Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process

BACKGROUND

On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need.

METHODS

We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists.

RESULTS

The patients' solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient's diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional?

CONCLUSION

All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.

Co-design and development of the sit-stand e-guide: An e-training program for the optimal use of sit-stand workstations

This paper describes the co-design and development process of an evidence-informed e-training program (Sit-Stand e-Guide) to support the safe and optimal use of sit-stand workstations from ergonomics and behavioural change perspectives. Using an instructional system design process, supported by a participatory design approach, data was collected through three workshops with workplace consumers (staff [n = 5] and managers [n = 5]), and subject matter experts (n = 5). Content and learning activities were developed based on behaviour change principles and optimal pedagogy. Key topics identified for the e-training were sedentary behaviour and health; workstation set-up; and strategies for behaviour change. Learning activities (scenarios and reflection) to enhance knowledge retention and skills implementation and an interactive one-page guide on completion were included in the e-training. The relevance and usefulness of the training prototype were reviewed through one-to-one think-aloud sessions with the workshop consumers (n = 5) and external health and safety professionals (n = 5) receiving positive feedback. The Sit-Stand e-Guide is readily available for workplace implementation and evaluation. This paper serves as a practical guide for future training development.

Identifying app components that promote physical activity: a group concept mapping study

Background

Digital interventions are a promising avenue to promote physical activity in healthy adults. Current practices recommend to include end-users early on in the development process. This study focuses on the wishes and needs of users regarding an a mobile health (mHealth) application that promotes physical activity in healthy adults, and on the differences between participants who do or do not meet the World Health Organization's recommendation of an equivalent of 150 minutes of moderate intensity physical activity.

Methods

We used a mixed-method design called Group Concept Mapping. In a first phase, we collected statements completing the prompt "In an app that helps me move more, I would like to see/ do/ learn the following…" during four brainstorming sessions with physically inactive individuals (n = 19). The resulting 90 statements were then sorted and rated by a new group of participants (n = 46). Sorting data was aggregated, and (dis)similarity matrices were created using multidimensional scaling. Hierarchical clustering was applied using Ward's method. Analyses were carried out for the entire group, a subgroup of active participants and a subgroup of inactive participants. Explorative analyses further investigated ratings of the clusters as a function of activity level, gender, age and education.

Results

Six clusters of statements were identified, namely 'Ease-of-use and Self-monitoring', 'Technical Aspects and Advertisement', 'Personalised Information and Support', 'Motivational Aspects', 'Goal setting, goal review and rewards', and 'Social Features'. The cluster 'Ease-of-use and Self-monitoring' was rated highest in the overall group and the active subgroup, whereas the cluster 'Technical Aspects and Advertisement' was scored as most relevant in the inactive subgroup. For all groups, the cluster 'Social Features' was scored the lowest. Explorative analysis revealed minor between-group differences.

Discussion

The present study identified priorities of users for an mHealth application that promotes physical activity. First, the application should be user-friendly and accessible. Second, the application should provide personalized support and information. Third, users should be able to monitor their behaviour and compare their current activity to their past performance. Fourth, users should be provided autonomy within the app, such as over which and how many notifications they would like to receive, and whether or not they want to engage with social features. These priorities can serve as guiding principles for developing mHealth applications to promote physical activity in the general population.

Communicating the results of risk-based breast cancer screening through visualizations of risk: a participatory design approach

BACKGROUND

Risk-based breast cancer (BC) screening raises new questions regarding information provision and risk communication. This study aimed to: 1) investigate women's beliefs and knowledge (i.e., mental models) regarding BC risk and (risk-based) BC screening in view of implications for information development; 2) develop novel informational materials to communicate the screening result in risk-based BC screening, including risk visualizations of both quantitative and qualitative information, from a Human-Centered Design perspective.

METHODS

Phase 1: Interviews were conducted (n = 15, 40-50 years, 5 lower health literate) on women's beliefs about BC risk and (risk-based) BC screening. Phase 2: In three participatory design sessions, women (n = 4-6 across sessions, 40-50 years, 2-3 lower health literate) made assignments and created and evaluated visualizations of risk information central to the screening result. Prototypes were evaluated in two additional sessions (n = 2, 54-62 years, 0-1 lower health literate). Phase 3: Experts (n = 5) and women (n = 9, 40-74 years) evaluated the resulting materials. Two other experts were consulted throughout the development process to ensure that the content of the information materials was accurate. Interviews were transcribed literally and analysed using qualitative thematic analysis, focusing on implications for information development. Notes, assignments and materials from the participatory design sessions were summarized and main themes were identified.

RESULTS

Women in both interviews and design sessions were positive about risk-based BC screening, especially because personal risk factors would be taken into account. However, they emphasized that the rationale of risk-based screening and classification into a risk category should be clearly stated and visualized, especially for higher- and lower-risk categories (which may cause anxiety or feelings of unfairness due to a lower screening frequency). Women wanted to know their personal risk, preferably visualized in an icon array, and wanted advice on risk reduction and breast self-examination. However, most risk factors were considered modifiable by women, and the risk factor breast density was not known, implying that information should emphasize that BC risk depends on multiple factors, including breast density.

CONCLUSIONS

The information materials, including risk visualizations of both quantitative and qualitative information, developed from a Human-Centered Design perspective and a mental model approach, were positively evaluated by the target group.

The development of a novel sexual health promotion intervention for young people with mental ill-health: the PROSPEct project

BACKGROUND

Young people with mental ill-health experience higher rates of high-risk sexual behaviour, have poorer sexual health outcomes, and lower satisfaction with their sexual wellbeing compared to their peers. Ensuring good sexual health in this cohort is a public health concern, but best practice intervention in the area remains under-researched. This study aimed to co-design a novel intervention to address the sexual health needs of young people with mental ill-health to test its effectiveness in a future trial undertaken in youth mental health services in Melbourne, Australia.

METHODS

We followed the 2022 Medical Research Council (MRC) guidelines for developing and evaluating complex interventions. This involved synthesising evidence from the 'top down' (published evidence) and 'bottom up' (stakeholder views). We combined systematic review findings with data elicited from qualitative interviews and focus groups with young people, carers, and clinicians and identified critical cultural issues to inform the development of our intervention.

RESULTS

Existing evidence in the field of sexual health in youth mental health was limited but suggested the need to address sexual wellbeing as a concept broader than an absence of negative health outcomes. The Information-Motivation-Belief (IMB) model was chosen as the theoretical Framework on which to base the intervention. Interviews/focus groups were conducted with 29 stakeholders (18 clinicians, three carers, and eight young people). Synthesis of the evidence gathered resulted in the co-design of a novel intervention consisting of an initial consultation and four 60-90-minute sessions delivered individually by a young 'sex-positive' clinician with additional training in sexual health. Barriers and supports to intervention success were also identified.

CONCLUSIONS

Using the MRC Framework has guided the co-design of a potentially promising intervention that addresses the sexual health needs of young people with mental ill-health. The next step is to test the intervention in a one-arm feasibility trial.

Co-designing community-level integral interventions for active ageing: a systematic review from the lens of community-based participatory research

BACKGROUND

While community-level interventions for promoting active ageing have received increasing attention and there is a trend to leverage technology to support traditional physical or social interventions, little hands-on guidance exists for designing these integral interventions. This study aimed to examine the interventions reported in the literature guided by Community-Based Participatory Research (CBPR) principles. The goal is to extract insights that inform future practices in co-designing integral interventions for active ageing.

METHODS

The systematic review focused on community-level interventions promoting active ageing that integrated physical, social, and digital elements, i.e., integral interventions. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The included interventions were analysed abductively based on the CBPR principles.

RESULTS

A total of 13 studies were included, and 24 design considerations were generated under eight categories. Further reflection identified the interrelated nature of these design considerations and pinpointed the gaps in current research. This study highlights the urgency and importance of sharing recruitment methods and resource allocation details, recording and reporting collaboration specifics, and disseminating findings to stakeholders beyond academia.

CONCLUSIONS

This study offers valuable insights and practical guidance to researchers and practitioners developing community-level integral interventions for active ageing. The findings also serve as a starting point for accumulating knowledge and practice in co-designing integral interventions for active ageing at the community level. The next crucial phase involves evaluating these design considerations within real-world cases to assess their applicability and identify potential areas for improvement.

Using a participatory design to develop an implementation framework for integrating falls prevention for older people within the Chinese primary health care system

BACKGROUND

Chinese National Essential Public Health Service Package (NEPHSP) has mandated primary health care providers to provide falls prevention for community-dwelling older people. But no implementation framework is available to guide better integration of falls prevention for older people within the primary health care system.

METHODS

This is a two-stage online participatory design study consisting of eight workshops with stakeholders from three purposively selected cities. First, two workshops were organised at each study site to jointly develop the framework prototype. Second, to refine, optimise and finalise the prototype via two workshops with all study participants. Data analysis and synthesis occurred concurrently with data collection, supported by Tencent Cloud Meeting software.

RESULTS

All participants confirmed that the integration of falls prevention for older people within the NEPHSP was weak and reached a consensus on five opportunities to better integrate falls prevention, including workforce training, community health promotion, health check-ups, health education and scheduled follow-up, during the delivery of NEPHSP. Three regional-tailored prototypes were then jointly developed and further synthesised into a generic implementation framework by researchers and end-users. Guided by this framework, 11 implementation strategies were co-developed under five themes.

CONCLUSIONS

The current integration of falls prevention in the NEPHSP is weak. Five opportunities for integrating falls prevention in the NEPHSP and a five-themed implementation framework with strategies are co-identified and developed, using a participatory design approach. These findings may also provide other regions or countries, facing similar challenges, with insights for promoting falls prevention for older people.

"People are now working together for a common good": The effect on social capital of participatory design for community-level sanitation infrastructure in urban informal settlements

Communities with higher levels of social capital perform better than communities with lower social capital in community-level water and sanitation interventions and have better health outcomes. Although research recommends bolstering social capital to improve intervention outcomes, few studies provide empirical evidence on the effect of intervention activities on social capital. This study aimed to evaluate the effect of participatory design and community engagement activities on social capital among urban informal settlements in Suva, Fiji and Makassar, Indonesia enrolled in the Revitalizing Informal Settlements and their Environments trial using the Short Adapted Social Capital Assessment Tool. We performed confirmatory factor analyses (CFA) to test tool performance and built structural equation models to assess intervention effect on CFA-informed, sub-scale scores for cognitive and structural social capital. Qualitative in-depth interviews in Fiji and Indonesia and focus group discussions in Fiji provided nuanced understanding of intervention effects on social capital from residents' perspectives. Results confirmed the hypothesized two-factor solution but revealed differences by country and by gender in Indonesia. The intervention appeared positively related to cognitive social capital among men and women in Indonesia and negatively related to cognitive and structural social capital among men and women in Fiji. While effect sizes were small and cluster-adjustment for a small number of settlements yielded non-significant effects, trends were consistent across models and bivariate analyses and were corroborated by qualitative findings. Several contextual factors may explain these results, including timing and duration of intervention activities and influence of COVID-19. Qualitative data suggested that the relationship between participatory design and social capital may be bidirectional, helping to explain why certain settlements appeared to be better equipped to benefit from intervention activities. Practitioners and program designers should carefully consider the social pre-conditions of communities in which they intend to work to optimize program outcomes and avoid unintended consequences.

Explaining neurological factors of hearing loss through digital technologies

The study investigated how inclusion of the considerable amount of knowledge generated through basic research in multisensory experiences can be brought into clinical paediatric audiology with a specific focus to enhance understanding of the neurological implications of childhood hearing loss.

OBJECTIVES

The overall aim of the project was to investigate how to use emerging technologies to enhance the understanding of the neurological impact of paediatric hearing loss. The specific objectives were to develop an app and to evaluate its ease of use and the understanding of neurology by all types of stakeholders and end-users.

METHODS

A collaborative participatory and human centred research design was used. This methodological approach brought stakeholders into the design process at an early point of time and workshops mapped the content and interaction of the iterative development of the app. Nine clinicians from Copenhagen Hearing and Balance Centre and 4 media technologists from Multisensory Experience Lab participated in the development of the app-prototype. Evaluations were made by use of questionnaires completed by stakeholders and end-users and focus group interviews. Eight parents with children with hearing loss, 13 internal stakeholders and 14 external stakeholders participated in the evaluation of the app.

RESULTS

The app was overall positively evaluated. End users/parents with children with hearing loss were slightly more positive than stakeholders/professionals in audiology.

CONCLUSIONS

Apps are a future media for providing health care information and it proved both relevant and applicable to start using apps also to provide complex information such as neurological implications of childhood hearing loss.

Simulation-based development: shaping clinical procedures for extra-uterine life support technology

BACKGROUND

Research into Artificial Placenta and Artificial Womb (APAW) technology for extremely premature infants (born < 28 weeks of gestation) is currently being conducted in animal studies and shows promising results. Because of the unprecedented nature of a potential treatment and the high-risk and low incidence of occurrence, translation to the human condition is a complex task. Consequently, the obstetric procedure, the act of transferring the infant from the pregnant woman to the APAW system, has not yet been established for human patients. The use of simulation-based user-centered development allows for a safe environment in which protocols and devices can be conceptualized and tested. Our aim is to use participatory design principles in a simulation context, to gain and integrate the user perspectives in the early design phase of a protocol for this novel procedure.

METHODS

Simulation protocols and prototypes were developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from participants with clinical expertise from a range of disciplines. The procedure made use of fetal and maternal manikins and included animations and protocol task cards.

RESULTS

Physical simulation with the active participation of clinicians led to the diffusion of tacit knowledge and an iteratively formed shared understanding of the requirements and values that needed to be implemented in the procedure. At each sequel, participant input was translated into simulation protocols and design adjustments.

CONCLUSION

This work demonstrates that simulation-based participatory design can aid in shaping the future of clinical procedure and product development and rehearsing future implementation with healthcare professionals.

Developing and evaluating an interprofessional shared decision-making care model for patients with perinatal depression in maternal care in urban China: a study protocol

BACKGROUND

The majority of patients with perinatal depression (PND) in China do not receive adequate treatment. As forming a therapeutic alliance with patients is crucial for depression treatment, shared decision-making (SDM) shows promise in promoting patients' uptake of evidence-based mental health services, but its impact on patient outcomes and implementation in real-world maternal care remain uncertain. Therefore, this study aims to develop and evaluate an interprofessional shared decision-making (IP-SDM) model for PND to enhance maternal mental health services.

METHODS

This study contains four research phases: feasibility testing (Phase 1), toolkit development (Phase 2), usability evaluation (Phase 3), and effectiveness evaluation (Phase 4). During the development stage, focus group interviews will be conducted with expectant and new mothers, as well as maternal care providers for feasibility testing. A toolkit, including a patient decision aid along with its user guide and training materials, will be developed based on the findings of Phase 1 and syntheses of up-to-date evidence and appraised by the Delphi method. Additionally, a cognitive task analysis will be used for assessing the usability of the toolkit. During the evaluation stage, a prospective randomized controlled trial embedded in a mixed methods design will be used to evaluate the effectiveness and cost-effectiveness of the IP-SDM care model. The study targets to recruit 410 expectant and new mothers who screen positive for depression. They will be randomly assigned to either an intervention group or a control group in a 1:1 ratio. Participants in the intervention group will receive decision aid, decision coaching, and clinical consultation, in addition to usual services, while the control group will receive usual services. The primary outcome is the quality of decision-making process, and the secondary outcomes include SDM, mental health service utilization and costs, depressive symptoms, and health-related quality of life. In-depth interviews will be used to explore the facilitating and hindering factors of SDM.

DISCUSSION

This study will develop an IP-SDM care model for PND that can be implemented in maternal care settings in China. This study will contribute to the understanding of how SDM impacts mental health outcomes and facilitate the integration of mental health services into maternal care.

TRIAL REGISTRATION

ChiCTR2300072559. Registered on 16 June 2023.

Information needs and preferences of patients with an ankle fracture: User involvement study creating an mHealth solution

OBJECTIVE

The aim of this study was to employ a user-driven participatory design (PD) approach to develop an mHealth solution that addresses patients' information needs after surgical or non-surgical treatment for an ankle fracture.

METHODS

Patients with an ankle fracture and health care professionals along the treatment pathway in both the hospital and municipality participated in four workshops (WS).

RESULTS

We found that patients with an ankle fracture need information on topics such as "a typical course," "bandages and assistive devices," "what can I feel," "what may I do," "what to usually worry about," "medicine," "tips and tricks," and "contact information." Moreover, patients requested diverse modes of dissemination, preferably a combination of text, timelines, pictures, animations, and videos. Alpha and beta testing of the digital platform was conducted, and content-related improvements were made. A readability analysis showed reading ease of 40.1 of 100, meaning that it should be easily understood by 15-16 year-olds.

CONCLUSION

Involving representatives of future users in creating this mHealth solution using PD demonstrates the benefits of creating a solution that aligns with users' needs.

PRACTICE IMPLICATIONS

The mHealth solution is now ready for implementation and large-scale evaluation in phase three of the overall PD study. An mHealth usability questionnaire will be employed to assess usability by future patients with surgically or non-surgically treated ankle fractures.

Application of participatory design and open source to a sustainable proposal for sorption reactor design

An implementation proposal that seeks to globalize the scope of the sustainable technologies developed in the University laboratories is presented. This approach uses the generation of triple-impact projects placing people at the center of technological development to bring technical and scientific knowledge into a service design oriented to global sustainable solutions. This research is an approach to what a hub for scientific research, technological implementation, and human needs would look like by designing common environments in which to interact and expand knowledge in an iterated way through the experience of all the actors involved in technological implementation. As a control case, a new technology developed at the Universidad de Buenos Aires, consisting of using sustainable materials as tubular reactor fillers for water treatment was chosen. Based on data obtained within the framework of a University extension project, in which the water quality diagnosis for human consumption was carried out and cross-examined with the mathematical analysis of sorption, design parameters of the reactor, participatory design, and open source concepts application, different virtual environments were generated with distinct objectives: i) open design environment: publishing and mapping of installed sorption reactors, reactor model plans, and useful information related to drinking water quality (aimed at contributors of the open source design environment); ii) platform for academic actors linking: connecting data between prototyping lab for participatory design of sorption reactors (aimed at university research users); iii) information disclosure page: space where the implemented technology impact is displayed and shows options to contact researchers and request a reactor design diagnosis for another community (aimed at beneficiary users). A technological service designed to link the University with the community was proposed, by resolving one of the main gaps related to the possibility for communities to access public financing for self-managed improvement projects, increasing the appropriation of the adopted technology and democratizing public investment, making it sustainable over time.

Participatory Design for Cognitive Science: Examples From the Learning Sciences and Human-Computer Interaction

Given the recent call to strengthen collaboration between researchers and relevant practitioners, we consider participatory design as a way to advance Cognitive Science. Building on examples from the Learning Sciences and Human-Computer Interaction, we (a) explore what, why, who, when, and where researchers can collaborate with community members in Cognitive Science research; (b) examine the ways in which participatory-design research can benefit the field; and (c) share ideas to incorporate participatory design into existing basic and applied research programs. Through this article, we hope to spark deeper discussions on how cognitive scientists can collaborate with community members to benefit both research and practice.

Ageism in the Discourse and Practice of Designing Digital Technology for Older Persons: A Scoping Review

BACKGROUND AND OBJECTIVES

Involving older persons in the design process of digital technology (DT) promotes the development of technologies that are appealing, beneficial, and used. However, negative discourse on aging and ageism are potential underlying factors that could influence which and how DTs are designed and how older persons are involved in the design process. This scoping review investigates the explicit and implicit manifestations of ageism in the design process of DT.

RESEARCH DESIGN AND METHODS

Seven databases were screened for studies reporting on the design of DT with older persons between January 2015 and January 2020. Data regarding study and DT characteristics, discourse about older persons, and their involvement in the design process were extracted, coded, and analyzed using critical discourse analysis.

RESULTS

Sixty articles met the inclusion criteria and were included in the analysis. Various forms of exclusion of older persons from the design process were identified, such as no or low involvement, upper-age limits, and sample biases toward relatively "active," healthy and "tech-savvy" older persons. Critical discourse analysis revealed the use of outdated language, stereotypical categorizations, and/or design decisions based on ageism in 71.7% of the studies.

DISCUSSION AND IMPLICATIONS

A discrepancy was found between an "ideal" discourse regarding the involvement of older persons throughout the design process and actual practice. Manifestations of ageism, errors, and biases of designing DT with older persons are discussed. This article calls for more authentic inclusion of older persons and higher awareness toward the implications of ageism in the design process of DT.

Impact of graphical versus textual sociotechnical prototypes on the generation of mental models in work design

In an experiment so-termed sociotechnical prototypes based on either a graphical or a textual representation of an envisioned work system were evaluated with regard to their ability to communicate a design vision to people involved in a participatory design process. Results of the study reveal, in line with hypotheses, that the graphical prototype, in contrast to the textual one, was significantly better accepted as well as faster explored and evaluated. Moreover, results support the hypothesis that the graphical sociotechnical prototype helps to build up a more accurate mental representation of the system with regard to its elements (e.g. job roles, tasks). However, no positive effect on the mental representation of the system in terms of the relations between its elements (e.g. which role performs which task?) was found. Finally, practical implications and perspectives for further development of the sociotechnical prototyping approach to envision future work systems are discussed.

How to Design Successful Participatory Design Workshops for Digital Health Solutions?

Participatory design (PD) is increasingly used to support design and development of digital health solutions. The involves representatives of future user groups and experts to collect their needs and preferences and ensure easy to use and useful solutions. However, reflections and experiences with PD in designing digital health solutions are rarely reported. The objective of this paper is to collect those experiences including lessons learnt and moderator experiences, and to identify challenges. For this purpose, we conducted a multiple case study to explore the skill development process required to successfully design a solution in the three cases. From the results, we derived good practice guidelines to support designing successful PD workshops. They include adapting the workshop activities and material to the vulnerable participant group and considering their environment and previous experiences, planning sufficient time for preparation and supporting the activities with appropriate material. We conclude that PD workshop results are perceived as useful for designing digital health solutions, but careful design is very relevant.

Learning Experience Design of Project PHoENIX: Addressing the Lack of Autistic Representation in Extended Reality Design and Development

This paper presents Project PHoENIX, which stands for Participatory, Human-centered, Equitable, Neurodiverse, Inclusive, eXtended reality. The project aims to co-produce research with autistic users to create a virtual reality (VR) environment that is highly usable, accessible, and sensitive to the needs and preferences of these individuals. Project PHoENIX utilizes participatory design within a learning experience design (LXD) frame to locate autistic people, their caregivers, and providers centrally in the processes of immersive technology design and development, as well as research design and execution. An overarching literature review on VR and autism and issues of limited design precedent of VR environments with autistic participants is provided, as well as details on the Project PHoENIX design framework, project description, and project design outcomes. Details are provided on how the online VR environment was co-designed and co-developed through collaborative research with autistic stakeholders while being sensitive to their needs and preferences. Research findings and implications are discussed regarding the design process, constraints, principles, and insights. The paper concludes by discussing lessons learned and how this project can provide much-needed design precedent for advancing the field towards a more inclusive, human-centered, and neurodiverse VR research and development paradigms.

From design to action: participatory approach to capacity building needs for local overdose response plans

BACKGROUND

In response to the rise in opioid-related deaths, communities across Ontario have developed opioid or overdose response plans to address issues at the local level. Public Health Ontario (PHO) leads the Community Opioid / Overdose Capacity Building (COM-CAP) project, which aims to reduce overdose-related harms at the community level by working with communities to identify, develop, and evaluate capacity building supports for local needs around overdose planning. The 'From Design to Action' co-design workshop used a participatory design approach to engage communities in identifying the requirements for capacity building support.

METHODS

A participatory approach (co-design) provided opportunity for collaborative discussion around capacity building needs at the community level. The co-design workshop included three structured collaborative activities to 1) prioritize scenarios that illustrated various challenges associated with community overdose response planning, 2) prioritize the challenges within each scenario and 3) prioritize the supports to address each of these challenges. It was conducted with fifty-two participants involved in opioid/overdose-related response plans in Ontario. Participatory materials were informed by the results of a situational assessment (SA) data gathering process, including survey, interview, and focus group data. A voting system, including dot stickers and discussion notes, was applied to identify priority supports and delivery mechanisms.

RESULTS

At the workshop, key challenges and top-priority supports were identified, for development and implementation. The prioritized challenges were organized into five categories of capacity building supports addressing: 1) stigma & equity; 2) trust-based relationships, consensus building & on-going communication; 3) knowledge development & on-going access to information and data; 4) tailored strategies and plan adaptation to changing structures and local context; and 5) structural enablers and responsive governance.

CONCLUSION

Using a participatory approach, the workshop provided an opportunity for sharing, generating, and mobilizing knowledge to address research-practice gaps at the community level for opioid response planning. The application of health design methods such as the 'From Design to Action' co-design workshop supports teams to gain a deeper understanding of needs for capacity building as well as illustrating the application of participatory approaches in identifying capacity building needs for complex public health issues such as the overdose crisis.

An "ultimate partnership": Older persons' perspectives on age-stereotypes and intergenerational interaction in co-designing digital technologies

AIM

There is often a gap between the ideal of involving older persons iteratively throughout the design process of digital technology, and actual practice. Until now, the lens of ageism has not been applied to address this gap. The goals of this study were: to voice the perspectives and experiences of older persons who participated in co-designing regarding the design process; their perceived role in co-designing and intergenerational interaction with the designers; and apparent manifestations of ageism that potentially influence the design of digital technology.

METHODS

Twenty-one older persons participated in three focus groups. Five themes were identified using thematic analysis which combined a critical ageism 'lens' deductive approach and an inductive approach.

RESULTS

Ageism was experienced by participants in their daily lives and interactions with the designers during the design process. Negative images of ageing were pointed out as a potential influencing factor on design decisions. Nevertheless, positive experiences of inclusive design pointed out the importance of "partnership" in the design process. Participants defined the "ultimate partnership" in co-designing as processes in which they were involved from the beginning, iteratively, in a participatory approach. Such processes were perceived as leading to successful design outcomes, which they would like to use, and reduced intergenerational tension.

CONCLUSIONS

This study highlights the potential role of ageism as a detrimental factor in how digital technologies are designed. Viewing older persons as partners in co-designing and aspiring to more inclusive design processes may promote designing technologies that are needed, wanted and used.

A rapid review for developing a co-design framework for a pediatric surgical communication application

BACKGROUND

The exponential growth in the use of mobile health (mHealth) applications in patient care has highlighted the importance of understanding end-users' needs for successful interventions, achievable through the process of co-design. This review aims to summarize previously published uses of co-design in mHealth applications. It will inform the development of a local mHealth tool in pediatric surgery.

METHODS

The rapid review was conducted following Cochrane Rapid Review guidelines. We searched four databases from inception until August 2021 for collaborative design in mHealth apps. Two reviewers independently screened titles and abstracts using Rayyan, with a third reviewer resolving any conflicts. Studies were excluded if they were non-empirical or in other languages than English.

RESULTS

Out of 984 records screened, 175 were included for full-text screening, and 27 met all eligibility criteria. The purpose of the studies related to care support, communication, self-management or information management. All interventions involved their target audience in the co-design process, and 85% included healthcare professionals for expert opinion. Stakeholder participation was solicited via interviews, surveys, focus groups, design sessions, and prototype evaluation. To initiate the process, 15 studies included needs identification, 8 did background research, and 7 performed literature reviews.

CONCLUSION

Co-design has a positive impact on mHealth development, research processes and outcomes. Its success relies on a clearly identified framework of terminology, activities involved, and evaluation techniques. The findings of this review will be integrated into a novel co-design framework, which will be used to inform the development of a pediatric surgery mHealth application.

LEVEL OF EVIDENCE

This review uses manuscripts that are rated level III-V.

The development of an electronic geriatric assessment tool: Comprehensive health assessment for my plan (CHAMP)

INTRODUCTION

Geriatric assessment (GA) provides information on key health domains of older adults and is recommended to help inform cancer treatment decisions and cancer care. However, GA is not feasible in many health institutions due to lack of geriatric staff and/or resources. To increase accessibility to GA and improve treatment decision making for older adults with cancer (≥65 years), we developed a self-reported, electronic geriatric assessment tool: Comprehensive Assessment for My Plan (CHAMP).

MATERIALS AND METHODS

Older adults with cancer were invited to join user-centered design sessions to develop the layout and content of the tool. Subsequently, they participated in usability testing to test the usability of the tool (ease of use, acceptability, etc.). Design sessions were also conducted with oncology clinicians (oncologists and nurses) to develop the tool's clinician interface. GA assessment questions and GA recommendations were guided by a systematic review and Delphi expert panel.

RESULTS

A total of seventeen older adults participated in the study. Participants were mainly males (82.4%) and 75% were aged 75 years and older. Nine oncology clinicians participated in design sessions. Older adults and clinicians agreed that the tool was user-friendly. Domains in the final CHAMP tool (with questions and recommendations) included functional status, falls risk, cognitive impairment, nutrition, medication review, social supports, depression, substance use disorder, and miscellaneous items.

DISCUSSION

CHAMP was designed for use by older adults and oncologists and may enhance access to GA for older adults with cancer. The next phase of the CHAMP study will involve field validation in oncology clinics.

Representative Participation in a Large-Scale Health IT Project

User involvement is widely recognized as best practice in the development of information technology (IT) systems. In large-scale IT projects, the involvement of users and other stakeholder groups is typically in the form of representatives, as opposed to the direct (in-person) participation characteristic for smaller projects. The potential new sharing of power that representative participation entails vis-à-vis direct stakeholder involvement, and the implications of such a shift, are an important discussion in the context of participatory design. This paper extends and adds to previous work on this subject. Drawing on stakeholder interviews conducted as part of a case study of an electronic health record implementation project in Norway, this paper seeks to describe and analyze problems that can arise with representative participation in a large-scale project. Our focus is on an observed decline of interaction between health professionals participating actively in the project and their advisory units consisting of colleagues without a formal project role. The paper describes how the project's structural arrangements might explain this decline. The paper also describes how the participating health professionals' involvement of the advisory units at regular intervals early in the project (broad involvement) was replaced by more ad hoc and competence-oriented approaches (narrow involvement). We further use the organizational structure of democracies as the basis for two analogies, (I) participants-as-political-representatives and (II) participants-as-technocrats. The observed decline in interaction between the participating health professionals and their advisory units can be seen as a transition in role from user representative to technocrat. Generalizing from the case, we suggest that (1) a project's structure strongly affects the possibilities of participating users to consult other users (e.g., non-participating colleagues) about issues concerning the design solution, (2) a project's structure conditions the role of participating users and who, or what, they represent, and (3) representative participation requires rethinking a project's structure.

'Getting our voices heard in research: a review of peer researcher's roles and experiences on a qualitative study of adult safeguarding policy

BACKGROUND

Historically, disabled people have been marginalised in research that traditionally adopted a medical model perspective. Since the 1970's, there has been a shift from research on disabled people to research with disabled people with a strong emphasis on co-produced participatory research. Co-production involves disabled people working with academics to produce research and outcomes which are informed by the end user. This paper reflects on the role and experiences of peer researchers in co-producing a recent UK-wide research project called 'Getting our Voices Heard'. This project sought to identify the best approaches for people with a learning disability and their supporting organisations to influence adult safeguarding policies, across the four jurisdictions of the UK.

METHODS

A co-produced participatory design was used to address the project aims; achieved through the establishment of a collaborative research team comprising academic researchers, key stakeholders and six peer researchers, each of whom had a learning disability. Semi-structured interviews were completed with senior policy makers. Following this, in each of the four Nations, an organisational case-study was completed (four in total). Organisations were purposively sampled to identify one organisation in each country which was recognised as being successful in influencing adult safeguarding policy. Data were gathered through focus groups discussions and semi-structured interviews with key stakeholders. Findings were developed into an Impact Strategy and Action Plan. Co-production methods were used throughout.

RESULTS

Six individuals with a learning disability were recruited and trained to work as peer researchers, involved at key stages of the project, working alongside a wider research team. The role and experiences of the peer researchers in the context of policy are presented. Peer researchers provided largely positive first-hand accounts of their experiences. The importance of collaboration, the invaluable role of Learning Disability support organisations, and the need for additional time and resources to facilitate co-production, was noted.

CONCLUSION

Whilst peer researchers were positive about their experiences, some success in promoting co-produced research and areas for improvement were evident. Collaboration at all stages would have been strengthened with research funding which enabled involvement of all team members in all research activities.

Biodiversity-based cropping systems: A long-term perspective is necessary

Biodiversity-based cropping systems are an interesting option to address the many challenges that agriculture faces. However, benefits of these systems should not obscure the fact that creating biodiversity-based cropping systems represents a major change for farmers. To address this challenge, we argue that designing biodiversity-based cropping systems requires transforming ecological concepts into technical opportunities. Indeed, integrating ecological concepts such as plant-soil feedback and plant functional traits more strongly into cropping system design offers promising opportunities for the provision of ecosystem services, such as pest and disease control, crop production (including crop yield stability), climate regulation and regulation of soil quality. Accordingly, we demonstrate that designing biodiversity-based cropping systems requires considering not only the short term but also the long term. This would ensure that the expected ecosystem services have enough time to build up and provide their full effects, that the cropping systems are resilient and that they avoid the limitations of short-term assessments, which do not sufficiently consider multi-year effects. Considering long-term consequences of system change - induced by biodiversity - is essential to identify potential trade-offs between ecosystem services, as well as agricultural obstacles to and mechanisms of change. Including farmers and other food-chain actors in cropping system design would help find acceptable compromises that consider not only the provision of ecosystem services, but also other dimensions related to economic viability, workload or the technical feasibility of crops, which are identified as major obstacles to crop diversification. This strategy represents an exciting research front for the development of agroecological cropping systems.

rapid crowd sourcing

Background

Participatory design methods are a key component of designing tailored implementation strategies. These methods vary in the resources required to execute and analyze their outputs. No work to date has examined the extent to which the output obtained from different approaches to participatory design varies.

Methods

We concurrently used two separate participatory design methods: (1) field observations and qualitative interviews (i.e., traditional contextual inquiry) and (2) rapid crowd sourcing (an innovation tournament). Our goal was to generate and compare information to tailor implementation strategies to increase the use of evidence-based data collection practices among one-to-one aides working with children with autism. Each method was executed and analyzed by study team members blinded to the output of the other method. We estimated the personnel time and monetary costs associated with each method to further facilitate comparison.

Results

Observations and interviews generated nearly double the number of implementation strategies (n = 26) than did the innovation tournament (n = 14). When strategies were classified into implementation strategies from the Expert Recommendations for Implementing Change (ERIC) taxonomy, there was considerable overlap in the content of identified strategies. However, strategies derived from observations and interviews were more specific than those from the innovation tournament. Five strategies (13%) reflected content unique to observations and interviews and 3 (8%) strategies were unique to the innovation tournament. Only observations and interviews identified implementation strategies related to adapting and tailoring to context; only the innovation tournament identified implementation strategies that used incentives. Observations and interviews required more than three times the personnel hours than the innovation tournament, but the innovation tournament was more costly overall due to the technological platform used.

Conclusions

There was substantial overlap in content derived from observations and interviews and the innovation tournament, although there was greater specificity in the findings from observations and interviews. However, the innovation tournament yielded unique information. To select the best participatory design approach to inform implementation strategy design for a particular context, researchers should carefully consider unique advantages of each method and weigh the resources available to invest in the process.

Development of a complex intervention to support parents of adolescents with chronic illness transferring from pediatrics to adult care (ParTNerSTEPs)

BACKGROUND

Transition from pediatric to adult care for adolescents with chronic illness is associated with outpatient non-attendance and low treatment adherence in adolescents, and with anxiety and concerns among parents. Recent studies have shown that parent involvement results in better transitions. The aim of this paper was to describe the development, through participatory design, of a comprehensive transfer program targeted to parents of adolescents with chronic illness.

METHODS

The study was based on the UK Medical Research Council's (MRC) framework on developing and testing complex interventions. To increase the program's feasibility and relevance, participatory design was chosen as the overall method. A collaboration group of parents, young people and health care professionals (HCP) were actively involved in the development of the program. The program was developed in three development stages, in accordance with the MRC framework: 1) identifying the evidence base, 2) identifying theory, and 3) modelling process and outcomes.

RESULTS

Together with the collaboration group, we developed a comprehensive transfer program targeting parents, by undertaking an iterative process, involving a literature review, individual interviews, workshops and online brainstorms. The program, called ParTNerSTEPs (Parents in Transition - a Nurse-led Support and Transfer Educational Program) comprised three components: 1) an informative website, 2) online educational events for parents, and 3) transfer consultations with providers from both pediatrics and adult care.

CONCLUSIONS

The MRC framework was successfully applied to develop a comprehensive transfer program targeting parents of adolescents with chronic ilness. By incorporating the principles of participatory design in the development phase, we ensured that both parents' and adolescents' needs were represented and addressed in the program.

TRIAL REGISTRATION

ClinicalTrials.gov ID NCT04969328.

Innovating Novel Online Social Spaces with Diverse Middle School Girls: Ideation and Collaboration in a Synchronous Virtual Design Workshop

Leveraging social media as a domain of high relevance in the lives of most young adolescents, we led a synchronous virtual design workshop with 17 ethnically diverse, and geographically-dispersed middle school girls (aged 11-14) to co-create novel ICT experiences. Our participatory workshop centered on social media innovation, collaboration, and computational design. We present the culminating design ideas of novel online social spaces, focused on positive experiences for adolescent girls, produced in small-groups, and a thematic analysis of the idea generation and collaboration processes. We reflect on the strengths of utilizing social media as a domain for computing exploration with diverse adolescent girls, the role of facilitators in a synchronous virtual design workshop, and the technical infrastructure that can enable age-appropriate scaffolding for active participation and use of participatory design principles embedded within educational workshops with this population.

Participatory design application in obesity prevention targeting young adults and adolescents: a mixed-methods systematic scoping review protocol

BACKGROUND

Prevention of obesity is economically and sociologically preferable to treatment, with early intervention key to preventing excess weight gain and obesity. The transition from adolescence to young adulthood is a critical intervention period. An expert-led, top-down model has dominated obesity prevention research and practice with limited success. Participatory design (PD) offers potential in transforming obesity prevention research and practice by delivering bottom-up solutions that young people value and may therefore voluntarily engage with over time. An evidence synthesis of PD application in obesity prevention targeting adolescents and young adults is currently lacking.

OBJECTIVES

Report the protocol for a mixed-methods systematic scoping review which aims to integrate and synthesise available evidence on PD application in obesity prevention targeting adolescents and young adults. Specifically, the review will address three research questions: RQ1: How is PD defined in obesity prevention interventions targeting adolescents and young adults? RQ2: To what extent is PD applied in obesity preventions interventions targeting adolescents and young adults? RQ3a: How is the utility of PD evaluated in obesity preventions interventions targeting adolescents and young adults? RQ3b: What is the utility of PD application in obesity prevention interventions targeting adolescents and young adults?

METHODS

This mixed-methods systematic scoping review protocol adheres to the PRISMA-P guidelines and is informed by the PRISMA extension for scoping reviews (PRISMA-ScR). The search strategy and eligibility criteria are informed by the sample, phenomenon of interest, design, evaluation, and research type tool. Eligible studies will be peer-reviewed literature published in English, reporting on PD application in obesity prevention interventions (including intervention development, implementation, and/or evaluation) targeting adolescents and young adults (aged 10-35 years). Study designs will include qualitative, quantitative, and mixed methods. The review will comprise a systematic literature search, eligibility screening, data extraction, quality assessment using the Mixed-Methods Appraisal Tool (MMAT), and data analysis using an iterative narrative evidence synthesis approach. Evidence on PD application will be thematically integrated in terms of who was involved, when they were involved, and how and why they were involved. Further thematic analyses will be conducted according to the MATE taxonomy and the United Kingdom Medical Research Council (UK MRC's) key functions of process evaluations. The MATE taxonomy classifies PD application in terms of methodology, agent of change, training, and engagement. The MRC describes three functions of process evaluations: implementation, mechanisms of impact, and context. Applying both in the evidence synthesis is intended to provide a more complete picture of PD application. Exploratory analyses will be conducted to assess any potential associations between PD application and effectiveness across key outcomes (weight, physical activity, sedentary time, nutrition and dietary habit, mental health, and sleep) reported within intervention evaluations.

CONCLUSIONS

Elucidating PD application is a prerequisite to establishing its utility. Through the location and synthesis of available evidence on PD application in obesity prevention targeting adolescents and young adults, this review will categorise and describe different methods of PD application and explore the utility of PD application including whether any differences may be observed between PD method applied and the effectiveness of obesity prevention interventions. Implications will be delineated from the narrative evidence synthesis to inform future research and advance practice in this context.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021268240.

Making Progress Monitoring Easier and More Motivating: Developing a Client Data Collection App Incorporating User-Centered Design and Behavioral Economics Insights

Data collection is an important component of evidence-based behavioral interventions for children with autism, but many one-to-one aides (i.e., behavioral support staff) do not systemically collect quantitative data that are necessary for best-practice client progress monitoring. Data collection of clients' behaviors often involves labor-intensive pen-and-paper practices. In addition, the solitary nature of one-to-one work limits opportunities for timely supervisor feedback, potentially reducing motivation to collect data. We incorporated principles from behavioral economics and user-centered design to develop a phone-based application, Footsteps, to address these challenges. We interviewed nine one-to-one aides working with children with autism and seven supervisors to ask for their app development ideas. We then developed the Footsteps app prototype and tested the prototype with 10 one-to-one aides and supervisors through three testing cycles. At each cycle, one-to-one aides rated app usability. Participants provided 76 discrete suggestions for improvement, including 29 new app features (e.g., behavior timer), 20 feature modifications (e.g., numeric type-in option for behavior frequency), four flow modifications (e.g., deleting a redundant form), and 23 out-of-scope suggestions. Of the participants that tested the app, 90% rated usability as good or excellent. Results support continuing to develop Footsteps and testing its impact in a clinical trial.

The experiences, needs and barriers of people with impairments related to usability and accessibility of digital health solutions, levels of involvement in the design process and strategies for participatory and universal design: a scoping review

Objective

Globally, the number of digital health solutions is increasing, but they are not always designed with access and utilisation for people with impairments in mind. Development efforts have often not included the voice and requirements of people with impairments, who make up 15% of the world’s population, despite the fact that this can help ensure broad access and utilisation. Little attention to and limited inclusion of people with impairments in the development of digital health solutions results in continued and reinforced inequalities in health services provision for people with impairments. This review investigates the needs and barriers of people with impairments related to use of digital health solutions and strategies to foster user participation, access and utilisation of digital health solutions.

Methods

This scoping review, based on the Joanna Briggs Institute Manual, had five phases: 1) identification of aim and research questions, 2) literature search in five databases (April/May 2020), 3) literature screening based on predetermined inclusion and exclusion criteria, 4) data extraction, and (5) reporting results.

Results

The literature search resulted in 5968 sources, of which 25 met our inclusion criteria. People with impairments appreciate digital health solutions that are designed to meet their specific impairment-related challenges. The reported needs and barriers related to technological design varied depending on the individuals’ challenges. The literature reported different types of participatory co-design strategies to foster access and utilisation of digital health solutions.

Conclusion

This scoping review support needs for increased awareness among developers to design solutions that meet people’s needs, contexts and states of health. By applying universal design as a strategy and including people with different types of impairments, starting in the idea creation phase of digital health solutions and throughout the development, developers can design solutions with better accessibility. Digital health solutions that are accessible and usable have a tremendous opportunity to foster health equity and achieve health promotion, prevention and self-care. This in turn can contribute to closing the gap between different population groups, reduce disparities and get the most from available healthcare services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12393-1.

Co-designing a curriculum model for career education: perspectives from regional communities in Australia

The vocational experiences and skills of young adolescents could be infused into formal education by identifying career competencies to be taught within the academic curriculum. Such curriculum practices that embed educational and career pathways must also include the perspectives of students and the community, particularly those from marginalised groups. Drawing on data from 111 teachers, principals, carers and students, this paper presents research undertaken to co-design career education lesson plans within an infused model of the curriculum for early Middle Year students from regional, rural, and remote Australia. The lesson plans and activities were designed to allow for meaningful self-reflection and goal-setting that could be seamlessly infused into the formal curriculum and help embed early-stage career education. The paper concludes by projecting opportunities and challenges for seamless curriculum integration, while pertinent to the Australian context, can also be read with broader relevance to other educational systems and schools.

Online Investigations on Optimizing the Danish Health Portal Sundhed.dk

In recent years, many people have experienced different problems and challenges in using the national Danish health portal sundhed.dk, as they find it difficult to obtain desired information about their own laboratory test results and treatment plans. Therefore, the aim of this study is to find solutions, to make patients laboratory results easily accessible and understandable for the users. To achieve this aim there will be used two participatory design methods, video observation and questionnaires. The results shows that only 43.5% normally understand their test results, whereas the remaining participants need help to understand their results.

Design and Redesign of the IACTA App, an Interactive Communication Tool Intended to Facilitate Young Children's Participation in Healthcare Situations

PURPOSE

To develop the storyboard of IACTA further, based on the child''s perspective, by testing and evaluating both re-designed and newly designed scenes.

DESIGN AND METHOD

A participatory design was used involving preschool children (n = 18) aged three to five who tested and evaluated evolving prototypes of the IACTA application. Think aloud and Active intervention were used to elicit verbal responses from the children. Additionally, observational protocols were used to capture, in a structured way, the children's interaction with the app.

RESULTS

By testing evolving prototypes, the children confirmed previous developments and challenged the newly added scenes of the app. By their interaction, important information regarding the children's ways of navigating the storyboard was obtained. Ways of becoming immersed in the storyboard and the eagerness of dealing with each scene provided information regarding likeability.

CONCLUSIONS

Overall, this article presents a participatory design process in which preschool aged children were involved in testing and evaluating prototypes of the re-designed IACTA app. In the process, the children provided their perspective on the design and content and eventually, based on their feedback, IACTA was proven to be an age-appropriate tool.

PRACTICAL IMPLICATIONS

Children are frequent visitors to healthcare services. Lack of knowledge might trigger fear and anxiety, whereas information provides understanding. Interactive, mobile solutions enable children to receive information within paediatric healthcare contexts. The IACTA application intends to provide children a situated understanding that facilitates their participation in healthcare situations.

Iterative heuristic design of temporal graphic displays with clinical domain experts

Conventional electronic health record information displays are not optimized for efficient information processing. Graphical displays that integrate patient information can improve information processing, especially in data-rich environments such as critical care. We propose an adaptable and reusable approach to patient information display with modular graphical components (widgets). We had two study objectives. First, reduce numerous widget prototype alternatives to preferred designs. Second, derive widget design feature recommendations. Using iterative human-centered design methods, we interviewed experts to hone design features of widgets displaying frequently measured data elements, e.g., heart rate, for acute care patient monitoring and real-time clinical decision-making. Participant responses to design queries were coded to calculate feature-set agreement, average prototype score, and prototype agreement. Two iterative interview cycles covering 64 design queries and 86 prototypes were needed to reach consensus on six feature sets. Interviewers agreed that line graphs with a smoothed or averaged trendline, 24-h timeframe, and gradient coloring for urgency were useful and informative features. Moreover, users agreed that widgets should include key functions: (1) adjustable reference ranges, (2) expandable timeframes, and (3) access to details on demand. Participants stated graphical widgets would be used to identify correlating patterns and compare abnormal measures across related data elements at a specific time. Combining theoretical principles and validated design methods was an effective and reproducible approach to designing widgets for healthcare displays. The findings suggest our widget design features and recommendations match critical care clinician expectations for graphical information display of continuous and frequently updated patient data.

Co-Designing Technology for Aging in Place: A Systematic Review

BACKGROUND AND OBJECTIVES

There is a growing interest to involve older adults in the co-design of technology to maintain their well-being and independence. What remains unknown is whether the beneficial effects of co-designed solutions are greater than those reported for non co-designed solutions. The aim of this study was to evaluate the effects and experiences of co-designed technology that support older adults to age in place.

RESEARCH DESIGN AND METHODS

We conducted a systematic review to (a) investigate the health and well-being outcomes of co-designed technology for older adults (≥60 years), (b) identify co-design approaches and contexts where they are applied, and (c) identify barriers and facilitators of the co-design process with older adults. Searches were conducted in MEDLINE, EMBASE, CINAHL, Science Citation Index (Web of Science), Scopus, OpenGrey, and Business Source Premiere.

RESULTS

We identified 14,649 articles and included 34 projects. Four projects reported health and well-being outcomes; the effects were inconsistent. Co-design processes varied greatly and in their intensity of older adult involvement. Common facilitators of and barriers to co-design included the building of relationships between stakeholders, stakeholder knowledge of problems and solutions, and expertise in the co-design methodology.

DISCUSSION AND IMPLICATIONS

The effect of co-designed technology on health and well-being was rarely studied and it was difficult to ascertain its impact. Future co-design efforts need to address barriers unique to older adults. Evaluation of the impact of co-designed technologies is needed and standardization of the definition of co-design would be helpful to researchers and designers.

A robot goes to rehab: a novel gamified system for long-term stroke rehabilitation using a socially assistive robot-methodology and usability testing

Background

Socially assistive robots (SARs) have been proposed as a tool to help individuals who have had a stroke to perform their exercise during their rehabilitation process. Yet, to date, there are no data on the motivating benefit of SARs in a long-term interaction with post-stroke patients.

Methods

Here, we describe a robot-based gamified exercise platform, which we developed for long-term post-stroke rehabilitation. The platform uses the humanoid robot Pepper, and also has a computer-based configuration (with no robot). It includes seven gamified sets of exercises, which are based on functional tasks from the everyday life of the patients. The platform gives the patients instructions, as well as feedback on their performance, and can track their performance over time. We performed a long-term patient-usability study, where 24 post-stroke patients were randomly allocated to exercise with this platform—either with the robot or the computer configuration—over a 5–7 week period, 3 times per week, for a total of 306 sessions.

Results

The participants in both groups reported that this rehabilitation platform addressed their arm rehabilitation needs, and they expressed their desire to continue training with it even after the study ended. We found a trend for higher acceptance of the system by the participants in the robot group on all parameters; however, this difference was not significant. We found that system failures did not affect the long-term trust that users felt towards the system.

Conclusions

We demonstrated the usability of using this platform for a long-term rehabilitation with post-stroke patients in a clinical setting. We found high levels of acceptance of both platform configurations by patients following this interaction, with higher ratings given to the SAR configuration. We show that it is not the mere use of technology that increases the motivation of the person to practice, but rather it is the appreciation of the technology’s effectiveness and its perceived contribution to the rehabilitation process. In addition, we provide a list of guidelines that can be used when designing and implementing other technological tools for rehabilitation.

Trial registration: This trial is registered in the NIH ClinicalTrials.gov database. Registration number NCT03651063, registration date 21.08.2018. https://clinicaltrials.gov/ct2/show/NCT03651063.

Using Participatory Design Methods to Explore Changes in the Self-Efficacy of Students with Visual Impairments After Playing Exergames

Objective: To explore changes in task/scheduling self-efficacy in children with visual impairments after playing exergames, using the participatory design (PD) method to guide students with visual impairments to engage in the design and test of exergames. Materials and Methods: A pre-/post-test was used with two experimental groups (nine high school students with visual impairments aged 18-21, nine junior high school students with visual impairments aged 14-17). Data were analyzed by an independent-/paired-sample t-test to assess changes in task/scheduling self-efficacy of different groups after gameplay. Data of three dimensions (psychological emotion, physical activity, and social interaction) were collected through texts, participative observations, live notetaking, and video recordings. These dimensions provide opportunities for children with visual impairments to improve their self-efficacy. Results: Exergames helped children with visual impairments to improve their task and scheduling self-efficacy. It confirmed that exergames can be useful to promote their psychological emotion, enhance levels of positive physical activity, and increase social opportunities to improve self-efficacy. Conclusion: Participants of various ages who engaged in exergames reported an improvement in both task and scheduling self-efficacy in terms of psychological emotion, physical activity, and social interaction. The PD approach may be useful in the design of products for people with visual impairments and may ultimately be helpful in supporting the social and physical needs of people with disabilities.

A spatiotemporal dataset for integrated assessment and modelling of crop-livestock integration with the MAELIA simulation platform

The general purpose of the primary and secondary data available in this article is to support an integrated assessment of scenarios of crop-livestock integration at the territorial level i.e. of exchanges between arable and livestock farms. The data is a result of a research collaboration between the scientist from INRAE, agricultural advisers from Chamber of Agriculture of Pays de la Loire (CRAPL) and a collective of five arable and two livestock farmers located in the district of Pays de Pouzauges (Vendée department, western France). All participants formed part of the DiverIMPACTS project (https://www.diverimpacts.net/) that aims to achieve the full potential of diversification of cropping systems for improved productivity, delivery of ecosystem services and resource-efficient and sustainable value chains in Europe. The first dataset corresponds to the inputs of MAELIA (http://maelia-platform.inra.fr/), a spatial agent-based simulation platform that was used to support an iterative design and assessment of scenarios to redesign cropping systems. The second dataset corresponds to the outputs of MAELIA simulations and the associated indicators at the farm, group and territory level. The data comprise multiple shape and csv files characterizing the edaphic-climatic heterogeneity of the territory and cropping systems, farmers’ crop management rules (IF-THEN rules) and general information about the farms (e.g. crops, agricultural equipment, average crop yields). Data is reported for the baseline situation and three exchange scenarios containing different innovative cropping systems co-designed by scientists, agricultural advisers and the farmers. The data presented here can be found in the Portail Data INRA repository (https://doi.org/10.15454/3ZTCF5) and were used in the research article “Fostering local crop-livestock integration via legume exchanges using an innovative integrated assessment and modelling approach: MAELIA” [1].

Barriers to a healthy postpartum lifestyle and the possibilities of an information technology-based intervention: A qualitative study

BACKGROUND

Being overweight or obese is associated with higher risk of adverse maternal and fetal outcomes, including gestational diabetes and childhood obesity. Many women exceed the gestational weight gain recommendations. Thus, it is important to focus on the women's lifestyle between their pregnancies to lower the risk of weight retention before the next pregnancy as well as in a life course perspective.

OBJECTIVE

The objective of this study was to explore barriers postpartum women experience with respect to a healthy lifestyle during the postpartum period, and to assess whether an IT-based intervention might be a supportive tool to assist and motivate postpartum women to healthy lifestyle.

METHOD

A systematic text condensation was applied to semi-structured focus groups. Five focus group interviews were carried out with a total of 17 postpartum women and two interviews with a total of six health professionals. Participants were recruited through the municipality in Svendborg, Denmark, and at Odense University Hospital in Odense, Denmark, during a four-month period in early 2018. The results were analysed within the frame of the capability, opportunity, motivation and behaviour model (COM-B).

RESULTS

From the women's perspective, better assistance is needed from the health professionals to obtain or maintain a healthy lifestyle. The women need tools that inform and help them understand and prioritize own health related risks, and to motivate them to plan and take care of their own health. There is room for engaging the partner more in the communication related to the baby and family's lifestyle. Lastly, the women already use audiobooks and podcasts to obtain information.

CONCLUSION

Postpartum women need tools that inform and motivate for a healthy lifestyle postpartum. The tools should allow access to high quality information from health care professionals when the information is needed and also allow engagement from the partner. An IT-based intervention could be a way to support and motivate postpartum women for a healthy lifestyle.

Integrating Cultural Relevance into a Behavioral mHealth Intervention for Native American Youth

Native American communities are disproportionately affected by a number of behavioral health disparities, including higher rates of depression, substance abuse, and suicide. As mobile health (mHealth) interventions gain traction as methods for addressing these disparities, they continue to lack relevance to Native American youth. In an effort to explore the design of relevant behavioral mHealth intervention for Native American communities, we have developed ARORA (Amplifying Resilience Over Restricted Internet Access), a prototype behavioral mHealth intervention that has been co-designed with Native American youth, a community advisory board, and a clinical psychologist. In this paper, we qualitatively analyze our co-design and focus group sessions using a grounded theory approach and identify the key themes that Native American community members have identified as being critical components of relevant mHealth designs. Notably, we find that the Native American youth who participated in our focus groups desired a greater level of didactic interaction with cultural and behavioral health elements. We conclude with a discussion of the significant challenges we faced in our efforts to co-design software with Native American stakeholders and provide recommendations that might guide other HCI researchers and designers through challenges that arise during the process of cross-cultural design.

[Socio-gerontechnology-a research program on technology and age(ing) at the interface of gerontology and science and technology studies]

Hintergrund

In der Gerontologie beschäftigt sich Forschung intensiv mit der Frage, wie und wieso ältere Menschen neue Technologien nutzen oder nicht. Diese Forschung basiert mehrheitlich auf einem differenzierten Alter(n)sverständnis, verwendet jedoch einen verengten Technikbegriff, der Technologien auf manifeste Artefakte reduziert. Zur Erweiterung ihres Technikbegriffs kann die Gerontologie von den Science-and-Technology Studies (STS) lernen. Deren Ansätze und Perspektiven auf Technik und Alter(n) werden im Beitrag diskutiert, und es wird der Frage nachgegangen, wie anschlussfähig solche an aktuelle gerontologische Debatten und Befunde sind.

Material und Methode

Auf Basis aktueller Literatur wird in diesem Beitrag 2 Fragen nachgegangen: Welche Aspekte werden aus einer STS-Perspektive im Themenbereich Alter(n) und Technik thematisiert? Welche konzeptionellen Positionen zeichnen eine Forschungsperspektive der STS auf Technik und Alter(n) aus?

Ergebnisse

Im Themenbereich Alter(n) und Technik beschäftigen sich STS-Studien einerseits mit Entwicklungs- und Designprozessen neuer Technologien für ältere Menschen und andererseits mit den alltagsweltlichen Interaktionen zwischen Technologien und älteren Menschen.

Schlussfolgerungen

Auf Basis der Ergebnisse skizziert der Beitrag das Feld der Socio-Gerontechnology als Forschungsprogramm an der Schnittstelle zwischen STS und Gerontologie anhand von 3 Themen: (1) Materialitäten des Alter(n)s, die über innovative Technologien hinausgehen, (2) das Verhältnis von Alter(n)s- und technologischen Innovationsdiskursen und (3) die technologische Handlungsmächtigkeit von älteren Menschen.

Moving towards the promise of participatory engagement of older adults in gerotechnology

Limited uptake and use of developed technologies by older adults have prompted interest in participatory design and related approaches in the gerotechnology field. Despite this, recent systematic reviews suggest that researchers continue to passively engage older adults in research projects, often only providing advice or feedback in the early or later phases of research. A key barrier to more meaningful and active engagement of older adults is a lack of understanding as to how participatory design differs from other participatory approaches, and in particular, participatory action research. We address this gap in understanding by exploring the theoretical similarities and differences of participatory design and participatory action research, including their scope, goals, and the nature of the involvement of older adults in each. We conclude with key barriers that are critical to address in order to achieve greater involvement of older adults in gerotechnology and to broaden and enrich the goals of this field.

A Cross University-Led COVID-19 Rapid-Response Effort: Design, Build, and Distribute Drexel AJFlex Face Shields

The purpose of this article is to demonstrate how a new cross-community leadership team came together, collaborated, coordinated across academic units with external community partners, and executed a joint mission to address the unmet clinical need for medical face shields during these unprecedented times. Key aspects of this success include the ability to forge and leverage new opportunities, overcome challenges, adapt to changing constraints, and serve the significant need across the Philadelphia region and healthcare systems. We teamed to design-build durable face shields (AJFlex Shields). This was accomplished by high-volume manufacturing via injection molding and by 3-D printing the key headband component that supports the protective shield. Partnering with industry collaborators and civic-minded community allies proved to be essential to bolster production and deliver approximately 33,000 face shields to more than 100 organizations in the region. Our interdisciplinary team of engineers, clinicians, product designers, manufacturers, distributors, and dedicated volunteers is committed to continuing the design-build effort and providing Drexel AJFlex Shields to our communities.

Digi-Do: a digital information tool to support patients with breast cancer before, during, and after start of radiotherapy treatment: an RCT study protocol

BACKGROUND

Radiation Therapy (RT) is a common treatment after breast cancer surgery and a complex process using high energy X-rays to eradicate cancer cells, important in reducing the risk of local recurrence. The high-tech environment and unfamiliar nature of RT can affect the patient's experience of the treatment. Misconceptions or lack of knowledge about RT processes can increase levels of anxiety and enhance feelings of being unprepared at the beginning of treatment. Moreover, the waiting time is often quite long. The primary aim of this study will be to evaluate whether a digital information tool with VR-technology and preparatory information can decrease distress as well as enhance the self-efficacy and health literacy of patients affected by breast cancer before, during, and after RT. A secondary aim will be to explore whether the digital information tool increase patient flow while maintaining or increasing the quality of care.

METHOD

The study is a prospective and longitudinal RCT study with an Action Research participatory design approach including mixed-methods data collection, i.e., standardised instruments, qualitative interviews (face-to-face and telephone) with a phenomenological hermeneutical approach, diaries, observations, and time measurements, and scheduled to take place from autumn 2020 to spring 2022. The intervention group (n = 80), will receive standard care and information (oral and written) and the digital information tool; and the control group (n = 80), will receive standard care and information (oral and written). Study recruitment and randomisation will be completed at two centres in the west of Sweden.

DISCUSSION

Research in this area is scarce and, to our knowledge, only few previous studies examine VR as a tool for increasing preparedness for patients with breast cancer about to undergo RT that also includes follow-ups six months after completed treatment. The participatory approach and design will safeguard the possibilities to capture the patient perspective throughout the development process, and the RCT design supports high research quality. Digitalisation brings new possibilities to provide safe, person-centred information that also displays a realistic picture of RT treatment and its contexts. The planned study will generate generalisable knowledge of relevance in similar health care contexts.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04394325. Registered May 19, 2020. Prospectively registered.

Community Led Co-Design of a Social Networking Platform with Adolescents with Autism Spectrum Disorder

Adolescents with ASD face challenges in forming positive friendships due to their ASD condition. This study developed a social networking platform based on the needs of a small group of ASD adolescents and their parents/carers and examined what potential benefits such a system could provide. We conducted seven co-design workshops with six adolescents with ASD over eight months. The team exchanged ideas and communicated through group discussions and drawings. The findings suggest that: (1) participants demonstrated self-advocacy skills through an iterative co-design process; (2) a safe and familiar environment encourages active participation from adolescents with ASD as co-designers; and (3) parents, community group and fellow participants play a pivotal role in engaging adolescents with ASD on a social-network.

Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment

BACKGROUND

Community behavioral health clinicians, supervisors, and administrators play an essential role in implementing new psychosocial evidence-based practices (EBP) for patients receiving psychiatric care; however, little is known about these stakeholders' values and preferences for implementation strategies that support EBP use, nor how best to elicit, quantify, or segment their preferences. This study sought to quantify these stakeholders' preferences for implementation strategies and to identify segments of stakeholders with distinct preferences using a rigorous choice experiment method called best-worst scaling.

METHODS

A total of 240 clinicians, 74 clinical supervisors, and 29 administrators employed within clinics delivering publicly-funded behavioral health services in a large metropolitan behavioral health system participated in a best-worst scaling choice experiment. Participants evaluated 14 implementation strategies developed through extensive elicitation and pilot work within the target system. Preference weights were generated for each strategy using hierarchical Bayesian estimation. Latent class analysis identified segments of stakeholders with unique preference profiles.

RESULTS

On average, stakeholders preferred two strategies significantly more than all others-compensation for use of EBP per session and compensation for preparation time to use the EBP (P < .05); two strategies were preferred significantly less than all others-performance feedback via email and performance feedback via leaderboard (P < .05). However, latent class analysis identified four distinct segments of stakeholders with unique preferences: Segment 1 (n = 121, 35%) strongly preferred financial incentives over all other approaches and included more administrators; Segment 2 (n = 80, 23%) preferred technology-based strategies and was younger, on average; Segment 3 (n = 52, 15%) preferred an improved waiting room to enhance client readiness, strongly disliked any type of clinical consultation, and had the lowest participation in local EBP training initiatives; Segment 4 (n = 90, 26%) strongly preferred clinical consultation strategies and included more clinicians in substance use clinics.

CONCLUSIONS

The presence of four heterogeneous subpopulations within this large group of clinicians, supervisors, and administrators suggests optimal implementation may be achieved through targeted strategies derived via elicitation of stakeholder preferences. Best-worst scaling is a feasible and rigorous method for eliciting stakeholders' implementation preferences and identifying subpopulations with unique preferences in behavioral health settings.

What do medical specialists think about a proposed academic, integrative health centre in Australia? A qualitative study

OBJECTIVES

This qualitative study aimed to explore medical specialists' perspectives on a proposed academic integrative healthcare (IHC) centre to be established in their local district.

METHODS

A convenience sample of medical specialists were recruited via direct email invitations that was augmented with snowball sampling until data saturation was reached. The in-depth, semi-structured interviews were conducted via telephone, audio recorded and transcribed verbatim, followed by a thematic analysis.

RESULTS

Eight participants took part in the study. Three main themes emerged: 1) the benefits of an academic setting, 2) sound clinical governance, and 3) specialists in the field of traditional, complementary and integrative medicine (TCIM). Underpinning the three themes was the belief that patients were at risk of harm due to haphazard, unsupervised use of unproven TCIM. It was anticipated that an academic centre would address these issues with appropriate risk management protocols, effective interprofessional communication, and by upholding the principles of evidence- based practice to ensure safe and coordinated patient-centred care. Opportunities from collaborations within secondary care included centre being recognized as specialists in the field of TCIM, conducting research, and bidirectional learning.

CONCLUSIONS

The findings demonstrated that medical specialists acknowledged the need for a TCIM model of care that interfaces with the local secondary care landscape through the implementation of sound safeguards, credentialed practitioners, and evidence-based practice to adequately protect patients and clinicians. The findings will be amalgamated with the input from other stakeholder groups via a community-based participatory research framework to refine the model of care.

Development of a ePRO-Based Palliative Care Intervention for Cancer Patients: A Participatory Design Approach

This paper describes a qualitative study conducted in the context of developing a novel ePRO (electronic Patient Reported Outcome) based palliative care intervention for cancer patients. The aim of the study was to elicit end-users' needs, judgements of the MyPal system and recommendations for improvement. A participatory design was chosen as the value of this approach has been well established in eHealth systems' design as well as the development of novel healthcare services. Focus groups with Chronic Lymphocytic Leukemia (CLL) patients were conducted at the Centre for Research and Technology (CERTH) in Greece using specially designed vignettes and discussion guides. Findings revealed that patients saw MyPal offering increased, direct contact with the healthcare team, freedom of physical and psychological symptom reporting as well as valid and reliable information. However, they had concerns about the appropriate use of data collected by MyPal, the efficiency of data analysis and data security adopted for sensitive personal information. The participatory design approach used has been very useful in encouraging the genuine involvement of participants, a factor which over time can empower and promote participants' long-term engagement.

Perceived risks and amelioration of harm in research using mobile technology to support antiretroviral therapy adherence in the context of methamphetamine use: a focus group study among minorities living with HIV

BACKGROUND

Methamphetamine use poses a barrier to antiretroviral therapy (ART) adherence. Black and Hispanic men who have sex with men living with HIV (PLWH) shoulder much of the health burden resulting from the methamphetamine and HIV syndemic. Smartphones are nearly ubiquitous in the USA and may be promising vehicles for delivering interventions for ART adherence and drug use cessation. However, the acceptability of using applications to collect sensitive information and deliver feedback in this population has not been adequately explored.

OBJECTIVE

This study examined minority PLWH's appraisals of the risks of participating in smartphone-based research to promote ART adherence in the context of methamphetamine use and explored their views on appropriate steps to mitigate perceived risks of participation.

METHODS

Three focus groups were conducted among Black and Hispanic PLWH who use methamphetamine. Of the 13 participants, 5 had previously participated in a smartphone-based observational study of ART adherence and substance use. Discussants provided feedback on smartphone-based research, including receiving probes for HIV medication adherence, mood, and substance use as well as feedback on passive location-tracking for personalized messages. Transcribed audio-recordings were thematically coded and analyzed using the qualitative software MAXQDA.

RESULTS

Participants expressed confidentiality concerns related to potential unintentional disclosure of their HIV status and methamphetamine use and to possible legal consequences. They additionally expressed concerns around the invasiveness of daily assessments and the potential of methamphetamine use questions to trigger cravings. To mitigate these concerns, they suggested maintaining participant privacy by indirectly asking sensitive questions, focusing on positive behaviors (e.g., number of days sober), allowing user-initiated reporting of location to tailor messages, and ensuring adequate data protections. In addition to financial compensation, participants cited altruism (specifically, continuing a tradition of volunteerism in HIV research) as a motivator for potentially engaging in such research.

CONCLUSIONS

Minority PLWH have concerns regarding the use of smartphones for ART adherence and methamphetamine sobriety intervention research. However, minority PLWH are likely to participate if studies include appropriate protections against risks to confidentiality and experimental harm and are designed to offer future benefit to themselves and other PLWH.