Conduct Usability Testing Research Articles

Pharmacist-facilitated Patient Reported Outcome Measure (PROM) monitoring: developing an EHR SmartForm© to monitor side effects of oral oncolytics during routine telehealth encounters.

Patient reported outcome measures (PROMs) are increasingly used in oncology care, but pharmacists providing direct patient care have been overlooked. We engaged pharmacists and adults receiving oral oncolytics (chemotherapy medication taken by mouth) to develop a SmartForm© in the electronic health record (EHR) for PROM monitoring. Pharmacists verbally ask the patient side effect questions during routine telehealth encounters and enter responses in real time. Our development process was guided by the Knowledge to Action Framework. In phase 1 (Knowledge Inquiry), we prioritized side effects to assess in the EHR SmartForm© via interviews with patients and a Delphi panel with pharmacists. Adults receiving oral oncolytics for breast (n = 12), thoracic (n = 12), or hematological (n = 12) cancer were interviewed, with purposeful sampling for adults who were aged 65 + years or Black. Interviews were coded with content analysis. We conducted three Delphi rounds, with 11/19, 13/19, and 19/19 pharmacists, respectively. In phase 2 (Knowledge Synthesis), PROM items were selected and the EHR SmartForm© programmed. In phase 3 (Knowledge Tailoring), we conducted usability testing with pharmacists. Pharmacists and patients were consistent in prioritizing side effects of oral oncolytics and 10 were retained. Patients advocated asking whether they can do their usual activities, while pharmacists added medication adherence. Usability testing yielded suggestions to simplify the SmartForm©. By presenting screenshots of our SmartForm©, our findings are useful to other healthcare systems looking for a PROM solution integrated in the EHR, with a reasonable pharmacist/clinician workload, and no requirement for patients to have internet access/comfort.

Integrating restoration and interactive exploration to enhance cultural heritage through VR storytelling

Redtory was transformed from an old industrial site into a creative park in Guangzhou. Unfortunately, it was demolished in May 2019. It holds a dual significance, representing both Guangzhou’s old industrial era and its first creative park (Art and Design). The objective of this study was to utilize Virtual Reality (VR) technologies to design an immersive environment with a narrative experience and restore the historical memory of Redtory. The project designs the interactive storytelling tour based on Bartle’s taxonomy theory. The VR project includes four primary scenes to tell the Redtory’s story: Starting Scene, Factory Buildings, Historical Square, and Creative Corridor. The study designs various interactive elements to engage tourists during exploration. The study conducted user tests to evaluate the system. A comparative experiment (N = 40) is conducted to evaluate the overall performance of the VR platform. The results indicate that the platform provides a smooth storytelling experience during the virtual tour with minimal bugs or disruptions. The project provides valuable user data and a design flow as a case study reference to contribute to the field of VR historical education.

Success Factors for Usability Testing of Digital Health Solutions.

The design and development of patient-centered digital health solutions requires user involvement, for example through usability testing. Although there are guidelines for conducting usability tests, there is a lack of knowledge about the technical, human, and organizational factors that influence the success of the tests. To summarize the success factors of usability testing in the context of patient-centered digital health solutions. We considered three case studies and collected experiences related to time management, relevance of results and challenges encountered. Success factors relate to participant privacy and data protection, test environment setup, device and application readiness, user comfort and accessibility, test tools and procedures, and adaptability to user limitations. Small organizational and technical details can have a big impact on the outcome of a usability test. Considering the aspects mentioned in this paper will not only save resources but also the trust of the participating patients.

Development, Evaluation, and User Testing of a Decision-Making Toolkit to Promote Organizations to Implement Universal Tumor Screening for Lynch Syndrome

Introduction: The Implementing Universal Lynch Syndrome Screening (IMPULSS) study explained institutional variation in universal tumor screening (UTS) with the goal of identifying ways to aid organizational decision-makers in implementing and optimizing Lynch syndrome UTS programs. Methods: After applying the Consolidated Framework for Implementation Research (CFIR 1.0) to analyze interviews with 66 stakeholders across 9 healthcare systems to develop a toolkit for implementation, we adapted the International Patient Decision Aid Standards (IPDAS) to assess toolkit potential to aid decision-making consistent with organizational values. We then conducted user testing with two experienced and four non-experienced implementers of UTS to improve the content and functionality of the toolkit and assess its acceptability and appropriateness. Results: Toolkit components were organized to address findings related to CFIR 1.0 constructs of evidence strength and quality, relative advantage, cost, engaging, planning, executing, and reflecting and evaluating. A home page was added to direct users to different sections based on whether they are deciding to implement UTS, planning for implementation, improving an existing UTS program, or considering a different approach to identify patients with Lynch syndrome. Upon initial evaluation, 31 of 64 IPDAS criteria were met by the original toolkit. All users rated the toolkit as acceptable and appropriate for assisting organizational decision-making and identified multiple areas for improvement. Numerous iterative changes were made to the toolkit, resulting in meeting 17 of the previously unmet IPDAS criteria. Conclusion: We demonstrate the rigorous development of a toolkit guided by the CFIR and show how user testing helped improve the toolkit to ensure it is acceptable, appropriate, and meets most IPDAS criteria relevant to organizational values-based decision-making.

Developing an Automated Virtual Reality Therapy for Improving Positive Self-Beliefs and Psychological Well-Being (Phoenix VR Self-Confidence Therapy): Tutorial.

Virtual reality (VR) is an immersive technology in which delivery of psychological therapy techniques can be automated. Techniques can be implemented similarly to real-world delivery or in ways that are not possible in the real world to enhance efficacy. The potential is for greater access for patients to effective therapy. Despite an increase in the use of VR for mental health, there are few descriptions of how to build and design automated VR therapies. We describe the development of Phoenix VR Self-Confidence Therapy, designed to increase positive self-beliefs in young patients diagnosed with psychosis in order to improve psychological well-being. A double-diamond, user-centered design process conducted over the course of 18 months was used, involving stakeholders from multiple areas: individuals with lived experience of psychosis, clinical psychologists, treatment designers, and VR software developers. Thirteen meetings were held with young patients diagnosed with psychosis to increase the understanding and improve the assessment of positive self-beliefs, help design the scenarios for implementing therapeutic techniques, and conduct user testing. The resulting Phoenix therapy is a class I United Kingdom Conformity Assessed (UKCA)-certified medical device designed to be used on the standalone Meta Quest 2 (Meta Platforms) headset. Phoenix aims to build up 3 types of positive self-beliefs that are connected to psychological well-being. In a community farm area, tasks are designed to increase a sense of mastery and achievement ("I can make a difference"); in a TV studio, users complete an activity with graded levels of difficulty to promote success in the face of a challenge ("I can do this"); and in a forest by a lake, activities are designed to encourage feelings of pleasure and enjoyment ("I can enjoy things"). Phoenix is delivered over the course of approximately 6 weekly sessions supported by a mental health provider. Patients can take the headsets home to use in between sessions. Usability testing with individuals with lived experience of psychosis, as well as patients in the National Health Service (aged 16-26 years), demonstrated that Phoenix is engaging, easy to use, and has high levels of satisfaction.

Construction of a virtual usability laboratory for conducting user tests during remote attendance

One of the educational challenges arising from the COVID-19 pandemic was the adaptation of theoretical-practical or practical courses to virtual formats. In this context, the Human-Computer Interaction (HCI) course in the Systems Engineering Program at the University of Cartagena faced the challenge of developing user testing, involving conducting tests with end-users in a controlled environment or usability laboratory. This article contributes by presenting the design and implementation of a virtual academic usability laboratory for conducting user tests. The proposed laboratory was built and evaluated based on practices undertaken by students in the aforementioned HCI course. This laboratory aims to serve as a reference for conducting usability tests in both academic and business settings.

Effects of AR-HMD Interactive Interface Layout on Usability and Obstacle Avoidance in Subway Overhauls

The maintenance and overhaul of rail transit vehicle frames are vital for ensuring the safe and reliable operation of equipment. AR-based maintenance has been proven to be cost-reducing and effective. Few studies explored the application of AR-based maintenance on subway overhaul. In this study, 74 participants were selected to conduct the underground maintenance AR recognition and obstacle avoidance experiment. And two-factor ANOVA, independent samples t-test, and non-parametric test were used for data statistics. The results show that a high-opacity AR interface has better recognition but affects obstacle avoidance. Facing different types of obstacles, AR interfaces with different layouts have significant differences in terms of recognizability and obstacle avoidance effects. Compared with the list layout, the matrix layout AR interface will make more effort for workers. The findings provide useful references for designing the visual information layout of AR interfaces and conducting usability testing of AR interfaces in complex scenarios such as underground maintenance. Highlights This study assessed the effects of the AR-HMD interface on workers’ recognition of and ability to safely avoid obstacles in a subway maintenance environment. A high-opacity AR interface leads to better recognition but affects obstacle avoidance. List AR interfaces lead to better recognition but increase the probability of obstacle avoidance failure by 50% under block obstacles. For linear obstacles, layout has no significant effect on recognition or obstacle avoidance. A matrix layout AR interface is more effortful than the list layout AR for the workers.

Co-designing discharge communication interventions for mental health visits to the pediatric emergency department: a mixed-methods study

BackgroundDischarge communication is essential to convey information regarding the care provided and follow-up plans after a visit to a hospital emergency department (ED), but it can be lacking for visits for pediatric mental health crises. Our objective was to co-design and conduct usability testing of new discharge communication interventions to improve pediatric mental health discharge communication.MethodsThe study was conducted in two phases using experience-based co-design (EBCD). In phase 1 (Sep 2021 to Jan 2022), five meetings were conducted with a team of six parents and two clinicians to co-design new ED discharge communication interventions for pediatric mental health care. Thematic analysis was used to identify patterns in team discussions and participant feedback related to discharge communication improvement and the Capability, Opportunity, Motivation, Behavior (COM-B) model was used to identify strategies to support the delivery of the new interventions. After meeting five, team members completed the Public and Patient Engagement Evaluation Tool (PPEET) to evaluate the co-design experience. In phase 2 (Apr to Jul 2022), intervention usability and satisfaction were evaluated by a new group of parents, youth aged 16–24 years, ED physicians, and nurses (n = 2 of each). Thematic analysis was used to identify usability issues and a validated 5-point Likert survey was used to evaluate user satisfaction. Evaluation results were used by the co-design team to finalize the interventions and delivery strategies.ResultsTwo discharge communication interventions were created: a brochure for families and clinicians to use during the ED visit, and a text-messaging system for families after the visit. There was high satisfaction with engagement in phase 1 (overall mean PPEET score, 4.5/5). In phase 2, user satisfaction was high (mean clinician score, 4.4/5; mean caregiver/youth score, 4.1/5) with both interventions. Usability feedback included in the final intervention versions included instructions on intervention use and ensuring the text-messaging system activates within 12–24 h of discharge.ConclusionsThe interventions produced by this co-design initiative have the potential to address gaps in current discharge practices. Future testing is required to evaluate the impact on patients, caregivers, and health care system use after the ED visit.

Usability Testing of Novel IoT-Infused Digital Services on Farm Equipment Reveals Farmer’s Requirements towards Future Human–Machine Interface Design Guidelines

The application of digital technologies in the agricultural sector is increasing. One of the new key technologies is the Internet of Things (IoT), which can facilitate the everyday work of farmers. For the successful adoption of IoT-enabled digital products and to ensure improved workflows, the usability of human–machine interfaces is highly important. Various design approaches of human–machine interfaces (HMIs) can currently be found in the monitoring of agricultural machinery. In this work, the most well-known HMIs are considered. Based on a usability test (participants n = 9), the user interface (UI) of a novel mobile application (NEVONEX Cockpit App) was chosen as an example of a design approach of an IoT ecosystem that is oriented towards the UI design of mobile applications. This work aims to identify the weak points of this UI. Conclusions about the needs, and thus an improvement of the user experience, are based on the suggestions for improvement and the information about the general requirements of farmers for a UI for agricultural machinery. Here, it was found that most farmers are satisfied with the UI design of their familiar tractor monitors. According to the survey, the three most important points to be considered in the UI design are intuitive operation and menu navigation, easy access to the essential functions and buttons, and sufficiently large control panels. The conducted usability tests can be considered a basis for developing HMIs for agriculture machinery. Through repeated execution of comparable usability tests, there is the possibility of developing future HMI guidelines for agriculture to improve the user experience (UX). For the NEVONEX ecosystem, feedback from the user interface testing was incorporated in a major revision of the Cockpit App’s design, where a lot more display space was given to the agronomic digital services by smartly arranging infrastructure functions in tiles.

The Development of Javanese Glossary Website as a Form of Language Maintenance and Revitalization

As a vital component of cultural identity, language is under pressure as a result of globalization. This article discusses the creation of a website that provides a dictionary of Javanese phrases to help preserve and revitalize the language. In this study, we collect, categorize, and display Javanese words on electronic resources. In addition, the system usability scale (SUS) was used to conduct usability tests on the investigated websites to determine how user-friendly they actually were. Gathering terms from multiple sources, categorizing them, and developing a user-friendly interface with a search bar are all steps in the process of making a website. Users from all walks of life fill out the SUS questionnaire as part of the usability testing process. The test results reveal how well the website satisfies its users' requirements. Creating a database of Javanese words online and putting it through the SUS test is a great example of how technology can be used to help preserve a language and its heritage. It is believed that by taking this step, more people will become familiar with the Javanese language and become invested in its continued existence in the modern world. The usability testing results demonstrate that the development strategy and interface design effectively fostered a positive user experience. High scores on the SUS questionnaire, with an average rating of 80.25, indicate that users find the website satisfactory and user-friendly.

CALM & CARE: A CHILD-CENTRED DIGITAL THERAPY PLATFORM FOR MENTAL HEALTH

Mental health, as critical as physical well-being, has gained significant importance during the COVID19 pandemic. Moreover, pandemic-induced lockdowns have exacerbated mental health issues, including suicides, spousal violence, and domestic bullying. Consequently, the demand for digital therapeutics has surged, manifesting as mobile and web applications and facilitating remote access to support. However, children have been underserved in this category despite their vulnerability to the emotional consequences of school closures and caregiver distress. This study's objectives and methodology encompassed developing a child centric digital therapy mobile application, conducting usability testing for optimal user-friendliness, creating content compliant with industry standards, gathering user feedback for improvements and providing ongoing maintenance for the application's effectiveness. The resulting 'Calm & Care' prototype empowers parents to authorise counselling sessions and motivational content for their children at home. Ten families participated in user testing, yielding positive feedback praising the vibrant interface, child-friendly visuals, and simplified language for an enhanced user experience. 'Calm & Care' can enable local clinics to accept mental health patients with lower infection risks and increase treatment success. This research underscores the pivotal role of digital solutions in addressing children's mental well-being during the pandemic.

Usability Testing Best Practices for Academic Library Websites & DIY Usability Testing Toolkit

I completed a sabbatical project in the spring semester of 2023 with three main goals: 1) conduct interviews with user experience librarians about best practices relating to usability testing in academic libraries; 2) create a comprehensive collection of best practices based on interview results and supporting research; and 3) create a do-it-yourself usability testing toolkit consisting of templates, documents, checklists, report shells, and other materials for librarians to quickly conduct usability testing from start to finish at their own institutions. 

Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing.

More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. We evaluated the prototype using Nielsen's 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app's design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone.

Development of Geographic Information System for Government With Extreme Programming and User-Centered Design Methods

Software development is among the most powerful needs in every organization and industry in the current generation. It is used to help the functionality of their system by using the software development guide named Software Development Life Cycle (SDLC). Various system developments have been conducted, including developing a public complaint service system. This research applies extreme programming (XP) and User-Centered Design (UCD) development methods to develop the geographic information system for the Badan Narkotika Nasional (BNN) Kediri City complaint service. These development methods are expected to meet user expectations. Also, it can reduce the time required to develop products with results that will be shown by conducting usability testing and validity tests. This research applied extreme programming and user-centered design development methods, both quantitative and qualitative for user testing. The application was successfully developed using XP and UCD development methods. The Kediri City BNN complaint service application was successfully developed in several stages: planning, implementing the design, and program code, followed by the evaluation stage. In the evaluation stage, usability testing results on the geotagging mobile application of the Kediri City BNN complaint service obtained a total score of 92.75% with a very good interpretation, and the validation testing results obtained a value of 100%. Applying extreme programming and user-centered design as a development method produces high usability testing and user experience because, in the development stage, it prioritizes interactions and user opinions.

187 Translating for Impact: a free online toolkit for demonstrating the larger impact of your work

OBJECTIVES/GOALS: The Translational Science Benefits Model offers an approach for evaluating the downstream health and social impact of research. Using the new Translating for Impact Toolkit of nine web-based tools, researchers can create free, secure accounts to plan, track, and demonstrate the impact of their work. METHODS/STUDY POPULATION: Development of the online toolkit includes 6 phases: 1) Review of existing tools, 2) Development of fillable PDF tool prototypes, 3) Pilot testing, 4) Development of web-based tools, 5) Usability testing, and 6) Refinement of web-based tools. First, we reviewed existing tools for measuring research impact. We then created prototypes of nine tools, published on the TSBM website, and pilot tested with researchers. Based on feedback and testing, we developed and launched web-based versions of the tools. We are currently conducting usability testing with researchers, which we will use to evaluate the ease-of-use and quality of the tools, identify areas for improvement, and refine the tools. RESULTS/ANTICIPATED RESULTS: Researchers can sign up for user accounts, create projects, invite collaborators and program administrators, and save progress as the complete the nine tools in the Translating for Impact Toolkit. The tools are divided into three steps: Plan (Roadmap to Impact, Benefits 2x2, Partner Mapper, and Team Manager), Track (Impact Tracker), and Demonstrate (Product Navigator, Case Study Builder, Impact Profile, and Dissemination Planner). The toolkit also includes a dashboard that provides a quick snapshot of translational impact for each project. The toolkit will help both individual translational scientists demonstrate the impact of their work and CTSA hubs evaluate impact of their projects. DISCUSSION/SIGNIFICANCE: The TSBM online toolkit is a free, secure, easy-to-use platform researchers can use to plan for, track, and demonstrate the impacts of their work. The toolkit provides a structured process that will help the next generation of scientists prioritize and promote translational impact in their work.

인공지능 기반 신생혈관성 나이관련황반변성 진단보조소프트웨어 사용자 인터페이스 개선 연구

With the recent development of Software as a Medical Device (SaMD), the significance of reducing use errors in medical devices is increasing. In this study, we conducted a formative evaluation of Artificial Intelligence (AI)-based software for ophthalmic image detection and diagnosis. The software automatically displays the presence or absence of neovascular age-related macular degeneration using fundus images to assist medical personnel in making diagnostic decisions. We aimed to find ways to reduce the number of use errors in formative evaluations. For this purpose, we conducted usability testing by performing tasks based on use scenarios for usability formative evaluations with intended users in their intended use environments, and then modified the user interface to reduce use errors. The initial formative evaluation revealed errors in utilizing the capture and dragand- drop functions for uploading fundus images, checking analysis results, and perform logout procedures. To reduce use errors, we improved the function by relocating the capture icon, displaying a hand-shaped cursor during dragging, inserting a fundus position guide, and eliminating the drag-and-drop function. We have also enhanced the design to present analytics results in a more intuitive manner and added a separate logout button to reduce the risk of use error. As a result, the number of use errors in the formative evaluation decreased from six to one in the summative evaluation. The development of ophthalmic image detection and diagnosis assistant software that reflects these improvements is expected to enhance user safety, usability, and reduce use errors.

A Peristaltic Pump to Improve Bladder Emptying and Irrigation in Patients Who Use Clean Intermittent Catheterization

Background: Neurogenic bladder patients who intermittently catheterize may have systems that drain slowly and incompletely. These limitations can lead to urinary tract infections and bladder stone formation and be time consuming. We hypothesize that a catheter accessory device could improve drainage, reduce residual bladder volume, and save time. Methods: A yearlong collaboration between an undergraduate biomedical engineering student design team and client mentors from the pediatric urology department led to an evaluation of solutions to enhance emptying of bladders that require intermittent catheterization. Students performed market analysis, identified design requirements, generated design concepts, conducted usability testing, and constructed alpha and beta prototypes verified through benchtop experimentation during the yearlong project. Prototypes were verified using a phantom bladder model built from a compliant stress ball with an attached catheter and placed under an external pressure of 5 cm H 2 O. Tests were conducted to measure the diff erence between passive drainage and device-assisted drainage at various bladder volumes and catheter sizes. Eight student peers compared passive emptying, irrigating, and aspirating a phantom bladder model using the prototype or syringe to assess the usability of the device. Results: We developed a pump that interfaces with commercially available catheters. The pump housing was designed and 3D printed. Fluid can be moved bi-directionally with a battery-powered peristaltic pump and microcontroller. The pump has a built-in current sensing threshold with an automatic shutoff safety mechanism. Testing results showed that for all bladder volumes and catheter sizes, the pump emptied more completely and drained between 1.6 and 6.3 times faster when compared to passive drainage. Usability feedback showed that the pump required less time to irrigate the bladder and was preferred when compared to the manual syringe technique. Conclusions: This portable catheter pump improves phantom bladder emptying by increasing flow rate, decreasing residual volume, and making irrigation easier. Future design improvements will work to implement safety mechanisms and miniaturize the pump. This project demonstrates the feasibility of a catheter accessory device to improve patient quality of life and the ability for understudied clinical problems to be addressed through collaborations between capstone engineering design teams and physicians.

Abstract P171: Patient and Interdisciplinary HIV Care Experts Illness Representations on HIV Comorbidities and Usability of a Virtual Environment as Heart Disease Prevention Education in Ethnic and Racial Sexual Minority Men With HIV

Background: Black and Latinx sexual minority men with HIV are at increased risk of CVD and have been underrepresented in clinical trials. The American Heart Association has called for an increase in interventions that focus on enhancing cardiovascular health in underserved communities by addressing social determinants and modifiable risk factors of CVD. Objective: To explore patient and HIV care experts’ perceptions about HIV comorbidities and assess usability of a virtual environment as CVD prevention education in Black and Latinx sexual minority men with HIV. Methods: This two-phase study is part of a pilot behavioral clinical trial informed by the American Heart Association’s metrics for cardiovascular health. Qualitative Phase 1 data were collected June 2021 to May 2022. Phase 2 data were collected August 2022 to October 2022. Using convenience sampling, we recruited a) Black and Latinx sexual minority men with HIV, and b) interdisciplinary HIV care experts. Eligibility criteria for non-HIV care experts were: 1) self-identify as gay or bisexual; 2) HIV serostatus positive; 3) ages 30 to 65; 4) access to a laptop or desktop. We explored HIV comorbidities of concern and conducted usability testing of the virtual environment. Eighty-four pages of interview data were analyzed using NVivo 12. Results: Phase 1 themes included: Mixed Perceptions about Health, High Risk for Comorbidities, and Virtual Environment Features. CVD risk factors were consistently expressed in relation to HIV, including hypertension, heart attack, stroke, and diabetes. Additionally, kidney, and liver disease were identified as important. Cancer was a common concern and so were the development of mental health conditions. All participants in Phase 2 completed the usability checklist with favorable feedback. Conclusions: We identified hypertension, diabetes, asthma, and cancer were comorbidities of concern. These findings carry significant implications for mitigating barriers to preventative health screenings in Black and Latinx sexual minority men with HIV, given shared risk factors between HIV, CVD, and cancer. We also found that usability of a virtual environment as CVD prevention education was promising as it offered anonymity and access to reliable health information that traverses geography. A virtual environment may serve as a novel modality for extending the reach of prevention education and clinical trials into the hands of ethnic and racial, sexual minoritized individuals that have been underrepresented in advancements in health equity.

Using Quality Improvement as a Mechanism for Fostering Partnerships and Promoting Equity in a Health System Change Model.

Quality improvement (QI) processes provide a framework for systematically examining target outcomes and what changes can be made to result in improvement and ensure equity. We present a case study of how QI processes were used as a means of partnership building to enhance equity in designing materials for a Medicaid pilot program, North Carolina Integrated Care for Kids (NC InCK). The NC InCK model addresses social determinants of health by providing structured care integration across core child health and social service areas and using an alternative payment model to incentivize high quality child outcomes. During the two-year planning period prior to the NC InCK model launch, we used Plan-Do-Study-Act (PDSA) cycles to conduct usability testing as a QI strategy for a component of the NC InCK model: the Shared Action Plan (SAP). We conducted usability testing with four Family Council members, nine care managers, and one physician. Participants reviewed the SAP and provided feedback via a survey. After reviewing feedback with InCK leadership and the Family Council, we implemented recommendations that led to a SAP that uses clear and accessible language, that highlights family strengths and family-identified goals, and that is distinct from other care management plans. Usability testing forced refinement of materials before NC InCK launched, created opportunities for building and enhancing community partnerships and promoted equity within the NC InCK team and Family Council by considering multiple perspectives when deciding on SAP revisions.

Project nature: promoting outdoor physical activity in children via primary care

BackgroundFamilies face a range of barriers in supporting their children’s active play in nature including family circumstances, environmental constraints, and behavioral factors. Evidence-based strategies to address these barriers are needed. We aimed to develop and pilot test a primary care-based family-centered behavioral intervention to promote active outdoor play in 4–10 year-old children.MethodsProject Nature, a provider-delivered intervention that provides informational resources and an age-appropriate toy for nature play, was initially developed for children ages 0–3. With stakeholder input, we adapted existing materials for 4–10 year-olds and conducted usability testing at an urban clinic serving families from diverse backgrounds. Subsequently, we conducted a mix-methods pilot study to evaluate intervention feasibility and acceptability. Parents of 4–10 year-olds completed pre- and post-surveys (n = 22), and a purposive subset (n = 10) completed qualitative interviews. Post-intervention, pediatric providers (n = 4) were interviewed about their implementation experiences.ResultsThe majority (82%) of parents liked the information provided and the remaining (18%) were neutral. Qualitatively, parents reported that: the toy provided a tangible element to help children and parents be active, they did not use the website, and they wished the intervention emphasized strategies for physical activity during cold and wet seasons. Providers felt the materials facilitated discussion about behavior change with families. There were no statistically significant changes in PA and outdoor time pre- and post-intervention.ConclusionsProject Nature was welcomed by providers and families and may be a practical intervention to promote outdoor active play during well-child visits. Providing an age-appropriate nature toy seemed to be a critical component of the intervention, and may be worth the additional cost, time and storage space required by clinics. Building from these results, Project Nature should be revised to better support active outdoor play during suboptimal weather and evaluated to test its efficacy in a fully-powered trial.