Human-centered Design Framework Research Articles

1078-P: Codesigning Diversity, Equity, and Inclusion Communication Tools for Diabetes Management

Only 29% of African-Americans and 39% of Latinx persons living with type 1 diabetes mellitus (T1DM) use insulin pumps, compared with 61% of white individuals. Social determinants of health contribute to suboptimal access to and use of DM devices. We applied a design thinking process to better understand these barriers, and created a publication that both persons living with DM (PWD) and health care professionals (HCP) could use to provide information and spark a dialogue on DM devices and management. The Double Diamond Process is a human-centered design framework that discovers, then defines a problem, to develop and deliver a prototype. After diversity, equity, and inclusion training with a consultancy, we interviewed 6 PWD, and 4 HCP (1 dietitian, 1 psychologist, and 2 physicians). We identified 3 key challenges: PWD feel that their contexts, experiences, and needs are often not well-represented or addressed by DM information resources; HCP may not discuss devices; and PWD may not feel fully seen or heard during clinic visits. User testing helped refine a low-fidelity prototype for an online and print publication, Humans of Diabetes (HOD), with two checklists. The first guides the PWD and HCP through key topics to discuss during clinic visits. The second invites the PWD to reflect on the interaction with the HCP. Both checklists increase PWD's and HCP's awareness of implicit bias and suggest talking points. Compiled with help from advocates of color in the DM communities, HOD features images and stories of people of color living well with DM; as well as resources on DM, devices, medications, and community support. PWD can easily tear off and keep the print version's checklists. HOD could be distributed widely in primary care and DM clinics. HOD grew out of the design thinking process. This patient-centered collaboration with individuals from diverse perspectives could better start and enhance important conversations, to further optimize access and engagement with devices and care. Disclosure E.C.Chao: None. H.Rataj: None. D.J.Pai: None. H.Nagra: Employee; One Drop.

441 Southeastern Wisconsin Community-Based Participatory Research using the All of Us Researcher Workbench

OBJECTIVES/GOALS: Using a community-based participatory research (CBPR) approach, the All of Us (AoU) Wisconsin Froedtert & the Medical College of Wisconsin (MCW) site aimed to improve public understanding of science by creating a Special Interest Group (SIG) of community members and scientists and driving healthcare research relevant to Southeastern Wisconsin. METHODS/STUDY POPULATION: We recruited community members from the AoU advisory boards and scientists from Froedtert & MCW. These SIG participants will converge on a hypothesis that aligns with community priorities and conduct research using the national AoU database, which combines EHR, survey, and whole genome sequencing data. A year of monthly SIG meetings from 2022-2023 will serve as focus group sessions that will be recorded and transcribed. In addition to descriptive statistics on participant demographics and affiliations, we plan to qualitatively characterize transcripts, field notes, and feedback, such as participation satisfaction or reflection on self- and group-driven impact. We will publish alongside all SIG members on both the research outcomes and the SIG-driven process to inform future similar endeavors. RESULTS/ANTICIPATED RESULTS: To date, we held three SIG meetings, which together formed the discover and define stages in the human-centered design framework. We narrowed down SIG membership to 15 consistent participants. Our coalition building conversations emphasized group priorities and future payoffs for independent research and community partnerships. Realizing a crucial need for bioinformaticians to prosecute SIG-driven research questions, we created a data subgroup of trainees and scientists to familiarize themselves with the AoU Researcher Workbench. Through shared decision making during this community engaged process, we are converging on a research direction centering on specific diseases or adverse outcomes with relevance to Southeastern Wisconsin communities and with implications for personalized medicine. DISCUSSION/SIGNIFICANCE: SIG scientists will learn about CBPR and access the AoU database. SIG community members will better understand the research process and share their lessons with local communities. The AoU Wisconsin research team will disseminate findings on the collective research process and empower scientist use of this nationally curated AoU database.

P79. Development of an evidence-based framework to increase patient-reported outcome response rates for orthopedic practices

<h3>BACKGROUND CONTEXT</h3> Collection of patient-reported outcomes (PROs) is increasingly viewed as the standard of care in various orthopedic surgeries given the intrinsic need for quality metrics and outcome collection requirements from government agencies and insurance carriers. Despite these incentives, low response rates to PRO collection tools remain a problem. Currently, most studies that address PRO response rates mainly focus on patients and few studies analyze strategies to improve response rates. To date, an evidence-based overview of successful PRO collection strategies incorporated into an overarching human-centered design framework is still absent. <h3>PURPOSE</h3> We aimed to systematically review existing literature, synthesize evidence, and develop an overarching framework of strategies to increase PRO collection rates. <h3>METHODS</h3> First, we systematically searched existing literature from 06-2011 to 06-2021 (using PubMed, EMBASE, Scopus, Business Source Complete) for studies that 1) included a primary or secondary outcome of PRO response rates evaluating one or more interventions, 2) included the PRO response rate achieved for each comparator group, 3) calculated response rates per PRO, 4) involved an orthopedic practice, 5) involved mainly adults. Included studies were assessed according to their focus on survey collection tool design or patient engagement; subsequently, a human-centered design approach was used to develop an evidence-based framework. In order to develop a comprehensive framework for strategies to increase PRO response rates, we developed a two-pronged framework: survey collection tool strategies and patient engagement strategies. <h3>RESULTS</h3> Among 15 included studies (conducted in 3 countries) there were 3 randomized controlled trials, 1 prospective study and 11 retrospective studies. PRO response rates achieved by interventions ranged from 46% to 100%; 3 studies included more than one intervention, and only 1 of these studies looked at each intervention separately. The remaining two were unable to identify which specific intervention was most effective. The most common intervention studied was the method of survey distribution modality, however, modalities' effectiveness was not uniform. Additional interventions studied were: dedicated research assistants, length of surveys, frequency of surveys, automated provider reminders and communication regarding standard of care. Having a dedicated research assistant, shorter surveys, and automated reminders for the provider showed an increase in response rate. Color-coding indicates which strategies have been studied and examples are included in italics. There are significant gaps in the literature, especially on the patient engagement side. The strategy studied most for patient engagement is the number of dedicated research assistants, which has higher associated costs due to dedicated labor hours. <h3>CONCLUSIONS</h3> Considering the two aspects of survey data collection: survey collection tool design and patient engagement, current literature has prioritized the former, leaving a considerable gap in the orthopedic community's understanding of strategies to improve PRO response rate. The framework presented strives to provide a systematic roadmap for orthopedic practices seeking to increase PRO response rates that do not drastically increase cost. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Human-centered design of clinical decision support for management of hypertension with chronic kidney disease

BackgroundPrimary care providers face challenges in recognizing and controlling hypertension in patients with chronic kidney disease (CKD). Clinical decision support (CDS) has the potential to aid clinicians in identifying patients who could benefit from medication changes. This study designed an alert to control hypertension in CKD patients using an iterative human-centered design process.MethodsIn this study, we present a human-centered design process employing multiple methods for gathering user requirements and feedback on design and usability. Initially, we conducted contextual inquiry sessions to gather user requirements for the CDS. This was followed by group design sessions and one-on-one formative think-aloud sessions to validate requirements, obtain feedback on the design and layout, uncover usability issues, and validate changes.ResultsThis study included 20 participants. The contextual inquiry produced 10 user requirements which influenced the initial alert design. The group design sessions revealed issues related to several themes, including recommendations and clinical content that did not match providers' expectations and extraneous information on the alerts that did not provide value. Findings from the individual think-aloud sessions revealed that participants disagreed with some recommended clinical actions, requested additional information, and had concerns about the placement in their workflow. Following each step, iterative changes were made to the alert content and design.DiscussionThis study showed that participation from users throughout the design process can lead to a better understanding of user requirements and optimal design, even within the constraints of an EHR alerting system. While raising awareness of design needs, it also revealed concerns related to workflow, understandability, and relevance.ConclusionThe human-centered design framework using multiple methods for CDS development informed the creation of an alert to assist in the treatment and recognition of hypertension in patients with CKD.

Human-Centered Design of a Digital Health Tool to Promote Effective Self-care in Patients With Heart Failure: Mixed Methods Study.

BackgroundEffective self-care is an important factor in the successful management of patients with heart failure (HF). Despite the importance of self-care, most patients with HF are not adequately taught the wide range of skills required to become proficient in self-care. Digital health technology (DHT) may provide a novel solution to support patients at home in effective self-care, with the view to enhancing the quality of life and ultimately improving patient outcomes. However, many of the solutions developed to date have failed to consider users’ perspectives at the point of design, resulting in poor effectiveness. Leveraging a human-centered design (HCD) approach to the development of DHTs may lead to the successful promotion of self-care behaviors in patients with HF.ObjectiveThis study aimed to outline the HCD, development, and evaluation process of a DHT designed to promote effective self-care in patients with HF.MethodsA design thinking approach within the HCD framework was undertaken, as described in the International Organization for Standardization 9241-210:2019 regulations, using a 5-step process: empathize, ideate, design, develop, and test. Patients with HF were involved throughout the design and evaluation of the system. The designed system was grounded in behavior change theory using the Theoretical Domains Framework and included behavior change techniques. Mixed methods were used to evaluate the DHT during the testing phase.ResultsSteps 1 to 3 of the process resulted in a set of evidence- and user-informed design requirements that were carried forward into the iterative development of a version 1 system. A cross-platform (iOS and Android) mobile app integrated with Fitbit activity trackers and smart scales was developed. A 2-week user testing phase highlighted the ease of use of the system, with patients demonstrating excellent adherence. Qualitative analysis of semistructured interviews identified the early potential for the system to positively influence self-care. Specifically, users perceived that the system increased their confidence and motivation to engage in key self-care behaviors, provided them with skills and knowledge that made them more aware of the importance of self-care behaviors, and might facilitate timely help seeking.ConclusionsThe use of an HCD methodology in this research has resulted in the development of a DHT that may engage patients with HF and potentially affect their self-care behaviors. This comprehensive work lays the groundwork for further development and evaluation of this solution before its implementation in health care systems. A detailed description of the HCD process used in this research will help guide the development and evaluation of future DHTs across a range of disease use cases.

A Human-Centered Design Approach to Creating Tools to Help Journalists Monitor Digital Political Ads: Insights and Challenges

Political actors have increasingly incorporated digital advertising into their persuasive efforts. Greater transparency of how political actors are using digital ads is necessary given concerns that they may be using digital ads to suppress voter turnout and spread disinformation and xenophobia. We apply a human-centered design framework to identify the design requirements necessary to create tools that satisfy journalists’ needs for covering digital political ads. Based on interviews with journalists, our findings indicate that they are interested in covering how political actors are using digital advertising as well as reporting on the platforms, such as their policies. Our findings also reveal serious obstacles that impede journalists’ ability to effectively cover digital political advertising. From the currently available tools, journalists we interviewed found it difficult to quickly identify key takeaways that could result in or contribute to stories. Journalists also need information that the most popular technology platforms do not offer. Supporting journalists’ efforts to provide greater transparency of digital political ads will require a collective effort on the part of designers and technology platforms to provide information that journalists need via tools that surface and synthesize this information in a way that satisfies journalists’ professional demands.

A Patient Outcomes-Driven Feedback Platform for Emergency Medicine Clinicians: Human-Centered Design and Usability Evaluation of Linking Outcomes Of Patients (LOOP).

BackgroundThe availability of patient outcomes–based feedback is limited in episodic care environments such as the emergency department. Emergency medicine (EM) clinicians set care trajectories for a majority of hospitalized patients and provide definitive care to an even larger number of those discharged into the community. EM clinicians are often unaware of the short- and long-term health outcomes of patients and how their actions may have contributed. Despite large volumes of patients and data, outcomes-driven learning that targets individual clinician experiences is meager. Integrated electronic health record (EHR) systems provide opportunity, but they do not have readily available functionality intended for outcomes-based learning.ObjectiveThis study sought to unlock insights from routinely collected EHR data through the development of an individualizable patient outcomes feedback platform for EM clinicians. Here, we describe the iterative development of this platform, Linking Outcomes Of Patients (LOOP), under a human-centered design framework, including structured feedback obtained from its use.MethodsThis multimodal study consisting of human-centered design studios, surveys (24 physicians), interviews (11 physicians), and a LOOP application usability evaluation (12 EM physicians for ≥30 minutes each) was performed between August 2019 and February 2021. The study spanned 3 phases: (1) conceptual development under a human-centered design framework, (2) LOOP technical platform development, and (3) usability evaluation comparing pre- and post-LOOP feedback gathering practices in the EHR.ResultsAn initial human-centered design studio and EM clinician surveys revealed common themes of disconnect between EM clinicians and their patients after the encounter. Fundamental postencounter outcomes of death (15/24, 63% respondents identified as useful), escalation of care (20/24, 83%), and return to ED (16/24, 67%) were determined high yield for demonstrating proof-of-concept in our LOOP application. The studio aided the design and development of LOOP, which integrated physicians throughout the design and content iteration. A final LOOP prototype enabled usability evaluation and iterative refinement prior to launch. Usability evaluation compared to status quo (ie, pre-LOOP) feedback gathering practices demonstrated a shift across all outcomes from “not easy” to “very easy” to obtain and from “not confident” to “very confident” in estimating outcomes after using LOOP. On a scale from 0 (unlikely) to 10 (most likely), the users were very likely (9.5) to recommend LOOP to a colleague.ConclusionsThis study demonstrates the potential for human-centered design of a patient outcomes–driven feedback platform for individual EM providers. We have outlined a framework for working alongside clinicians with a multidisciplined team to develop and test a tool that augments their clinical experience and enables closed-loop learning.

Development of a Digital Health Intervention for Rheumatoid Arthritis Symptom Management in a Biotechnology Industry Context: Protocol for the Application of a Human-Centered Design Framework.

BackgroundInvolving chronically ill patients in the management of their health is widely recognized as a vital component of high-quality health care. However, to assume the role of informed participants, patients need both access to their health information and assistance in interpreting such data. Smartphone technology with SMS text messaging functionality offers a convenient and minimally demanding mechanism for providing such dual capabilities to patients. To date, a number of similar digital tools have been developed for use in various chronic and progressive disease conditions, including rheumatoid arthritis.ObjectiveThis paper aims to describe the development of a research protocol that applies a human-centered design (HCD) approach to develop a mobile health (mHealth) intervention to support symptom management and treatment adherence for rheumatoid arthritis.MethodsTo guide the development of the mHealth intervention for use within a commercial biotechnology context, we selected and applied an HCD framework consisting of three phases: understanding, ideation, and implementation.ResultsLeveraging the framework, we mapped the key objectives and research questions to each phase and identified the HCD techniques and methods most suitable for addressing them. In addition, we identified the need to include a fourth phase, one that referred to postimplementation assessment, which would enable evaluation of patient engagement and intervention impact on symptom self-management.ConclusionsThis paper presents a research protocol that applied an HCD framework to guide the development of an mHealth intervention within a commercial biotechnology context. This type of guidance is salient because commercial entities are becoming one of the leading producers of this type of intervention. However, the methodologies used and challenges faced from a research and development perspective are not well-represented in the published research literature to date. Our application of the HCD framework yielded important findings. Each phase of the HCD framework provided important guidance for increasing the likelihood that the final product would be understandable, acceptable, feasible, and engaging to use. Consistent with other researchers in the field of mHealth interventions, we identified the need to add a fourth phase to the HCD framework, one that focused on a postimplementation assessment to guide further improvements to support adoption in real-world settings.International Registered Report Identifier (IRRID)RR1-10.2196/16430

Description of a Human-Centered Design Approach to Develop Novel Virtual Reality Applications to Improve Functional Outcomes Following Brain Injury

<h3>Research Objectives</h3> Brain injury continues to be a leading cause of serious long-term disability. The objective of this project is to develop and implement innovative assessment and intervention strategies, via robotics and virtual reality systems, to improve balance and walking capabilities for persons with neurologic conditions. <h3>Design</h3> A Human-centered design (HCD) framework is being used to guide the development process and to ensure its end products are usable and useful. HCD develops solutions by involving the stakeholder perspective in all steps of the problem solving process - which includes brainstorming, conceptualizing, developing, and implementing the solution. <h3>Setting</h3> Remote collaboration between a Neuro-recovery Center and an independent virtual reality (VR) and robotics laboratory (Immersive Experience Laboratories LLC (IXL)). <h3>Participants</h3> Physical Therapists, Occupational Therapists, persons with traumatic brain injury, and VR application hardware and software developers. <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Description of the development process of a clinician-designed virtual reality (VR) application for deployment with individuals recovering from brain injury; time to initial uptake of technology; patient and clinician preferences; and clinical outcome scores. <h3>Results</h3> Focus group meetings with clinicians have revealed needs that have strong potential to be effectively addressed by immersive and interactive virtual-reality (VR) interventions, including Identification of Hazards, Care of Others, Garage Time, and Guided Walking. Development of functional platforms for immersive VR training and asset development of indoor household settings is principally complete. Development of treadmill-integrated gait-management platform is principally complete. We currently continue iterative development of content with biweekly feedback from subject-matter-expert clinicians. <h3>Conclusions</h3> The HCD framework could be readily adaptable to other rehabilitation centers interested in developing and implementing these kinds of technologies for the patients they serve. <h3>Author(s) Disclosures</h3> No conflicts of interest

Parallel Assessment Tracks for Human-Centered Design (PATH): A Framework for Transitioning to a New Health Information Technology System

This practice-oriented paper presents a human-centered design (HCD) framework that we developed to perform a comprehensive evaluation of a new health information technology (HIT) system under development, intended to replace a legacy system. The Department of Veterans Affairs (VA) Veteran Crisis Line (VCL) program provides a vital service in crisis intervention and suicide prevention. VCL staff rely on a Customer Relationship Management (CRM) legacy system, Medora. VCL intended to replace Medora with Microsoft Dynamics 365 (D365) CRM system. Due to wide-spread criticism of D365, the VA Human Factors Engineering (HFE) team engaged in a multi-study, mixed-method HCD evaluation to investigate the legacy system and intended replacement in terms of ability to support VCL staff needs. The HCD framework we developed to perform this evaluation may be adapted for other large-scale HIT transitions and may provide human factors practitioners with guidance to make evidence-based decisions to support (or abandon) such transitions.

Concept evaluation of a new aircraft passenger privacy bubble using virtual prototyping: A Human-Centered Design framework.

The Human-Centered Design methodology advocates VR prototyping, as an effective tool to evaluate concepts in a cost-efficient, time-saving way. It is the question of whether it works in the development of a product intended to increase privacy while flying. The current study aims at the application of virtual reality on the evaluation of a new privacy bubble called PRIVA for the passenger cabin. An interactive VR was created and aligned with the HTC VIVE headset. 40 participants took part in the experiment as well as in the post-experiment survey. The concept was in overall, desirable as it was perceived to be more private, comfortable, satisfactory, effective, and appealing to participants compared to the current seat experiences. It was also perceived as more satisfactory with regards to the activities. The VR was effective, although there are limitations, the product seems promising and should be developed further.

Using Grounded Theory to Inform the Human-Centered Design of Digital Health in Geriatric Palliative Care

ContextDigital health offers innovative mechanisms to engage in palliative care, yet digital systems are typically designed for individual users, rather than integrating the patient's caregiving “social convoy” (i.e., family members, friends, neighbors, formal caregiving supports) to maximize benefit. As older adults with serious illness increasingly rely on the support of others, there is a need to foster effective integration of the social convoy in digitally supported palliative care. ObjectivesConduct a qualitative study examining patient, social convoy, and health care provider perspectives on digital health for palliative care to inform the design of future digital solutions for older adults with serious illness and their social convoy. MethodsGrounded theory approach using semi-structured interviews (N = 81) with interprofessional health care providers, older adults with serious illness, and their social convoy participants at home, clinic, or Zoom. Interviews were conducted using question guides relevant to the participant group and audio-recorded for verbatim transcription. Two coders lead the inductive analysis using open and axial coding. ResultsThematic results aligned with the human-centered design framework, which is a participatory approach to the design process that incorporates multiple user stakeholders to develop health solutions. The human-centered design process and corresponding theme included the following: 1) Empathy: Patient, Caregiver, and Provider Experience reports participants' experience with managing serious illness, caregiving, social support, and technology use. 2) Define: Reactions to Evidence-Based Care Concepts and Barriers illustrates participants' perspectives on the domains of palliative care ranging from symptom management to psychosocial-spiritual care. 3) Ideation: Desired Features reports participant recommendations for designing digital health tools for palliative care domains. ConclusionDigital health provides an opportunity to expand the reach of geriatric palliative care interventions. This paper documents human-centered preferences of geriatric palliative care digital health to ensure technologies are relevant and meaningful to health care providers, patients, and the caregiving social convoy.

Use of Synchronous Digital Health Technologies for the Care of Children With Special Health Care Needs and Their Families: Scoping Review.

BackgroundUse of synchronous digital health technologies for care delivery to children with special health care needs (having a chronic physical, behavioral, developmental, or emotional condition in combination with high resource use) and their families at home has shown promise for improving outcomes and increasing access to care for this medically fragile and resource-intensive population. However, a comprehensive description of the various models of synchronous home digital health interventions does not exist, nor has the impact of such interventions been summarized to date.ObjectiveWe aim to describe the various models of synchronous home digital health that have been used in pediatric populations with special health care needs, their outcomes, and implementation barriers.MethodsA systematic scoping review of the literature was conducted, guided by the Arksey and O’Malley Scoping Review Framework. MEDLINE, CINAHL, and EMBASE databases were searched from inception to June 2018, and the reference lists of the included systematic reviews and high-impact journals were hand-searched.ResultsA total of 38 articles were included in this review. Interventional articles are described as feasibility studies, studies that aim to provide direct care to children with special health care needs, and studies that aim to support family members to deliver care to children with special health care needs. End-user involvement in the design and implementation of studies is evaluated using a human-centered design framework, and factors affecting the implementation of digital health programs are discussed in relation to technological, human, and systems factors.ConclusionsThe use of digital health to care for children with special health care needs presents an opportunity to leverage the capacity of technology to connect patients and their families to much-needed care from expert health care providers while avoiding the expenses and potential harms of the hospital-based care system. Strategies to scale and spread pilot studies, such as involving end users in the co-design techniques, are needed to optimize digital health programs for children with special health care needs.

A human centered approach to design a diet app for patients with metabolic syndrome.

The objective of this study was to utilize a human-centered approach in designing a diet app that would assist in management of patients with metabolic syndrome. A convenience sample of 10 dietetic interns (DIs) who were attending their informatics rotation at the City University of New York School of Public Health and Health Policy (CUNY GSPHHP) were recruited during October 2017. The study was conducted in two phases. In phase 1, the DIs received a tutorial on the use of human-centered approach in designing mobile health applications. In phase 2, the DIs were provided a case study for which they designed an app for patients to manage metabolic syndrome using a human centered approach. The goal of phase 2 was to identify the features that were believed to be most important when designing this metabolic syndrome app. An initial questionnaire was administered to the DIs to gather information on their socio-demographics, prior training in nutrition, smart phone usage, perceptions about food logs, and calorie intake calculations. Subsequent questionnaires gathered information from the DIs on their preferred diet app components, app features, rankings of the features, and mock representations of the diet app with the selected features. The DIs were enrolled in the supervised practice component of their training to be Registered Dietitian Nutritionists (RDNs). Fifty percent of them had previously worked in a nutrition-related field. One-third of them were currently using a nutrition app. The top five features of the proposed diet app which the DIs identified as very important included (I) personalization of the app based on user preferences (80%, n=8); (II) disease specific education tips (90%, n=9); (III) ability to track progress (80%; n=8); (IV) reminders (70%, n=7) and (V) reinforcement based on user feedback (50%, n=5). In translating the identified features into functional requirements, majority of the DIs felt that the five key features identified should incorporate the following components: (I) personalization of the app should comprise information on medical factors, personal information, personal preferences, and recording weights; (II) disease specific educational tips should comprise information on food selections, low sodium options, and recipes for diabetes; (III) tracking progress should comprise features for storing audio files, viewing previous logs and uploading photos into a library; (IV) reminders should comprise daily messages to the users from the app; and (V) reinforcement should comprise provisions to enter motivational messages. Our study lends support to the need for utilizing human-centered design (HCD) approaches in developing e-health dietary apps as well other non-diet related apps. App developers are encouraged to incorporate user characteristics, needs and preferences using a HCD framework that will allow for reproducibility, tailoring, user satisfaction, and effectiveness assessments.

A Call for Inclusion of Human Centered Design Framework into Apparel Design Curriculum

A Call for Inclusion of Human Centered Design Framework into Apparel Design Curriculum