new two-floor emergency department. Despite the new environment, there were usability and workflow challenges with the space. The authors of this paper created a multidisciplinary, human-centered design collaborative of clinicians, university faculty, and students in an effort to increase emergency department efficiency. After thorough design-research and clinician-focused collaboration, the authors and design team identified the need to improve medical supply retrieval time, which directly impacts patient care and clinician satisfaction. The primary interventions consisted of a redesign that is as follows: (a) created standardized icons related to organ system, (b) increased visibility of supply labels, and (c) reorganized supplies based on usage data. Although a successful project, it was not without several barriers discussed in this article, including design researcher and clinician-level setting and engagement, academic/institutional policies, and conflicting schedules. In addition, the lessons learned from implementing human-centered design concepts into clinical workflow sets forth future research opportunities and inspiration for other institutions to collaborate.
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Affiliation(s)
| | | | | | - Neil A Ray
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Marion Leary
- University of Pennsylvania, Philadelphia, PA, USA
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12
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Leason I, Longridge N, Nickpour F. Application and evolution of design in oral health: A systematic mapping study with an interactive evidence map. Community Dent Oral Epidemiol 2024; 52:1-12. [PMID: 37526262 PMCID: PMC10952138 DOI: 10.1111/cdoe.12892] [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: 04/24/2023] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES There is increasing recognition of the value and capabilities of design in healthcare. Beyond the development of medical devices, design is increasingly being applied to intangible, complex and systemic healthcare problems. However, there is limited evidence on the use of design specifically in the field of oral health. This systematic mapping study aims to collate and catalogue evidence of design in oral health. METHODS A systematic search of academic databases and grey literature was performed. Duplicate results were removed, and publications relating to the same project were grouped. Reviewers from design and oral health independently screened a sample of the dataset. Projects of both relevance to oral health, and with input from a designer or clear implementation of a design methodology or approach were included. Projects were coded and plotted on a novel interactive evidence map. RESULTS 119 design and oral health projects were included between 1973 and 2022. Interventional (n = 94, 79%), empirical (n = 46, 39%), methodological (n = 35, 29%) and theoretical (n = 7, 6%) design contributions were identified across the projects. The projects were categorized by four orders of design: first-graphics (n = 6, 5%), second-products (n = 41, 34%), third-interactions (n = 70, 59%), and fourth-systems (n = 2, 2%). Design was found in a diverse range of contexts in oral health; most commonly being relevant to general patients (n = 61, 51%), and for use in general dental practice (n = 56, 47%). Further design outcome categories (digital material; printed material; object; room or space; apparel; process; smart device; tangible interface; graphical interface; virtual reality; service; policy; system) and oral health themes (oral health literacy; oral care training; dental clinic design; dental instruments and equipment; personal oral care; dental appliance; clinician health and productivity; clinical information systems; informed consent; oral health promotion and prevention; oral care training; patient interactions and experience) were identified. CONCLUSIONS The novel interactive evidence map of design in oral health created enables ongoing and open-ended multivariant documentation and analysis of the evidence, as well as identification of strategic opportunities. Future research and policy implications include; recognition and engagement with the full capabilities of design; integration of design experts; fostering inclusive engagement and collaboration; disentangling patient and public involvement; advancing human-centred systems approaches; adopting design-led approaches for policy-making.
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Affiliation(s)
- Isobel Leason
- Division of Industrial Design, School of EngineeringUniversity of LiverpoolLiverpoolUK
| | | | - Farnaz Nickpour
- Division of Industrial Design, School of EngineeringUniversity of LiverpoolLiverpoolUK
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13
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Ulmido ML, Reñosa MDC, Wachinger J, Endoma V, Landicho-Guevarra J, Landicho J, Bravo TA, Aligato M, McMahon SA. Conflicting and complementary notions of responsibility in caregiver's and health care workers' vaccination narratives in the Philippines. J Glob Health 2024; 14:04016. [PMID: 38206315 PMCID: PMC10783206 DOI: 10.7189/jogh.14.04016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background Vaccine hesitancy (VH) continues to pose a public health threat globally. Understanding the attitudes and perceptions about vaccination of key stakeholders in vaccine decision-making (such as health care workers (HCWs) and caregivers) about vaccination can pave the way toward novel approaches to bolster vaccine confidence. In this study, we explored the role of notions of responsibilities among HCWs and caregivers in shaping vaccination interactions and decision-making in the Philippines. Methods We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with 44 vaccine-hesitant caregivers, seven HCWs, and 20 community health workers (barangay health workers) in the Philippines between August 2020 and March 2021. The interviews and focus groups were conducted online, transcribed verbatim, and analysed through the reflexive thematic analysis approach. Results Caregivers highlighted responsibility in terms of being a good caregiver, managing risk to one's own child, and seeking and validating information. Meanwhile, HCWs highlighted responsibility as: being a good HCW, managing risk to children and to the community, and providing and transforming information. Our findings suggest that responsibility manifests differently in HCWs' and caregivers' narratives, and that these notions can be both conflicting and complementary, shaping the interaction between stakeholders and, ultimately, their vaccine decision-making. We also found that fostering a good relationship between HCWs and caregivers through communication techniques such as motivational interviewing could help bridge the gap created by mistrust in vaccinations. HCWs sharing their own experiences as parents who vaccinate their own children also resonate with caregivers. Conclusions Notions of responsibility can underpin collaborative and divisive interactions between HCWs and caregivers. Public health messaging and interventions related to vaccination must consider strategies that align with these notions to address VH.
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Affiliation(s)
- Ma Leslie Ulmido
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Mila Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Metro Manila, Philippines
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls Universität Heidelberg, Heidelberg, Baden-Württemberg, Germany
- International Health Department, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA
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14
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Burke HM, Callahan RL, Lawton A, Turinayo A, Oyekenu O, Niyonsaba S, Taiwo O, Semaganda VM, Awiti A, Fratus A, Mubiru F, OlaOlorun FM. Using Human-Centered Design to Explore Potential Users' and Men's Views of New Injectable Contraceptives in Kampala and Lagos. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2300215. [PMID: 38135521 PMCID: PMC10749653 DOI: 10.9745/ghsp-d-23-00215] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Injectable contraceptives are the most used method in sub-Saharan Africa. We conducted market research to assess potential user attitudes toward 4- and 6-month injectables. We also present user suggestions for marketing these new injectables once they are available. METHODS We implemented a 2-phase market research study from October through December 2021 in Kampala, Uganda, and Lagos, Nigeria. We conducted 11 focus group discussions (FGDs) with 51 participants in Kampala and 12 FGDs with 67 participants in Lagos. FGDs included current and potential injectable users and men stratified by marital status and age. Next, 23 women in Kampala and 24 in Lagos participated in cocreation workshops using human-centered design methods to explore marketing and communications strategies for each injectable. Data collection teams completed semistructured data extraction tables that were then analyzed thematically. RESULTS Participants liked both injectable options due to the reduced number of facility visits that would save time and money and increase privacy. Primary concerns included side effects, delayed return to fertility, cost, self-efficacy to self-inject, and stock-outs. Participants in Kampala preferred a shorter reinjection window (or "grace period") because it is easier to remember and they assumed it meant a quicker return to fertility, but participants in Lagos preferred a longer window because it provides extra time for reinjection. Citing norms around women needing to get pregnant quickly after marriage, participants in both sites felt that the 4-month injectable would benefit young people with busy lifestyles or limited access to facilities, whereas the 6-month injectable would benefit women who already had children. CONCLUSIONS We found that participants in Kampala and Lagos would prefer additional injectable options to meet the wide-ranging needs of users in different stages of their reproductive lives. Family planning program planners can apply the marketing insights we identified when these new injectables become available.
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Affiliation(s)
- Holly M Burke
- Reproductive, Maternal, Newborn, Child Health, FHI 360, Durham, NC, USA.
| | | | - Anna Lawton
- Product Development and Introduction, FHI 360, Durham, NC, USA
| | | | | | | | | | | | | | - Audrey Fratus
- Product Development and Introduction, FHI 360, Durham, NC, USA
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15
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Tacey A, Behne J, Patten RK, Ngo MT, Thomas R, Ancilleri J, Bone C, Paredes Castro A, McCarthy H, Harkin K, Gilmartin-Thomas JF, Takla A, Downie C, Mulcahy J, Ball M, Sharples J, Dash S, Lawton A, Wright B, Sleeth P, Kostecki T, Sonn C, McKenna MJ, Apostolopoulos V, Lane R, Said CM, De Gori M, McAinch A, Tran P, Levinger I, Parker A, Woessner MN, Pascoe M. Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study. JMIR Form Res 2023; 7:e41974. [PMID: 38064257 PMCID: PMC10746964 DOI: 10.2196/41974] [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: 08/24/2022] [Revised: 12/02/2022] [Accepted: 10/20/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. OBJECTIVE This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. METHODS The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63%; male: n=6, 38%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64%; male: n=4, 36%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80%; male: n=3, 20%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. RESULTS Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. CONCLUSIONS Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial.
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Affiliation(s)
- Alexander Tacey
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Department of Orthopaedic Surgey, Western Health, Melbourne, Australia
| | - Jack Behne
- Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Rhiannon K Patten
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Minh Truc Ngo
- Department of Orthopaedic Surgey, Western Health, Melbourne, Australia
| | - Rees Thomas
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Jessica Ancilleri
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Chelsea Bone
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | | | - Helen McCarthy
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Katherine Harkin
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- First Year College, Victoria University, Melbourne, Australia
| | - Julia Fm Gilmartin-Thomas
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Australia
| | - Amir Takla
- Australian Sports Physiotherapy, Melbourne, Australia
- Department of Health Professions, Swinburne University of Technology, Melbourne, Australia
- School of Physiotherapy, Melbourne School of Health science, The University of Melbourne, Melbourne, Australia
| | - Calum Downie
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Jane Mulcahy
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Michelle Ball
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Jenny Sharples
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Sarah Dash
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Amy Lawton
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Breanna Wright
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Peter Sleeth
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Tina Kostecki
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- School of Social Sciences, University of Tasmania, Launceston, Australia
| | - Christopher Sonn
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Michael J McKenna
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Vasso Apostolopoulos
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Rebecca Lane
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Catherine M Said
- Department of Physiotherapy, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
- School of Physiotherapy, Melbourne School of Health science, The University of Melbourne, Melbourne, Australia
| | - Mary De Gori
- Department of Physiotherapy, Western Health, Melbourne, Australia
| | - Andrew McAinch
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Phong Tran
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Department of Orthopaedic Surgey, Western Health, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Itamar Levinger
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - Alexandra Parker
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Mary N Woessner
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
| | - Michaela Pascoe
- Institute for Health and Sport (iHeS), Victoria University, Melbourne, Australia
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16
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Miller M, Kuntsche S, Kuntsche E, Cook M, Wright CJC. Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design. Health Promot Int 2023; 38:daad175. [PMID: 38128081 PMCID: PMC10735253 DOI: 10.1093/heapro/daad175] [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: 12/23/2023] Open
Abstract
Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.
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Affiliation(s)
- Mia Miller
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Sandra Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Emmanuel Kuntsche
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Megan Cook
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- Institute for Social Marketing, University of Stirling, Stirling, Scotland
| | - Cassandra J C Wright
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Institute for Social Marketing, University of Stirling, Stirling, Scotland
- Burnet Institute, Melbourne, Australia
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Antonishak J, Suellentrop K, Steiner RJ, Lloyd L, Axelson SM. Catalyzing Technology-Based Innovation in Teen Pregnancy Prevention: an Implementation Model and Findings from a Human-Centered Design Initiative. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:185-195. [PMID: 37466808 PMCID: PMC10764401 DOI: 10.1007/s11121-023-01523-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 07/20/2023]
Abstract
From 2015 to 2021, the US Department of Health and Human Services' Teen Pregnancy Prevention (TPP) program funded Power to Decide, a national reproductive health nonprofit organization, to catalyze innovation in adolescent sexual and reproductive health through the development of technology-based interventions. Power to Decide's initiative, Innovation Next, supported twenty innovation teams in using human-centered design (HCD) to develop new products, services, and programs. We describe the Innovation Next implementation model, which can inform future efforts to develop innovative, technology-based TPP programs using HCD. To that end, we draw on quantitative and qualitative data collected for program improvement to summarize key implementation findings.
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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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Akama EO, Beres LK, Kulzer JL, Ontuga G, Adhiambo H, Bushuru S, Nyagesoa E, Osoro J, Opondo I, Sang N, Oketch B, Nyanga J, Osongo CO, Nyandieka E, Ododa E, Omondi E, Ochieng F, Owino C, Odeny T, Kwena ZA, Eshun-Wilson I, Petersen M, Bukusi EA, Geng EH, Abuogi LL. A youth-centred approach to improving engagement in HIV services: human-centred design methods and outcomes in a research trial in Kisumu County, Kenya. BMJ Glob Health 2023; 8:e012606. [PMID: 38030226 PMCID: PMC10689376 DOI: 10.1136/bmjgh-2023-012606] [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: 04/17/2023] [Accepted: 10/01/2023] [Indexed: 12/01/2023] Open
Abstract
IntroductionInnovative interventions are needed to improve HIV outcomes among adolescents and young adults (AYAs) living with HIV. Engaging AYAs in intervention development could increase effectiveness and youth acceptance, yet research is limited. We applied human-centred design (HCD) to refine adherence-support interventions pretrial and assessed HCD workshop acceptability. METHODS We applied an iterative, four-phased HCD process in Kenya that included: (1) systematic review of extant knowledge, (2) prioritisation of design challenges, (3) a co-creation workshop and (4) translation tables to pair insights with trial intervention adaptations. The co-creation workshop was co-led by youth facilitators employing participatory activities to inform intervention adaptations. Iterative data analysis included rapid thematic analysis of visualised workshop outputs and notes using affinity mapping and dialogue to identify key themes. We conducted a survey to assess workshop acceptability among participants. RESULTS Twenty-two participants engaged in the 4-day workshop. Co-creation activities yielded recommendations for improving planned interventions (eg, message frequency and content; strategies to engage hard-to-reach participants), critical principles to employ across interventions (eg, personalisation, AYA empowerment) and identification of unanticipated AYA HIV treatment priorities (eg, drug holidays, transition from adolescent to adult services). We revised intervention content, peer navigator training materials and study inclusion criteria in response to findings. The youth-led HCD workshop was highly acceptable to participants. CONCLUSIONS Research employing HCD among youth can improve interventions preimplementation through empathy, youth-led inquiry and real-time problem solving. Peer navigation may be most influential in improving retention when engagement with young people is based on mutual trust, respect, privacy and extends beyond HIV-specific support. Identifying opportunities for personalisation and adaptation within intervention delivery is important for AYAs. Patient engagement interventions that target young people should prioritise improved transition between youth and adult services, youth HIV status disclosure, AYA empowerment and healthcare worker responsiveness in interactions and episodic adherence interruptions.
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Affiliation(s)
- Eliud Omondi Akama
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Laura K Beres
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jayne Lewis Kulzer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Gladys Ontuga
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Harriet Adhiambo
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Sarah Bushuru
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Edwin Nyagesoa
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Joseph Osoro
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Isaya Opondo
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Norton Sang
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Bertha Oketch
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - James Nyanga
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Cirilus Ogollah Osongo
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
- Family AIDS Care and Education Services (FACES) Clinic, Kisumu, Kenya
| | - Evelyn Nyandieka
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Evelyn Ododa
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Eunice Omondi
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Felix Ochieng
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Clinton Owino
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Thomas Odeny
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Zachary Arochi Kwena
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Ingrid Eshun-Wilson
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Maya Petersen
- Biostatistics and Epidemiology, University of California, Berkeley, California, USA
| | - Elizabeth A Bukusi
- Centre for Microbiology Research (CMR), Kenya Medical Research Institute, Nairobi, Kenya
| | - Elvin H Geng
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lisa L Abuogi
- Department of Pediatrics, University of Colorado, Denver, Colorado, USA
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Luitel NP, Pudasaini K, Pokhrel P, Lamichhane B, Gautam K, Adhikari S, Makhmud A, Taylor Salisbury T, Votruba N, Green E, Chowdhary N, Jordans MJ, Kohrt BA, Dua T, Thornicroft G, Carswell K. Development and functioning of the mobile app-based mh-GAP intervention guide in detection and treatment of people with mental health conditions in primary healthcare settings in Nepal. Glob Ment Health (Camb) 2023; 10:e90. [PMID: 38161752 PMCID: PMC10755379 DOI: 10.1017/gmh.2023.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024] Open
Abstract
This paper describes the development process of a mobile app-based version of the World Health Organization mental health Gap Action Programme Intervention Guide, testing of the app prototypes, and its functionality in the assessment and management of people with mental health conditions in Nepal. Health workers' perception of feasibility and acceptability of using mobile technology in mental health care was assessed during the inspiration phase (N = 43); the ideation phase involved the creation of prototypes; and prototype testing was conducted over multiple rounds with 15 healthcare providers. The app provides provisional diagnoses and treatment options based on reported symptoms. Participants found the app prototype useful in reminding them of the process of assessment and management of mental disorders. Some challenges were noted, these included a slow app prototype with multiple technical problems, including difficulty in navigating 'yes'/'no' options, and there were challenges reviewing detailed symptoms of a particular disorder using a "more information" icon. The initial feasibility work suggests that if the technical issues are addressed, the e-mhGAP warrants further research to understand if it is a useful method in improving the detection of people with mental health conditions and initiation of evidence-based treatment in primary healthcare facilities.
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Affiliation(s)
- Nagendra P. Luitel
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Kriti Pudasaini
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Pooja Pokhrel
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Bishnu Lamichhane
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Kamal Gautam
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Sandarba Adhikari
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Akerke Makhmud
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Nicole Votruba
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, UK
- The George Institute for Global Health UK, Imperial College London, London, UK
| | - Eric Green
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Mark J.D. Jordans
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Brandon A. Kohrt
- Center for Global Mental Health Equity, Department of Psychiatry and Behavioral Health, George Washington University, Washington, DC, USA
- Research Department, Transcultural Psychosocial Organization (TPO) Nepal, Baluwatar, Nepal
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Graham Thornicroft
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, London, UK
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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O’Leary P, Domeracki A, Raymond J, Kozhumam A, Macha V, Sakita F, Krym V, Riccardo Nickenig Vissoci J, Staton C. A feasibility assessment of a traumatic brain injury predictive modelling tool at Kilimanjaro Christian Medical Center and Duke University Hospital. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002154. [PMID: 38016001 PMCID: PMC10684081 DOI: 10.1371/journal.pgph.0002154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/18/2023] [Indexed: 11/30/2023]
Abstract
Traumatic brain injury (TBI) is the most common cause of death and disability globally. TBI, which disproportionately affects low middle-income countries (LMIC), uses significant amounts of health system resources in costly care and management. Innovative solutions are required to address this high burden of TBI. One possible solution is prognostic models which enhance diagnostic ability of physicians, thereby helping to tailor treatments more effectively. This study aims to evaluate the feasibility of a TBI prognostic model developed in Tanzania for use by Kilimanjaro Christian Medical Center (KCMC) healthcare providers and Duke-affiliated healthcare providers using human centered design methodology. Duke participants were included to gain insight from a different context with more established practices to inform the TBI tool implementation strategy at KCMC. To evaluate the feasibility of integrating the TBI tool into potential workflows, co-design interviews were conducted with emergency physicians and nursing staff at KCMC and Duke. Qualitatively, the TBI tool was assessed using human centered design (HCD) techniques. Our research design methods were created using the Consolidated Framework for Implementation Research which considers overarching characteristics of successful implementation to contribute to theory development and verification of implementation strategies across multiple contexts. Our knowledge translation method was guided using the knowledge-to-action framework. Of the 21 participants interviewed, 12 were associated with Duke Hospital, and 9 from Kilimanjaro Christian Medical Centre. Emerging from the data were 6 themes that impacted the implementation of the TBI tool: access, barriers, facilitators, use of the TBI tool, outer setting, and inner setting. To our knowledge, this is the first study to investigate the pre-implementation of a sub-Saharan Africa (SSA) data- based TBI prediction tool using human centered design methodology. Findings of this study will aid in determining under what conditions a TBI prognostic model intervention will work at KCMC.
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Affiliation(s)
- Paige O’Leary
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Alexis Domeracki
- Duke University School of Medicine, Durham, North Carolina, United States of America
| | | | - Arthi Kozhumam
- Northwestern University Feinburg School of Medicine, Chicago, Illinois, United States of America
| | | | | | - Valerie Krym
- Department of Emergency Medicine, University of Toronto Medical School, Toronto, Ontario, Canada
| | - Joao Riccardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Catherine Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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22
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Dukhanin V, Wolff JL, Salmi L, Harcourt K, Wachenheim D, Byock I, Gonzales MJ, Niehus D, Parshley M, Reay C, Epstein S, Mohile S, Farrell TW, Supiano MA, Jajodia A, DesRoches CM. Co-Designing an Initiative to Increase Shared Access to Older Adults' Patient Portals: Stakeholder Engagement. J Med Internet Res 2023; 25:e46146. [PMID: 37991827 PMCID: PMC10701652 DOI: 10.2196/46146] [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: 02/02/2023] [Revised: 05/02/2023] [Accepted: 07/22/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The patient portal is a widely available secure digital platform offered by care delivery organizations that enables patients to communicate electronically with clinicians and manage their care. Many organizations allow patients to authorize family members or friends-"care partners"-to share access to patient portal accounts, thus enabling care partners to receive their own identity credentials. Shared access facilitates trilateral information exchange among patients, clinicians, and care partners; however, uptake and awareness of this functionality are limited. OBJECTIVE We partnered with 3 health care organizations to co-design an initiative that aimed to increase shared access registration and use and that can be implemented using existing patient portals. METHODS In 2020, we undertook a rigorous selection process to identify 3 geographically diverse health care organizations that had engaged medical informatics teams and clinical champions within service delivery lines caring for older adults. We prioritized selecting organizations that serve racially and socioeconomically diverse populations and possess sophisticated reporting capabilities, a stable patient portal platform, a sufficient volume of older adult patients, and active patient and family advisory councils. Along with patients and care partners, clinicians, staff, and other stakeholders, the study team co-designed an initiative to increase the uptake of shared access guided by either an iterative, human-centered design process or rapid assessment procedures of stakeholders' inputs. RESULTS Between February 2020 and April 2022, 73 stakeholder engagements were conducted with patients and care partners, clinicians and clinic staff, medical informatics teams, marketing and communications staff, and administrators, as well as with funders and thought leaders. We collected insights regarding (1) barriers to awareness, registration, and use of shared access; (2) features of consumer-facing educational materials to address identified barriers; (3) features of clinician- and staff-facing materials to address identified barriers; and (4) approaches to fit the initiative into current workflows. Using these inputs iteratively via a human-centered design process, we produced brochures and posters, co-designed organization-specific web pages detailing shared access registration processes, and developed clinician and staff talking points about shared access and staff tip sheets that outline shared access registration steps. Educational materials emphasized the slogan "People remember less than half of what their doctors say," which was selected from 9 candidate alternatives as resonating best with the full range of the initiative's stakeholders. The materials were accompanied by implementation toolkits specifying and reinforcing workflows involving both in-person and telehealth visits. CONCLUSIONS Meaningful and authentic stakeholder engagement allowed our deliberate, iterative, and human-centered co-design aimed at increasing the use of shared access. Our initiative has been launched as a part of a 12-month demonstration that will include quantitative and qualitative analysis of registration and use of shared access. Educational materials are publicly available at Coalition for Care Partners.
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Affiliation(s)
- Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Liz Salmi
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Kendall Harcourt
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Deborah Wachenheim
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Ira Byock
- The Institute for Human Caring at Providence, Gardena, CA, United States
| | - Matthew J Gonzales
- The Institute for Human Caring at Providence, Gardena, CA, United States
| | - Doug Niehus
- Providence Medical Group, Portland, OR, United States
| | | | - Caroline Reay
- Providence Medical Group, Portland, OR, United States
| | - Sara Epstein
- The Institute for Human Caring at Providence, Gardena, CA, United States
| | - Supriya Mohile
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Timothy W Farrell
- Division of Geriatrics, Spencer Fox Eccles School of Medicine and the Center on Aging, University of Utah, Salt Lake City, UT, United States
- Salt Lake City Geriatric Research, Education, and Clinical Center, Veterans Affairs, Salt Lake City, UT, United States
| | - Mark A Supiano
- Division of Geriatrics, Spencer Fox Eccles School of Medicine and the Center on Aging, University of Utah, Salt Lake City, UT, United States
| | - Anushka Jajodia
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Catherine M DesRoches
- OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
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23
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Sim A, Jirapramukpitak T, Eagling-Peche S, Lwin KZ, Melendez-Torres GJ, Gonzalez A, Oo NN, Castello Mitjans I, Soan M, Punpuing S, Lee C, Chuenglertsiri P, Moo T, Puffer E. A film-based intervention to reduce child maltreatment among migrant and displaced families from Myanmar: Protocol of a pragmatic cluster randomized controlled trial. PLoS One 2023; 18:e0293623. [PMID: 37903143 PMCID: PMC10615270 DOI: 10.1371/journal.pone.0293623] [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: 06/06/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Child maltreatment is a global public health crisis with negative consequences for physical and mental health. Children in low- and middle-income countries (LMIC)-particularly those affected by poverty, armed conflict, and forced migration-may be at increased risk of maltreatment due to heightened parental distress and disruptions to social support networks. Parenting interventions have been shown to reduce the risk of child maltreatment as well as improve a range of caregiver and child outcomes, yet large-scale implementation remains limited in low-resource displacement settings. This study will examine the impact of an entertainment-education narrative film intervention on reducing physical and emotional abuse and increasing positive parenting among migrant and displaced families from Myanmar living in Thailand. METHOD The study is a pragmatic, superiority cluster randomized controlled trial with approximately 40 communities randomized to the intervention or treatment as usual arms in a 1:1 ratio. Participating families in the intervention arm will be invited to attend a community screening of the film intervention and a post-screening discussion, as well as receive a poster depicting key messages from the film. Primary outcomes are changes in physical abuse, emotional abuse, and positive parenting behaviour. Secondary outcomes include caregiver knowledge of positive parenting, caregiver attitudes towards harsh punishment, caregiver psychological distress, and family functioning. Outcomes will be assessed at 3 time points: baseline, 4 weeks post-intervention, and 4-month follow up. A mixed methods process evaluation will be embedded within the trial to assess intervention delivery, acceptability, perceived impacts, and potential mechanisms of change. DISCUSSION To our knowledge, this study will be the first randomized controlled trial evaluation of a film-based intervention to reduce child maltreatment among migrant and displaced families in a LMIC. An integrated knowledge translation approach will inform uptake of study findings and application to potential scale up pending evaluation results. TRIAL REGISTRATION The study was prospectively registered with the Thai Clinical Trials Registry on 22 February 2023 (TCTR20230222005).
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Affiliation(s)
- Amanda Sim
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Khaing Zar Lwin
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | | | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Mary Soan
- Sermpanya Foundation, Mae Sot, Tak, Thailand
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Bangkok, Thailand
| | - Catherine Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Th’Blay Moo
- Inclusive Education Foundation, Mae Sot, Tak, Thailand
| | - Eve Puffer
- Department of Psychology & Neuroscience, Duke Global Health Institute, Duke University, Durham, NC, United States of America
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24
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Gresh A, Batchelder A, Glass N, Mambulasa J, Kapito E, MacDonald A, Ngutwa N, Plesko C, Chirwa E, Patil CL. Adapting group care to the postpartum period using a human-centered design approach in Malawi. BMC Health Serv Res 2023; 23:1098. [PMID: 37838673 PMCID: PMC10576327 DOI: 10.1186/s12913-023-10036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 09/14/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Responsive and resilient strategies to reduce high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of the highest maternal and infant mortality rates globally. Group healthcare is a service delivery model that integrates these strategies. Although primarily implemented during the prenatal period, its potential for improving both maternal and infant health outcomes during the postpartum period has not been realized. The purpose of this study was to adapt and co-design the prototype for an evidence-based group care model for the postpartum period using a human-centered design approach with key stakeholders in Malawi. METHODS We completed steps of a framework guiding the use of human-centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Qualitative methods were used to complete steps 2-4. In-depth interviews (n = 24), and incubator sessions (n = 6) that employed free listing, pile sorting and ranking were completed with key stakeholders. Data analysis consisted of content analysis of interviews and framework analysis for incubator sessions to produce the integrated group postpartum and well-child care model prototype. The fifth step is detailed in a separate paper. RESULTS All stakeholders reported a desire to participate in and offer group care in the postpartum period. Stakeholders worked collaboratively to co-create the prototype that included a curriculum of health promotion topics and interactive activities and the service delivery structure. Health promotion topic priorities were hygiene, breastfeeding, family planning, nutrition, and mental health. The recommended schedule included 6 sessions corresponding with the child vaccination schedule over the 12-month postpartum period. CONCLUSIONS Using a human-centered design approach to adapt an evidence-based group care model in an LMIC, specifically Malawi, is feasible and acceptable to key stakeholders and resulted in a prototype curriculum and practical strategies for clinic implementation.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA.
| | - Anne Batchelder
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Nancy Glass
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Janet Mambulasa
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Esnath Kapito
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Amy MacDonald
- Pomelo Care, Hillsborough, North Carolina, USA
- Group Care Global, Philadelphia, PA, USA
| | - Nellie Ngutwa
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Cori Plesko
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Ellen Chirwa
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Crystal L Patil
- School of Nursing, University of Michigan, 400 N. Ingalls, Suite 3320, Ann Arbor, MI, 48109, USA
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Medina-Marino A, Sibanda N, Putt M, Joseph Davey D, Smith P, Thirumurthy H, Bekker LG, Buttenheim A. Improving HIV testing, linkage, and retention in care among South African men through U=U messaging: A study protocol for two sequential hybrid type 1 effectiveness- implementation randomized controlled trials. RESEARCH SQUARE 2023:rs.3.rs-3349696. [PMID: 37886512 PMCID: PMC10602079 DOI: 10.21203/rs.3.rs-3349696/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: 10/28/2023]
Abstract
BACKGROUND Increasing HIV testing and treatment coverage among people living with HIV (PLHIV) is essential for achieving global AIDS epidemic control. However, compared to women, cis-gender heterosexual men living with HIV are significantly less likely to know their HIV status, initiate anti-retroviral therapy (ART) and achieve viral suppression. This is particularly true in South Africa, where men are also at increased risk of mortality resulting from AIDS-related illnesses. While there is growing knowledge of Treatment as Prevention or the concept Undetectable=Untransmittable (U=U) among PLHIV in Western and high-income countries, the reach and penetration of the U=U message in sub-Saharan Africa remains limited, and few studies have evaluated the impact of accessible and relatable U=U messages on ART initiation and adherence. To address these gaps, rigorous evaluations of interventions that incorporate U=U messages are needed, especially among men in high prevalence settings. METHODS Building on our U=U messages that we previously developed for men using behavioral economics insights and a human-centered design, we will conduct two sequential hybrid type 1 effectiveness-implementation trials to evaluate the impact of U=U messages on men's uptake of community-based HIV testing and ART initiation (Trial 1), and retention in care and achievement of viral suppression (Trial 2). A cluster randomized trial will be implemented for Trial 1, with HIV testing service site-days randomized to U=U or standard-of-care (SoC) messages inviting men to test for HIV. An individual-level randomized control trial will be implemented for Trial 2, with men initiating ART at six government clinics randomized to receive U=U counselling or SoC treatment adherence messaging. We will incorporate a multi-method evaluation to inform future implementation of U=U messaging interventions. The study will be conducted in the Buffalo City Metro Health District of the Eastern Cape Province and in the Cape Town Metro Health District in the Western Cape Province in South Africa. DISCUSSION These trials are the first to rigorously evaluate the impact of U=U messaging on HIV testing uptake, ART initiation and achievement of viral suppression among African men. If effective, these messaging interventions can shape global HIV testing, treatment and adherence counselling guidelines and practices.
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Sisimayi T, Nhamo D, Chatora K, Chapwanya G, Mawoyo T, Ncube G, Bruns C, Harris EL, Shelley KD. Early implementation learnings on acceptability and feasibility of "V": a multi-level PrEP intervention designed with and for adolescent girls and young women in Zimbabwe. Health Res Policy Syst 2023; 21:101. [PMID: 37784195 PMCID: PMC10546763 DOI: 10.1186/s12961-023-01040-3] [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: 12/15/2022] [Accepted: 08/11/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) remain disproportionately affected by HIV in Zimbabwe. Several HIV prevention options are available, including oral tenofovir-based pre-exposure prophylaxis (PrEP), however AGYW face unique barriers to PrEP uptake and continuation and novel approaches are therefore needed to empower AGYW to use PrEP. The objective of this study was to characterize early learnings from implementing a multi-level intervention consisting of fashionable branding (including a "V Starter Kit"), service integration, and peer education and support throughout a young woman's journey using oral PrEP across four phases of implementation, from creating demand, preparing for PrEP, initiation of PrEP, and adherence to PrEP. METHODS A mixed methods implementation research study was undertaken, including site observations and interviews to explore the acceptability of "V" and its relevance to target users, as well as the feasibility of integrating "V" with existing service delivery models. Interviews (n = 46) were conducted with healthcare workers, Brand Ambassadors, and young women purposively sampled from four implementation sites. Interview data was analyzed thematically using the framework method for qualitative data management and analysis. Project budgets and invoices were used to compile unit cost and procurement data for all "V" materials. RESULTS "V" was acceptable to providers and young women due to attractive branding coupled with factual and thought-provoking messaging, establishing "a girl code" for discussing PrEP, and addressing a gap in communications materials. "V" was also feasible to integrate into routine service provision and outreach, alongside other services targeting AGYW. Cost for the "V" branded materials ranked most essential-FAQ insert, pill case, makeup bag, reminder sticker-were $7.61 per AGYW initiated on PrEP. CONCLUSION "V" is a novel approach that is an acceptable and feasible multi-level intervention to improve PrEP access, uptake, and continuation among AGYW, which works through empowering AGYW to take control of their HIV prevention needs. In considering "V" for scale up in Zimbabwe, higher volume procurement and a customized lighter package of "V" materials, while still retaining V's core approach, should be explored.
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Affiliation(s)
| | - Definate Nhamo
- Pangaea Zimbabwe AIDS Trust (PZAT), 27 Rowland Square, Milton Park, Harare, Zimbabwe
| | - Kumbirai Chatora
- Population Services International (PSI), 45 Piers Road, Sam Levy's Village Block C, Harare, Zimbabwe
| | - Gwendoline Chapwanya
- Pangaea Zimbabwe AIDS Trust (PZAT), 27 Rowland Square, Milton Park, Harare, Zimbabwe
| | - Tinovonga Mawoyo
- Population Services International (PSI), 45 Piers Road, Sam Levy's Village Block C, Harare, Zimbabwe
| | - Getrude Ncube
- Ministry of Health and Child Care (MoHCC), 4th Floor Kaguvi Building, Harare, Zimbabwe
| | - Cal Bruns
- Matchboxology, 70, 7th Avenue, Parktown North, Johannesburg, 2193, South Africa
| | - Emily L Harris
- United States Agency for International Development (USAID), Office of HIV/AIDS, Washington, DC, USA
| | - Katharine D Shelley
- PATH, Primary Health Care, 2201 Westlake Ave Suite 200, Seattle, WA, 98121, USA
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Oliveira M, E Silva GD, Zancul E. Design and Early Evaluation of a Device to Improve the Sharp Count Process in Operating Rooms. Surg Innov 2023; 30:672-675. [PMID: 37057446 DOI: 10.1177/15533506231170935] [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: 04/15/2023]
Abstract
NEED Counting surgical sharps in surgeries mitigates the risk of retained surgical items in patients. Current procedures rely on manual counts throughout and at the end of each surgery. The manual count is lengthy, burdensome, and carries the risk of injuries. TECHNICAL SOLUTION This paper presents the design and early evaluation of a technology aid to automatize the sharps' counting process; it is composed of a shell holding a set of optical sensors that count needles that pass through the shell's top slot. PROOF OF CONCEPT The device was tested with needles originating from 20 surgeries. Users surveyed reported a decrease in counting time and perceived injury risk. The average count error was 4.4%, indicating the need to continue advancing the technology. NEXT STEPS The counting technology needs to be refined to increase accuracy, and a user guide for the equipment must be prepared. Thereafter, a new set of trials must be performed. CONCLUSION Our work provides a detailed requirements list for developing a technology aid to improve the needle count process and investigates one possible technological route to address this problem.
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Affiliation(s)
- Mariana Oliveira
- University of São Paulo School of Engineering, São Paulo, Brazil
| | | | - Eduardo Zancul
- University of São Paulo School of Engineering, São Paulo, Brazil
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Reñosa MDC, Wachinger J, Guevarra JR, Landicho-Guevarra J, Aligato MF, Endoma V, Landicho J, Bravo TA, Malacad C, Demonteverde MP, Silvestre C, Bärnighausen K, Bärnighausen T, Chase RP, McMahon SA. Human-centred design bolsters vaccine confidence in the Philippines: results of a randomised controlled trial. BMJ Glob Health 2023; 8:e012613. [PMID: 37865401 PMCID: PMC10603469 DOI: 10.1136/bmjgh-2023-012613] [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] [Received: 04/18/2023] [Accepted: 09/22/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND The public's confidence in vaccinations has eroded, and anti-vaccination movements have gained traction around the world, including in the Philippines. 'Salubong', a Filipino term, refers to welcoming someone back into one's life and elicits ideas about friendship and family relationships. We extended this concept to vaccines in efforts to design an intervention that would re-welcome vaccines into homes. METHODS Using human-centred design, we developed and refined a story-based intervention that engages Filipino families, community leaders and community health workers. We conducted a randomised controlled trial among 719 caregivers of small children to test the developed intervention against a control video. We assessed the binary improvement (improvement vs no improvement) and the amount of improvement in vaccine attitudes and intentions after intervention exposure. RESULTS Although the intervention group began with marginally higher baseline vaccine attitude scores, we found that 62% of the intervention group improved their vaccine attitude scores versus 37% of the control group (Fisher's exact, p<0.001). Among individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale (Cohen's d=0.32 with 95% CI 0.10 to 0.54, two-sided t-test, p<0.01). We observed similar patterns among participants who stated that they had previously delayed or refused a vaccine for their child: 67% of 74 in the intervention group improved their vaccine attitude scores versus 42% of 54 in the control group (Fisher's exact, p<0.001). Among the subset of these individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale that were marginally significant (Cohen's d=0.35 with 95% CI -0.01 to 0.70, two-sided t-test, p=0.06). CONCLUSIONS Our results provide solid evidence for the potential of co-designed vaccine confidence campaigns and regulations.
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Affiliation(s)
- Mark Donald C Reñosa
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Jerric Rhazel Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Jhoys Landicho-Guevarra
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Mila F Aligato
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Vivienne Endoma
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Jeniffer Landicho
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Thea Andrea Bravo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Carol Malacad
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Maria Paz Demonteverde
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Catherine Silvestre
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine - Department of Health, Muntinlupa City, Philippines
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, Durban, South Africa
| | - Rachel P Chase
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- International Health Department, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Romero V, Donaldson H. Human-centred design thinking and public health education: A scoping review. Health Promot J Austr 2023. [PMID: 37643841 DOI: 10.1002/hpja.802] [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: 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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An Q, Kelley MM, Hanners A, Yen PY. Sustainable Development for Mobile Health Apps Using the Human-Centered Design Process. JMIR Form Res 2023; 7:e45694. [PMID: 37624639 PMCID: PMC10492175 DOI: 10.2196/45694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/31/2023] [Accepted: 06/28/2023] [Indexed: 08/26/2023] Open
Abstract
Well-documented scientific evidence indicates that mobile health (mHealth) apps can improve the quality of life, relieve symptoms, and restore health for patients. In addition to improving patients' health outcomes, mHealth apps reduce health care use and the cost burdens associated with disease management. Currently, patients and health care providers have a wide variety of choices among commercially available mHealth apps. However, due to the high resource costs and low user adoption of mHealth apps, the cost-benefit relationship remains controversial. When compared to traditional expert-driven approaches, applying human-centered design (HCD) may result in more useable, acceptable, and effective mHealth apps. In this paper, we summarize current HCD practices in mHealth development studies and make recommendations to improve the sustainability of mHealth. These recommendations include consideration of factors regarding culture norms, iterative evaluations on HCD practice, use of novelty in mHealth app, and consideration of privacy and reliability across the entire HCD process. Additionally, we suggest a sociotechnical lens toward HCD practices to promote the sustainability of mHealth apps. Future research should consider standardizing the HCD practice to help mHealth researchers and developers avoid barriers associated with inadequate HCD practices.
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Affiliation(s)
- Qingfan An
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Marjorie M Kelley
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Audra Hanners
- College of Nursing, The Ohio State University, Columbus, OH, United States
| | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine in St Louis, St Louis, MO, United States
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Kelly M, Fullen B, Martin D, Bradley C, O'Mahony B, McVeigh JG. Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - 'eHealth: It's TIME': a study protocol. HRB Open Res 2023; 5:73. [PMID: 37675192 PMCID: PMC10477747 DOI: 10.12688/hrbopenres.13611.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/08/2023] Open
Abstract
Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the "eHealth: It's TIME prototype". The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 - 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 - 5) and musculoskeletal physiotherapists (n = 3 - 5). Conclusion: The eHealth: It's TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.
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Affiliation(s)
- Marie Kelly
- Discipline of Physiotherapy, University College Cork, Cork, Ireland
- Department of Physiotherapy, Mercy University Hospital, Cork, Ireland
| | - Brona Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Billy O'Mahony
- School of Computer Science and Information Technology, University College Cork, Cork, Ireland
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Scanzera AC, Beversluis C, Potharazu AV, Bai P, Leifer A, Cole E, Du DY, Musick H, Chan RVP. Planning an artificial intelligence diabetic retinopathy screening program: a human-centered design approach. Front Med (Lausanne) 2023; 10:1198228. [PMID: 37484841 PMCID: PMC10361413 DOI: 10.3389/fmed.2023.1198228] [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: 04/04/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Diabetic retinopathy (DR) is a leading cause of vision loss in the United States and throughout the world. With early detection and treatment, sight-threatening sequelae from DR can be prevented. Although artificial intelligence (AI) based DR screening programs have been proven to be effective in identifying patients at high risk of vision loss, adoption of AI in clinical practice has been slow. We adapted the United Kingdom Design Council's Double-Diamond model to design a strategy for care delivery which integrates an AI-based screening program for DR into a primary care setting. Methods from human-centered design were used to develop a strategy for implementation informed by context-specific barriers and facilitators. The purpose of this community case study is to present findings from this work in progress, including a system of protocols, educational documents and workflows created using key stakeholder input.
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Affiliation(s)
- Angelica C. Scanzera
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
| | - Cameron Beversluis
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Archit V. Potharazu
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Patricia Bai
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
| | - Ariel Leifer
- Department of Family and Community Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Emily Cole
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, United States
| | - David Yuzhou Du
- Segal Design Institute, Northwestern University, Evanston, IL, United States
| | - Hugh Musick
- Institute for Healthcare Delivery Design, Office of Population Health Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - R. V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL, United States
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Beeman A, Kwesiga J, Ippoliti N, Bhandari T, Pandya G, Acam FA, Lee S, Hope R, Gibbs T, Levine J. Using human-centered design to co-design dedicated menstrual health spaces with people who menstruate in Bidi Bidi refugee settlement, Uganda: Learnings for further adaptation and scale in humanitarian settings. BMC Womens Health 2023; 23:319. [PMID: 37340385 DOI: 10.1186/s12905-023-02421-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/09/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Many people who menstruate in low- and middle-income countries struggle to manage their menstruation safely, hygienically, and with dignity. This is exacerbated in humanitarian settings with limited access to menstrual products and safe, private spaces for changing, washing, and disposing of menstrual products. To address these challenges, Youth Development Labs (YLabs) used a human-centered design approach to co-design the Cocoon Mini, a safe, physical structure for managing menstruation in the Bidi Bidi Refugee Settlement in Uganda. METHODS The study comprised five phases, including background research, design research, rough prototyping, live prototyping, and a pilot study. A total of 340 people, including people who menstruate, male community members, and community stakeholders, participated in interviews, focus groups, and co-design sessions. Solution prototypes were created, evaluated, and iterated upon in each successive project phase. The final intervention design, the Cocoon Mini, was evaluated qualitatively for feasibility and acceptability during a three-month pilot using structured interviews with 109 people who menstruate utilizing Cocoon Mini structures, 64 other community members, and 20 Cocoon Mini supervisors. RESULTS Results showed widespread desirability and acceptability of the Cocoon Mini among people who menstruate and other community members. Overall, 95% (104/109) of people who menstruate stated the space had made menstrual health management easier, primarily by providing designated waste bins, solar lights, and additional water sources. The Cocoon Mini provided an increased sense of physical and psychological safety in knowing where to privately manage menstruation. Furthermore, the Cocoon Mini demonstrated that an intervention could be run and maintained sustainably at the household level in humanitarian contexts, without continued external stakeholder intervention. Each Cocoon Mini structure costs approximately $360 USD to build and maintain and serves 15-20 people who menstruate, leading to a cost per person of $18-$24. Furthermore, attaching an incinerator to the structure for easier and quicker disposal of waste bin contents (compared to transporting full waste bins elsewhere) costs $2110 USD. CONCLUSIONS People who menstruate lack access to safe, private spaces for menstrual health and product disposal in humanitarian settings. The Cocoon Mini provides a solution for the safe and effective management of menstruation. Customizing and scaling up dedicated menstrual health spaces should be considered a high-priority intervention in humanitarian settings.
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Affiliation(s)
- Aly Beeman
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda.
| | - Joseph Kwesiga
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | | | - Tanya Bhandari
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | - Geetika Pandya
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | | | - Saehee Lee
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | - Rebecca Hope
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | - Theodora Gibbs
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
| | - Jordan Levine
- Youth Development Labs (YLabs), KN 14 St, Kigali, Rwanda
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Simkovich SM, Foeller ME, Tunçalp Ö, Papageorghiou A, Checkley W. Integrating non-communicable disease prevention and control into maternal and child health programmes. BMJ 2023; 381:e071072. [PMID: 37220922 PMCID: PMC10203824 DOI: 10.1136/bmj-2022-071072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Suzanne M Simkovich
- Division of Healthcare Delivery Research, MedStar Health Research Institute, Hyattsville, USA
- Division of Pulmonary and Critical Care Medicine, Georgetown University, Washington USA
| | - Megan E Foeller
- Department of Obstetrics and Gynaecology, St Alphonsus Regional Medical Center, Boise, USA
| | - Özge Tunçalp
- UNDP, UNFPA, Unicef, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Aris Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, USA
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, USA
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Khan B, Hameed W, Avan BI. Psychosocial support during childbirth: Development and adaptation of WHO's Mental Health Gap Action Programme (mhGAP) for maternity care settings. PLoS One 2023; 18:e0285209. [PMID: 37216373 DOI: 10.1371/journal.pone.0285209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Poor psychosocial support and lack of respectful care for women during childbirth are commonplace in health facilities in low- and middle-income countries. While WHO recommends providing supportive care to pregnant women, there is a scarcity of material for building the capacity of maternity staff to provide systematic and inclusive psychosocial support to women in the intrapartum phase, and prevent work stress and burnout in maternity teams. To address this need we adapted WHO's mhGAP for maternity staff to provide psychosocial support in labour room settings in Pakistan. Mental Health Gap Action Programme (mhGAP) is an evidence-based guidance which provides psychosocial support in resource-limited health care settings. This paper aims to describe the adaptation of mhGAP to develop psychosocial support capacity building materials for maternity staff to provide support to maternity patients, and also to staff, in the labour room context. METHODS Adaptation was conducted within the Human-Centered-Design framework in three phases: inspiration, ideation, and implementation feasibility. In inspiration, a review of national-level maternity service-delivery documents and in-depth interviews of maternity staff were conducted. Ideation involved a multidisciplinary team to develop capacity-building materials by adapting mhGAP. This phase was iterative and included cycles of pretesting, deliberations, and revision of materials. In implementation feasibility, materials were tested via the training of 98 maternity staff and exploring system feasibility via post-training visits to health facilities. RESULTS Inspiration phase identified gaps in policy directives and implementation and formative study identified limited understanding and skills of staff to assess patients' psychosocial needs and provide appropriate support. Also, it became evident that staff themselves needed psychosocial support. In ideation, team developed capacity-building materials comprising two modules: one dedicated to conceptual understanding, the other to implementing psychosocial support in collaboration with maternity staff. In implementation feasibility, staff found the materials relevant and feasible for the labour room setting. Finally, users and experts endorsed usefulness of the materials. CONCLUSION Our work in developing psychosocial-support training materials for maternity staff extends the utility of mhGAP to maternity care settings. These materials can be used for capacity-building of maternity staff and their effectiveness can be assessed in diverse maternity care settings.
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Affiliation(s)
- Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Fuster M, Dimond E, Handley MA, Rose D, Stoecker C, Knapp M, Elbel B, Conaboy C, Huang TTK. Evaluating the outcomes and implementation determinants of interventions co-developed using human-centered design to promote healthy eating in restaurants: an application of the consolidated framework for implementation research. Front Public Health 2023; 11:1150790. [PMID: 37275479 PMCID: PMC10233011 DOI: 10.3389/fpubh.2023.1150790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Background Restaurants are an emerging yet underutilized setting to facilitate healthier eating, particularly among minoritized communities that disproportionately experience health inequities. The present study aimed to examine outcomes from interventions co-developed using Human-Centered Design (HCD) in two Latin American restaurants, including sales of healthier menu items (HMI) and the consumer nutrition environment. In addition, we aimed to assess implementation outcomes (acceptability, fidelity, and sustainability) and elucidate the determinants for implementation using the Consolidated Framework for Implementation Research. Methods This study used a mixed-methods, longitudinal design. Data were collected pre-, during, and post-intervention testing. Intervention outcomes were examined through daily sales data and the Nutrition Environment Measures Survey for Restaurants (NEMS-R). Changes in HMI sales were analyzed using interrupted time series. Implementation outcomes and determinants were assessed through site visits [observations, interviews with staff (n = 19) and customers (n = 31)], social media monitoring, and post-implementation key informant interviews with owners and staff. Qualitative data were analyzed iteratively by two independent researchers using codes developed a priori based on CFIR. Results The HCD-tailored interventions had different outcomes. In restaurant one (R1), where new HMI were introduced, we found an increase in HMI sales and improvements in NEMS-R scores. In restaurant two, where existing HMI were promoted, we found no significant changes in HMI sales and NEMS-R scores. Acceptance was high among customers and staff, but fidelity and sustainability differed by restaurant (high in R1, low in R2). Barriers and facilitators for implementation were found across all CFIR constructs, varying by restaurant and intervention. Most relevant constructs were found in the inner setting (restaurant structure, implementation climate), individual characteristics, and process (HCD application). The influence of outer setting constructs (policy, peer pressure) was limited due to lack of awareness. Conclusion Our findings provide insights for interventions developed in challenging and constantly changing settings, as in the case of restaurants. This research expands the application of CFIR to complex and dynamic community-based settings and interventions developed using HCD. This is a significant innovation for the field of public health nutrition and informs future interventions in similarly dynamic and understudied settings.
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Affiliation(s)
- Melissa Fuster
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Emily Dimond
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Margaret A. Handley
- Partnership for Research in Implementation Science for Equity (PRIDE) Center and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, United States
| | - Donald Rose
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Charles Stoecker
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
- Department of Health Policy and Management, New Orleans, LA, United States
| | - Megan Knapp
- Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, United States
| | - Brian Elbel
- Department of Medicine, New York University Grossman School of Medicine,New York, NY, United States
- Wagner Graduate School of Public Service, New York University,New York, NY, United States
| | - Cara Conaboy
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Terry T. K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, City University of New York Graduate School of Public Health and Health Policy, New York, NY, United States
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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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Robinson DB, Harenberg S, Walters W, Barrett J, Cudmore A, Fahie K, Zakaria T. Game Changers: A participatory action research project for/with students with disabilities in school sport settings. Front Sports Act Living 2023; 5:1150130. [PMID: 37090817 PMCID: PMC10117838 DOI: 10.3389/fspor.2023.1150130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/15/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionAlthough school communities may be required to provide physical education opportunities for all students—including for those with disabilities—the same is not generally true with respect to school sport (i.e., participation in interscholastic or intramural sport programs). Hence, opportunities for inclusive school sport participation are consequently limited. Recognizing the need for continued attention and action in this area, we recently developed and piloted Game Changers—a participatory action research project. Together, 27 students with various cognitive and/or intellectual disabilities (i.e., student-participants), their schools’ six physical education teachers and learning support teachers (i.e., champion-participants), four university researchers (i.e., researcher-participants), and two community partners [i.e., Physical and Health Education (PHE) Canada, Special Olympics Nova Scotia] engaged in the Game Changers project with three idealized goals: (a) to bring to the fore para/adapted/inclusive sport opportunities for all students; (b) to provide an empowering opportunity for students with disabilities to participate, make choices, and act as leaders in the development of sport programming; and (c) to engage youth with disabilities in sport as participants, leaders, mentors, and role models.MethodsUtilizing a mixed-methods design, data were collected from a variety of sources before the implementation of the Game Changers program, during its implementation, and once it was complete. These four data sources included the following: pre- and post-program survey for student-participants, pre- and post-program focus group interviews for student-participants, pre- and post-program focus group interviews for champion-participants, and school/sport observations.ResultsThe first cycle of this participatory action research project has yielded positive and informative findings. Strictly positive findings, among others, relate to the following: improving upon students' perceived competence and autonomy, inviting student voice, identifying and responding to sport participation barriers, and creating genuine sport opportunities within school settings. More undesirable yet informative findings, among others, relate to the following: unachieved intrinsic motivation and belonging, (un)sustainability of sport programs without “interventions” like Game Changers, recreation/leisure as “substitutes” for sport, and a continued want for authentic leadership and mentorship opportunities.DiscussionWith these findings, we offer insights for future iterations of Game Changers (and programs like it) in similar school communities.
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Affiliation(s)
- Daniel B. Robinson
- Department of Teacher Education, St. Francis Xavier University, Antigonish, NS, Canada
- Correspondence: Daniel B. Robinson
| | - Sebastian Harenberg
- Department of Human Kinetics, St. Francis Xavier University, Antigonish, NS, Canada
| | - William Walters
- Department of Teacher Education, St. Francis Xavier University, Antigonish, NS, Canada
| | - Joe Barrett
- Department of Educational Studies, Brock University, St. Catherines, ON, Canada
| | - Anna Cudmore
- Department of Teacher Education, St. Francis Xavier University, Antigonish, NS, Canada
| | - Kelsey Fahie
- Physical and Health Education Canada, Ottawa, ON, Canada
| | - Tricia Zakaria
- Physical and Health Education Canada, Ottawa, ON, Canada
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Dolan SB, Wittenauer R, Njoroge A, Onyango P, Owiso G, Shearer JC, Lober WB, Liu S, Puttkammer N, Rabinowitz P. Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study of Modified User Workflows. JMIR Form Res 2023; 7:e39777. [PMID: 36927606 PMCID: PMC10019767 DOI: 10.2196/39777] [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: 05/23/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Digital health interventions have the potential to improve the provision of health care services through digitized data collection and management. Low- and middle-income countries are beginning to introduce electronic immunization registries (EIRs) into their routine immunization services to better capture and store childhood vaccination information. Especially in Africa, where 25% of children remain unimmunized or underimmunized, technologies that can help identify children due for a vaccination are particularly important for improving vaccination coverage. However, an improved understanding of the effectiveness of these systems is needed to develop and deploy sustainable EIRs in low- and middle-income countries. OBJECTIVE We conducted an interventional pretest-posttest design study that sought to improve time efficiency through workflow modifications in Kenyan immunization clinics. Our aim was to describe how activity times differed after introducing workflow modifications that could potentially reduce the time needed to perform routine data entry activities. Our intent was to demonstrate changes in efficiency when moving from the existing dual-data entry workflow to a future paperless workflow by health facility size and experience length of health care workers (HCWs). METHODS We tested how 3 workflow modifications would affect time utilization among HCWs using the EIR at the point of care compared with baseline immunization clinic workflows. Our outcome of interest was the time taken to complete individual activities and a patient's total time in the clinic where we compared the time spent during the baseline workflow with that during the modified workflow. We used a standardized tool to observe and document the immunization clinic workflow. To estimate differences in time utilization, we used bivariate analyses and fit multivariate linear mixed-effects models. RESULTS Our study found that for HCWs using an EIR, the introduction of modified workflows decreased the amount of time needed to provide services to children seen in the immunization clinic. With a baseline mean time of 10 minutes spent per child, this decreased by about 3 minutes when the preparation modification was introduced and almost 5 minutes for the paperless and combined modifications. Results pertaining to the EIR's performance and ability to connect to the internet were particularly insightful about potential causes of delays. CONCLUSIONS We were able to conduct a concise clinical simulation exercise by introducing modified workflows and estimating their impact on time utilization in immunization clinics using an EIR. We found that the paperless workflow provided the largest time savings when delivering services, although this was threatened by poor EIR performance and internet connectivity. This study demonstrated that not only should digital health interventions be built and adapted for particular use cases but existing user workflows also need to adapt to new technology.
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Affiliation(s)
- Samantha B Dolan
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Rachel Wittenauer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anne Njoroge
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - George Owiso
- International Training and Education Center for Health, University of Washington, Nairobi, Kenya
| | | | - William B Lober
- Department of Global Health, University of Washington, Seattle, WA, United States
- Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Shan Liu
- Department of Industrial and Systems Engineering, University of Washington, Seattle, WA, United States
| | - Nancy Puttkammer
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Peter Rabinowitz
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
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Dolan SB, Wittenauer R, Shearer JC, Njoroge A, Onyango P, Owiso G, Lober WB, Liu S, Puttkammer N, Rabinowitz P. Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability. JMIR Form Res 2023; 7:e39775. [PMID: 36917157 PMCID: PMC10131705 DOI: 10.2196/39775] [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: 05/23/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries. OBJECTIVE In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry's usability. METHODS Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers. RESULTS Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1-ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2-confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3-identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4-make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality. CONCLUSIONS We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users' workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users' needs and again after scale-up to ensure that interventions are suitable for all user settings.
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Affiliation(s)
- Samantha B Dolan
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Rachel Wittenauer
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Anne Njoroge
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - George Owiso
- International Training and Education Center for Health, University of Washington, Nairobi, Kenya
| | - William B Lober
- Department of Global Health, University of Washington, Seattle, WA, United States.,Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
| | - Shan Liu
- Department of Industrial and Systems Engineering, University of Washington, Seattle, WA, United States
| | - Nancy Puttkammer
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Peter Rabinowitz
- International Training and Education Center for Health, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
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Liu JX, Vallin J, Chiu C, Cabrera FA, Hunter LA, Rao A, Njau P, McCoy SI. Designing for two: How enhancing human-centered design with behavioral nudges unlocked breakthroughs to promote young women's psychological safety and access to reproductive care in Tanzania. Soc Sci Med 2023; 320:115683. [PMID: 36709692 PMCID: PMC10798268 DOI: 10.1016/j.socscimed.2023.115683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/16/2023]
Abstract
Adolescent girls and young women (AGYW; ages 15-24) in sub-Saharan Africa face many barriers to accessing preventive sexual and reproductive health (SRH) services. We drew upon the strengths of two complementary approaches, human-centered design and behavioral economics, to craft a holistic, highly-tailored, and empathetic intervention to motivate AGYW to seek contraception and HIV self-test kits at community drug shops. To encourage engagement, we embedded "nudge" strategies at different opportunity points (uncovered during our design research) along the care-seeking and service delivery journey. Our Malkia Klabu intervention is a loyalty program designed to enhance drug shops' role as SRH providers through which AGYW earned punches for shop purchases redeemable for small prizes; free SRH products could be requested at any time. From our 4-month pilot in Shinyanga, Tanzania, we assess the extent to which different behavioral nudge strategies motivated behaviors as predicted by synthesizing findings from (1) in-depth interviews with AGYW and shopkeepers, (2) shop program records, (3) shop observations, and (4) customer exit surveys. Overall, we find that AGYW and shopkeepers were motivated by many intervention features as intended and consistent with hypothesized mechanisms. We found strong evidence of social norms for helping to spread awareness of Malkia Klabu among peers, prize incentives for drawing AGYW back to shops, and the opt-out default membership gift of an HIV self-test kit for encouraging testing uptake and exploration of contraceptives. Shopkeepers in both arms noted increased community status from distributing HIV self-testing kits (ego). Malkia Klabu shopkeepers experienced increased customer traffic and business revenues (incentives), which reduced shopkeepers' gatekeeping tendencies and earned them additional recognition as champions of AGYW well-being. Integrating human-centered design and behavioral economics was effective for developing an innovative and effective intervention that simultaneously met the different needs of economic actors in support of public health priorities.
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Affiliation(s)
- Jenny X Liu
- Institute for Health and Aging; Bixby Center for Global Reproductive Health; University of California, San Francisco, 490 Illinois St. 123J, San Francisco, CA 94158, USA.
| | - Janelli Vallin
- Institute for Health and Aging; Bixby Center for Global Reproductive Health; University of California, San Francisco, 490 Illinois St. 123J, San Francisco, CA 94158, USA.
| | - Calvin Chiu
- School of Public Health; University of California, Berkeley; 2121 Berkeley Way, Berkeley, CA, 94704, USA.
| | - F Abigail Cabrera
- Center for Excellence in Primary Care; University of California, San Francisco; Zuckerberg San Francisco General Hospital; 995 Potrero Ave, Ward 83, San Francisco, CA, 94110, USA.
| | - Lauren A Hunter
- School of Public Health; University of California, Berkeley; 2121 Berkeley Way, Berkeley, CA, 94704, USA.
| | - Aarthi Rao
- Behavioral Insights and Program Design; Cityblock Health; 86 Laws Brook Rd, Concord, MA 01742, USA.
| | - Prosper Njau
- National AIDS Control Programme, Ministry of Health, Community Development, Gender, Elderly and Children; Government City - Mtumba, Afya Road, P.O. Box 743, 40478 Dodoma, United Republic of Tanzania.
| | - Sandra I McCoy
- School of Public Health; University of California, Berkeley; 2121 Berkeley Way, Berkeley, CA, 94704, USA.
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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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Mavragani A, Johnson C, Kiche S, Dastrup K, Nguyen J, Daniels A, Mbwayo A, Amanya C, Munson S, Collins PY, Weiner BJ, Dorsey S. Understanding Lay Counselor Perspectives on Mobile Phone Supervision in Kenya: Qualitative Study. JMIR Form Res 2023; 7:e38822. [PMID: 36729591 PMCID: PMC9936369 DOI: 10.2196/38822] [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: 04/18/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Task shifting is an effective model for increasing access to mental health treatment via lay counselors with less specialized training that deliver care under supervision. Mobile phones may present a low-technology opportunity to replace or decrease reliance on in-person supervision in task shifting, but important technical and contextual limitations must be examined and considered. OBJECTIVE Guided by human-centered design methods, we aimed to understand how mobile phones are currently used when supervising lay counselors, determine the acceptability and feasibility of mobile phone supervision, and generate solutions to improve mobile phone supervision. METHODS Participants were recruited from a large hybrid effectiveness implementation study in western Kenya wherein teachers and community health volunteers were trained to provide trauma-focused cognitive behavioral therapy. Lay counselors (n=24) and supervisors (n=3) participated in semistructured interviews in the language of the participants' choosing (ie, English or Kiswahili). Lay counselor participants were stratified by supervisor-rated frequency of mobile phone use such that interviews included high-frequency, average-frequency, and low-frequency phone users in equal parts. Supervisors rated lay counselors on frequency of phone contact (ie, calls and SMS text messages) relative to their peers. The interviews were transcribed, translated when needed, and analyzed using thematic analysis. RESULTS Participants described a range of mobile phone uses, including providing clinical updates, scheduling and coordinating supervision and clinical groups, and supporting research procedures. Participants liked how mobile phones decreased burden, facilitated access to clinical and personal support, and enabled greater independence of lay counselors. Participants disliked how mobile phones limited information transmission and relationship building between supervisors and lay counselors. Mobile phone supervision was facilitated by access to working smartphones, ease and convenience of mobile phone supervision, mobile phone literacy, and positive supervisor-counselor relationships. Limited resources, technical difficulties, communication challenges, and limitations on which activities can be effectively performed via mobile phone were barriers to mobile phone supervision. Lay counselors and supervisors generated 27 distinct solutions to increase the acceptability and feasibility of mobile phone supervision. Strategies ranged in terms of the resources required and included providing phones and airtime to support supervision, identifying quiet and private places to hold mobile phone supervision, and delineating processes for requesting in-person support. CONCLUSIONS Lay counselors and supervisors use mobile phones in a variety of ways; however, there are distinct challenges to their use that must be addressed to optimize acceptability, feasibility, and usability. Researchers should consider limitations to implementing digital health tools and design solutions alongside end users to optimize the use of these tools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s43058-020-00102-9.
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Affiliation(s)
| | - Clara Johnson
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Sharon Kiche
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Kara Dastrup
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Julie Nguyen
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Alayna Daniels
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Sean Munson
- Human Centered Design & Engineering, University of Washington, Seattle, WA, United States
| | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of of Health Services, University of Washington, Seattle, WA, United States
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, United States
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Lamahewa K, Griffin S, Seward N, Temmerman M, West J, de Melo M, Raby E, Alonso A, Burnside B, Chissale F, Gheerawo R, Chepchichir EL, Mandlate F, Mahangue D, Mohiddin A, Neagu E, Salisbury TT. Protocol for intervention development to improve adolescent perinatal mental health in Kenya and Mozambique: The INSPIRE project. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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45
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Hunter LA, Rao A, Napierala S, Kalinjila A, Mnyippembe A, Hassan K, Bertozzi SM, Mfaume R, Njau P, Liu JX, McCoy SI. Reaching Adolescent Girls and Young Women With HIV Self-Testing and Contraception at Girl-Friendly Drug Shops: A Randomized Trial in Tanzania. J Adolesc Health 2023; 72:64-72. [PMID: 36241492 PMCID: PMC9893895 DOI: 10.1016/j.jadohealth.2022.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/22/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE We hypothesized that an intervention designed to create girl-friendly drug shops would increase access to sexual and reproductive health products and services among adolescent girls and young women (AGYW) (ages 15-24 years) in Tanzania. METHODS We conducted a four-month randomized trial at 20 drug shops in Shinyanga, Tanzania from August-December 2019 to determine if the Malkia Klabu ("Queen Club") intervention increased AGYW patronage and the provision of HIV self-testing (HIVST), contraception, and health facility referrals to AGYW (primary outcomes). Drug shops were randomized 1:1 to the intervention or comparison arm. All shops were provided with OraQuick HIVST kits to give to AGYW for free. Intervention shops implemented Malkia Klabu, a loyalty program for AGYW created using human-centered design through which AGYW could also access free contraception. We compared outcomes in intention-to-treat analyses using shop observations and shopkeeper records. RESULTS By endline, shops implementing Malkia Klabu had higher AGYW patronage than comparison shops (rate ratio: 4.4; 95% confidence interval: 2.0, 9.8). Intervention shops distributed more HIVST kits (median per shop: 130.5 vs. 58.5, P = .02) and contraceptives (325.5 vs. 7.0, P < .01) to AGYW and provided more referrals for HIV, family planning, or pregnancy services combined (3.5 vs. 0.5, P = .02) than comparison shops. DISCUSSION The Malkia Klabu intervention increased AGYW patronage and the provision of HIVST kits, contraception, and referrals to AGYW at drug shops, despite HIVST kits being freely available at all participating shops. Enhancing drug shops with girl-friendly services may be an effective strategy to reach AGYW with sexual and reproductive health services.
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Affiliation(s)
- Lauren A. Hunter
- School of Public Health; University of California, Berkeley; Berkeley, California, U.S
| | - Aarthi Rao
- Cityblock Health; Boston, Massachusetts, U.S
| | | | | | | | - Kassim Hassan
- Health for a Prosperous Nation; Dar es Salaam, Tanzania
| | - Stefano M. Bertozzi
- School of Public Health; University of California, Berkeley; Berkeley, California, U.S
| | - Rashid Mfaume
- Shinyanga Regional Medical Office; Shinyanga, Tanzania
| | - Prosper Njau
- Health for a Prosperous Nation; Dar es Salaam, Tanzania.,National AIDS Control Program; Ministry of Health, Community Development, Gender, Elderly, and Children; Dar es Salaam, Tanzania
| | - Jenny X. Liu
- Institute for Health and Aging; Bixby Center for Global Reproductive Health; University of California, San Francisco; San Francisco, California, U.S
| | - Sandra I. McCoy
- School of Public Health; University of California, Berkeley; Berkeley, California, U.S
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46
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Atoyebi O, Beaudoin M, Routhier F, Auger C, Demers L, Wister A, Plante M, Mortenson WB. Potential assistive technology preferences of informal caregivers of people with disability. J Rehabil Assist Technol Eng 2023; 10:20556683231172671. [PMID: 37168036 PMCID: PMC10164850 DOI: 10.1177/20556683231172671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
Background Preferences of informal caregivers of people with neurocognitive disorders for technological solutions are important in user- centered design approaches. It is crucial to take into consideration the needs and preferences of users when developing new technology to facilitate their uptake. Objectives The objective of this study was to determine caregiver preferences for potential technological solutions to help address their needs and compare technology preferences of caregivers who provide care to those with and without neurocognitive disorders (NCD). Methods This was a quantitative descriptive study. We surveyed informal caregivers of older adults with disability in Canada. Participants were asked to answer questions about their preferences for 10 potential technological solutions that could be developed to make caregiving easier. Results Data from 125 respondents (72 caregivers of people with NCD and 53 caregivers of people with non-NCD-related disabilities) were analyzed. Generally, caregivers preferred web-based solutions as these were among the first five choices for both groups combined. However, there were some differences in the order of preference of potential solutions in both groups. Conclusion Informal caregivers of people with NCD preferred web-based solutions to help address their needs.
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Affiliation(s)
- Oladele Atoyebi
- University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Research Program, Vancouver, Canada
| | - Maude Beaudoin
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de La Capitale-Nationale, Québec City, Canada
- Université Laval, Québec City, Canada
| | - François Routhier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé et de Services Sociaux de La Capitale-Nationale, Québec City, Canada
- Université Laval, Québec City, Canada
| | - Claudine Auger
- Université de Montréal, Montréal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, Canada
| | - Louise Demers
- Université de Montréal, Montréal, Canada
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal, Montréal, Canada
| | - Andrew Wister
- Gerontology Research Centre, Vancouver, Canada
- Simon Fraser University, Vancouver, Canada
| | - Michelle Plante
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal, Montréal, Canada
| | - W Ben Mortenson
- University of British Columbia, Vancouver, Canada
- GF Strong Rehabilitation Research Program, Vancouver, Canada
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47
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Sarley D, Hwang A, Fenton Hall B, Ford A, Giersing B, Kaslow DC, Wahl B, Friede M. Accelerating access for all through research and innovation in immunization: Recommendations from Strategic Priority 7 of the Immunization Agenda 2030. Vaccine 2022:S0264-410X(22)01454-2. [PMID: 36529593 DOI: 10.1016/j.vaccine.2022.11.041] [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: 04/19/2021] [Revised: 06/08/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
Research and innovation have been fundamental to many of the successes in immunization thus far, and will play important roles in the future success of Immunization Agenda 2030 (IA2030). Strategic Priority 7 (SP7) of IA2030, which addresses research and innovation, is explicitly informed by country needs and priorities, and aims to strengthen the innovation ecosystem through capacity building and collaboration at country, regional, and global levels. SP7 identifies four key focus areas: (1) "needs-based innovation", (2) "new and improved products, services, and practices", (3) "evidence for implementation", and (4) "local capacity". Strategic interventions in these key focus areas apply the lessons of the Global Vaccine Action Plan and the "Decade of Vaccines" to emphasize local innovation, promote the use of research by countries to improve program performance and impact, and encourage capacity building for the development and implementation of innovations. The proposed approach will maintain a focus on the development of new vaccines and the improvement of existing vaccines, and increase attention to innovation in service delivery. Monitoring and evaluation will foster evidence-based priority setting at the country level and help to ground the global research and development (R&D) agenda in the needs of communities. Together, these approaches are intended to harness the power of research and innovation more effectively, to meet the challenges of the future and achieve the ambitious goals of IA2030.
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Affiliation(s)
- David Sarley
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | | | - B Fenton Hall
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andrew Ford
- Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Brian Wahl
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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48
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King G, Bowman LR, Curran CJ, Oh A, Thompson L, McDougall C, Menna-Dack D, Howson-Strong L. A case study of a strategic initiative in pediatric rehabilitation transition services: An insiders' perspective on team principles and practices. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:999973. [PMID: 36569639 PMCID: PMC9786113 DOI: 10.3389/fresc.2022.999973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
Aims The aim was to describe an innovative initiative that took place in a pediatric rehabilitation hospital. The goal of this organization-wide strategic initiative, called the Transition Strategy, was to improve service delivery to children/youth with disabilities and their families at times of life transition. The research question was: What are the key elements that have contributed to the success of the Strategy, from the perspective of team members? The objectives were to describe: (a) the guiding principles underlying team functioning and team practices, (b) key enablers of positive team functioning, (c) the nature of effective team practices, and (d) lessons learned. Methods A holistic descriptive case study was conducted, utilizing historical documents, tracked outcome data, and the experiences and insights of multidisciplinary team members (the authors). Reflecting an insiders' perspective, the impressions of team members were key sources of data. The perspectives of team members were used to generate key teamwork principles, enablers of team functioning, team practices, and key learnings. Findings and Discussion Team members identified four guiding humanistic principles (respect, support, partnership, and open communication). These principles underpinned three novel practices that contributed to team effectiveness in the eyes of team members: supportive relational practices, human-centered co-design, and solution-focused communication. Key enablers were the relational style of leadership, and a team climate of innovation, autonomy, and trust, supported by the organizational vision. This team climate fostered a sense of psychological safety, thereby encouraging both experimentation and learning from failure. Conclusions This article provides information for other healthcare organizations interested in understanding the Strategy's value and its implementation. It provides a practical example of how to adopt a humanistic approach to health care, leading to both innovative service development and thriving among team members.
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Affiliation(s)
- Gillian King
- Bloorview Research Institute and Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada,Correspondence: Gillian King
| | - Laura R. Bowman
- Holland Bloorview Kids Rehabilitation Hospital and Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - C. J. Curran
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Anna Oh
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Laura Thompson
- Holland Bloorview Kids Rehabilitation Hospital and Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Carolyn McDougall
- Holland Bloorview Kids Rehabilitation Hospital and Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Dolly Menna-Dack
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Laura Howson-Strong
- Holland Bloorview Kids Rehabilitation Hospital and Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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Bacchin D, Pernice GFA, Pierobon L, Zanella E, Sardena M, Malvestio M, Gamberini L. Co-Design in Electrical Medical Beds with Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16353. [PMID: 36498422 PMCID: PMC9738800 DOI: 10.3390/ijerph192316353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Among the plethora of instruments present in healthcare environments, the hospital bed is undoubtedly one of the most important for patients and caregivers. However, their design usually follows a top-down approach without considering end-users opinions and desires. Exploiting Human-centered design (HCD) permits these users to have a substantial role in the final product outcome. This study aims to empower caregivers to express their opinion about the hospital bed using a qualitative approach. For a holistic vision, we conducted six focus groups and six semi-structured interviews with nurses, nursing students, social-health operators and physiotherapists belonging to many healthcare situations. We then used thematic analysis to extract the themes that participants faced during the procedures, providing a comprehensive guide to designing the future electrical medical bed. These work results could also help overcome many issues that caregivers face during their everyday working life. Moreover, we identified the User Experience features that could represent the essential elements to consider.
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Affiliation(s)
- Davide Bacchin
- Department of General Psychology, University of Padova, 35131 Padova, Italy
| | | | - Leonardo Pierobon
- Human Inspired Technology (HIT) Research Centre, University of Padova, 35121 Padova, Italy
| | - Elena Zanella
- Human Inspired Technology (HIT) Research Centre, University of Padova, 35121 Padova, Italy
| | | | | | - Luciano Gamberini
- Human Inspired Technology (HIT) Research Centre, University of Padova, 35121 Padova, Italy
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50
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Moser A, Korstjens I. Series: Practical guidance to qualitative research. Part 5: Co-creative qualitative approaches for emerging themes in primary care research: Experience-based co-design, user-centred design and community-based participatory research. Eur J Gen Pract 2022; 28:1-12. [PMID: 35037811 PMCID: PMC8765256 DOI: 10.1080/13814788.2021.2010700] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 11/03/2022] Open
Abstract
This article, the fifth in a series aiming to provide practical guidance for qualitative research in primary care, introduces three qualitative approaches with co-creative characteristics for addressing emerging themes in primary care research: experience-based co-design, user-centred design and community-based participatory research. Co-creation aims to define the (research) problem, develop and implement interventions and evaluate and define (research and practice) outcomes in partnership with patients, family carers, researchers, care professionals and other relevant stakeholders. Experience-based co-design seeks to understand how people experience a health care process or service. User-centred design is an approach to assess, design and develop technological and organisational systems, for example, eHealth, involving end-users in the design and decision-making processes. Community-based participatory research is a collaborative approach addressing a locally relevant health issue. It is often directed at hard-to-reach and vulnerable people. We address the context, what, why, when and how of these co-creative approaches, and their main practical and methodological challenges. We provide examples of empirical studies using these approaches and sources for further reading.
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Affiliation(s)
- Albine Moser
- Research Centre Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Irene Korstjens
- Research Centre for Midwifery Science, Zuyd University of Applied Sciences, Maastricht, The Netherlands
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