Human-centered Design Process Research Articles

Developing an mHealth program to improve HIV care continuum outcomes among young Black gay and bisexual men

BackgroundYoung Black gay and bisexual men (YBGBM) in the United States face significant disparities in HIV care outcomes. Mobile health (mHealth) interventions have shown promise with improving outcomes for YBGBM across the HIV care continuum.MethodsWe developed an mHealth application using human-centered design (HCD) from 2019–2021 in collaboration with YBGBM living with HIV and with HIV service providers. Our HCD process began with six focus groups with 50 YBGBM and interviews with 12 providers. These insights were used to inform rapid prototyping, which involved iterative testing and refining of program features and content, with 31 YBGBM and 12 providers. We then collected user feedback via an online survey with 200 YBGBM nationwide and usability testing of a functional prototype with 21 YBGBM.ResultsFocus groups and interviews illuminated challenges faced by YBGBM living with HIV, including coping with an HIV diagnosis, stigma, need for social support, and a dearth of suitable information sources. YBGBM desired a holistic approach that could meet the needs of those newly diagnosed as well as those who have been living with HIV for many years. Program preferences included video-based content where users could learn from peers and experts, a range of topics, a community of people living with HIV, and tools to support their health and well-being. Providers expressed enthusiasm for an mHealth program to improve HIV care outcomes and help them serve clients. Rapid prototyping resulted in a list of content topics, resources, video characteristics, community features, and mHealth tools to support adherence, retention, goal setting, and laboratory results tracking, as well as tools to help organization staff to support clients. Online survey and usability testing confirmed the feasibility, acceptability, and usability of the content, tools, and features.ConclusionsThis study demonstrates the potential of a video-based mHealth program to address the unique needs of YBGBM living with HIV, offering support and comprehensive information through a user-friendly interface and videos of peers living with HIV and of experts. The HCD approach allowed for continuous improvements to the concept to maximize cultural appropriateness, utility, and potential effectiveness for both YBGBM and HIV service organizations.

HCI-modelling for improving the clinical usability of digital health technologies

IntroductionDigital Health Technologies (DHTs) have been shown to have variable usability as measured by efficiency, effectiveness and user satisfaction despite large-scale government projects to regulate and standardise user interface (UI) design. We hypothesised that Human-Computer Interaction (HCI) modelling could improve the methodology for DHT design and regulation, and support the creation of future evidence-based UI standards and guidelines for DHTs. MethodologyUsing a Design Science Research (DSR) framework, we developed novel UI components that adhered to existing standards and guidelines (combining the NHS Common User Interface (CUI) standard and the NHS Design System). We firstly evaluated the Patient Banner UI component for compliance with the two guidelines and then used HCI-modelling to evaluate the “Add New Patient” workflow to measure time to task completion and cognitive load. ResultsCombining the two guidelines to produce new UI elements is technically feasible for the Patient Banner and the Patient Name Input components. There are some inconsistencies between the NHS Design System and the NHS CUI when implementing the Patient Banner. HCI-modelling successfully quantified challenges adhering to the NHS CUI and the NHS Design system for the “Add New Patient” workflow. DiscussionWe successfully developed new design artefacts combing two major design guidelines for DHTs. By quantifying usability issues using HCI-modelling, we have demonstrated the feasibility of a methodology that combines HCI-modelling into a human-centred design (HCD) process could enable the development of standardised UI elements for DHTs that is more scientifically robust than HCD alone. ConclusionCombining HCI-modelling and Human-Centred Design could improve the scientific progress towards developing safer and more user-friendly DHTs.

Supporting cognitive intelligence for smart manufacturing systems using HMI design: challenges and fundamental issues

As the rate of digitalisation grows in the manufacturing sector, there is a need to address the manner in which design for the human experience is conceptualised. In industrial systems, user experience/user interface (UX/UI) as a paradigm does not fit in squarely, as industrial technologies require a blend of humans and technology for productivity. Thus, the aim of this article is to highlight the challenges and fundamental issues related to human-machine interaction (HMI) design in smart manufacturing from the disciplines of Human Factors and Interaction Design in terms of major themes: (1) designing for operator experience, (2) meaning-based analytics and design for complexity, and (3) human-centered design process for enabling reliability, maintainability, availability, and safety. These various challenges are depicted using a case study of HMI concept design for monitoring an additive manufacturing setup. The article concludes by discussing future steps for addressing HMI design in the manufacturing sector.

MyTrack+: Human-centered design of an mHealth app to support long-term weight loss maintenance.

A growing body of research has focused on the utility of adaptive intervention models for promoting long-term weight loss maintenance; however, evaluation of these interventions often requires customized smartphone applications. Building such an app from scratch can be resource-intensive. To support a novel clinical trial of an adaptive intervention for weight loss maintenance, we developed a companion app, MyTrack+, to pair with a main commercial app, FatSecret (FS), leveraging a user-centered design process for rapid prototyping and reducing software engineering efforts. MyTrack+ seamlessly integrates data from FS and the BodyTrace smart scale, enabling participants to log and self-monitor their health data, while also incorporating customized questionnaires and timestamps to enhance data collection for the trial. We iteratively refined the app by first developing initial mockups and incorporating feedback from a usability study with 17 university students. We further improved the app based on an in-the-wild pilot study with 33 participants in the target population, emphasizing acceptance, simplicity, customization options, and dual app usage. Our work highlights the potential of using an iterative human-centered design process to build a companion app that complements a commercial app for rapid prototyping, reducing costs, and enabling efficient research progress.

Centering healthcare workers in digital health design: Usability and acceptability of two-way texting to improve retention in antiretroviral therapy in a public HIV clinic in Lilongwe, Malawi.

New initiates on antiretroviral therapy (ART) are at high risk of treatment discontinuation, putting their health at risk. In low- and middle-income countries, like Malawi, appropriate digital health applications (apps) must fit into local clinic, connectivity and resource constraints. We describe the human centered design (HCD) and development process of an open-source, hybrid, two-way texting (2wT) system to improve ART retention. We detail the critical role of diverse healthcare workers (HCWs) in the HCD process to inform app usability, create buy-in, and ensure appropriate optimization for the local context. We optimized 2wT usability and acceptability over three HCD phases: 1) informal feedback sessions with diverse 2wT stakeholders, 2) a small pilot, and 3) key informant interviews. Phase one included four sessions with diverse HCWs, including "expert ART clients", clinical, technical, supervisory, and evaluation teams to inform 2wT design. In phase 2, a small pilot with 50 participating ART clients aimed to inform implementation improvement. Phase three included interviews with ten HCWs to deepen understanding of 2wT acceptability and usability, documenting strengths and weaknesses to inform optimization. Multi-phase feedback sessions with HCWs helped refine 2wT language and message timing for both weekly and tailored client-specific visit reminders. The pilot led to improvements in educational materials to guide client responses and ease interaction with HCWs. In interviews, the HCWs appreciated the HCD co-creation process, suggested ways to increase access for low-literacy clients or those without consistent phone access, and felt integrating 2wT with other eHealth platforms would improve scalability. Inclusion of HCWs across phases of HCD design, adaption, and optimization increased 2wT usability and acceptability among HCWs in this setting. Engaging HCWs into 2wT co-ownership from inception appears successful in co-creation of an app that will meet HCW needs, and therefore, enhance support for 2wT clients to attend visits and remain in care.

280 Enhancing Nephrology Care Access: Development and Implementation of a Telenephrology Dashboard Through Human-Centered Design

OBJECTIVES/GOALS: Our objective is to develop a Telenephrology dashboard for the 150,000 Veterans that obtain care through the Iowa City Veterans Affairs Health Care System. Our goal is to create a comprehensive and user-friendly tool for monitoring kidney health and facilitating remote nephrology consultations. METHODS/STUDY POPULATION: We structured our intervention according to the five stages of human-centered design: (1) Empathize, (2) Define, (3) Ideate, (4) Prototype and (5) Test. During the empathy stage, the principal investigator spent 10 hours immersed in the clinical setting observing how nephrologists approach a remote nephrology consultation. These observations were augmented by unstructured interviews with clinicians and patients to better understand the process and dynamics. Following this, a rapid ideation workshop was convened to generate creative solutions that balance technical requirements with the needs of clinicians and patients. These led to rapid prototyping and testing to identify what elements of the prototypes worked and which needed improvement. RESULTS/ANTICIPATED RESULTS: Through the empathy and define stages, three needs were identified: (1) clarity in visualizing data, (2) accuracy of information, and (3) balancing standardization with individualization. During the rapid ideation workshop, the concept of a four-frame dashboard was settled upon. This led to the creation of five prototypes, which were tested. These were reconciled and modified to make a final product. This final product, the Telenephrology Dashboard, contains 5 elements that support nephrologists and supporting staff: (1) a graph of kidney function over time, (2) tables synthesizing lab data, (3) options to drill down events to specific times, (4) customization of views, and (5) integration of kidney disease progression models. DISCUSSION/SIGNIFICANCE: A Telenephrology dashboard was created to facilitate remote nephrology consultations through a Human-Centered Design process. Our next steps include determining if this dashboard may improve end-user satisfaction, referring clinician satisfaction, access to specialist care, and patient outcomes.

Applying human-centered design to the construction of a cirrhosis management clinical decision support system.

Electronic health record (EHR)-based clinical decision support is a scalable way to help standardize clinical care. Clinical decision support systems have not been extensively investigated in cirrhosis management. Human-centered design (HCD) is an approach that engages with potential users in intervention development. In this study, we applied HCD to design the features and interface for a clinical decision support system for cirrhosis management, called CirrhosisRx. We conducted technical feasibility assessments to construct a visual blueprint that outlines the basic features of the interface. We then convened collaborative-design workshops with generalist and specialist clinicians. We elicited current workflows for cirrhosis management, assessed gaps in existing EHR systems, evaluated potential features, and refined the design prototype for CirrhosisRx. At the conclusion of each workshop, we analyzed recordings and transcripts. Workshop feedback showed that the aggregation of relevant clinical data into 6 cirrhosis decompensation domains (defined as common inpatient clinical scenarios) was the most important feature. Automatic inference of clinical events from EHR data, such as gastrointestinal bleeding from hemoglobin changes, was not accepted due to accuracy concerns. Visualizations for risk stratification scores were deemed not necessary. Lastly, the HCD co-design workshops allowed us to identify the target user population (generalists). This is one of the first applications of HCD to design the features and interface for an electronic intervention for cirrhosis management. The HCD process altered features, modified the design interface, and likely improved CirrhosisRx's overall usability. The finalized design for CirrhosisRx proceeded to development and production and will be tested for effectiveness in a pragmatic randomized controlled trial. This work provides a model for the creation of other EHR-based interventions in hepatology care.

Configuration of a telerehabilitation system to deliver a comprehensive aphasia therapy program via telerehabilitation (TeleCHAT): A human-centred design approach

ABSTRACT The delivery of Intensive Comprehensive Aphasia Programs (ICAPs) via telerehabilitation is a potential solution to the ongoing geographical, transport, and mobility barriers that people with aphasia (PWA) face in accessing this service model. To ensure the ICAP retains its evidence-based elements, configuration of the telerehabilitation system requires consideration of user and therapy task requirements. The human-centred design (HCD) process incorporates user and task considerations when developing technological systems. Therefore, the aim of this study was to use the HCD process to translate the Comprehensive High-dose Aphasia Therapy (CHAT) program for delivery via telerehabilitation (TeleCHAT). Methods The HCD translation process used consisted of five iterative stages. Relevant literature was reviewed, and speech-language pathologists (SLPs) experienced in delivering ICAPs were consulted to understand the therapy context. Researchers gathered therapy task and user requirements of PWA, support people (SP) and SLPs to engage in therapy. Technology that met user and therapy task requirements were identified and a preliminary technology configuration was tested in a simulated environment. The finalised system was tested in a pilot trial of TeleCHAT with a cohort of four PWA, two SPs, and two SLPs. Feedback and technical and user issues were collated from users and analysed to inform improvements to the TeleCHAT configuration and protocol. Results User and therapy task requirements to deliver TeleCHAT were identified with consideration of communication and participation supports for PWA. The configured technology system comprised of Zoom© as the videoconferencing platform of choice, and additional critical technical functions including screen and audio sharing of therapy content, and multi-point interaction using remote control and annotation tools. Simulation testing and a pilot trial of the configuration confirmed system operability and identified modifications to optimise functioning. Conclusion The HCD framework was used to successfully configure an optimal technology system for the delivery of TeleCHAT. The HCD framework can be used by clinicians to identify patient needs and configure optimal telerehabilitation systems for delivery of complex interventions.

A dynamic approach for visualizing and exploring concept hierarchies from textbooks.

In this study, we propose a visualization technique to explore and visualize concept hierarchies generated from a textbook in the legal domain. Through a human-centered design process, we developed a tool that allows users to effectively navigate through and explore complex hierarchical concepts in three kinds of traversal techniques: top-down, middle-out, and bottom-up. Our concept hierarchies offer an overview over a given domain, with increasing level of detail toward the bottom of the hierarchy which is consisting of entities. In the legal use case we considered, the concepts were adapted from section headings in a legal textbook, whereas references to law or legal cases inside the textbook became entities. The design of this tool is refined following various steps such as gathering user needs, pain points of an existing visualization, prototyping, testing, and refining. The resulting interface offers users several key features such as dynamic search and filter, explorable concept nodes, and a preview of leaf nodes at every stage. A high-fidelity prototype was created to test our theory and design. To test our concept, we used the System Usability Scale as a way to measure the prototype's usability, a task-based survey to asses the tool's ability in assisting users in gathering information and interacting with the prototype, and finally mouse tracking to understand user interaction patterns. Along with this, we gathered audio and video footage of users when participating in the study. This footage also helped us in getting feedback when the survey responses required further information. The data collected provided valuable insights to set the directions for extending this study. As a result, we have accounted for varying hierarchy depths, longer text spans than only one to two words in the elements of the hierarchy, searchability, and exploration of the hierarchies. At the same time, we aimed for minimizing visual clutter and cognitive overload. We show that existing approaches are not suitable to visualize the type of data which we support with our visualization.

Design recommendations for XR-based motor rehabilitation exergames at home

Introduction: Acquired brain injuries pose significant societal and individual challenges worldwide. The adoption of XR technologies presents an opportunity to enhance current rehabilitation procedures. However, a comprehensive understanding of the specific requirements of different user groups in XR-based rehabilitation remains incomplete. Our objective was to identify design recommendations for designers and researchers of XR-based exergames for motor rehabilitation for lower-limb motor recovery at home.Methods: After initially conducting a mini-literature review and brief market analysis, we used a human-centered design process, interviewing central stakeholders to understand their perspectives and using thematic analysis to identify recurring themes and insights related to XR-based rehabilitation.Results: The resulting eight key themes for integrating XR-based exergames into acquired brain injuries (ABI) rehabilitation were safety, flexibility, efficacy, usability, technology, motivation, ownership, and social factors.Conclusion: By addressing technical and user-oriented demands, our resulting design recommendations aid designers in developing meaningful XR-based rehabilitation exercises.

Tactical Conflict Avoidance of Manned Traffic - Display Concepts for UAV Pilots

The number of collisions between manned and unmanned aerial vehicles (UAVs) has risen due to the increased use of UAVs. Pilots of manned aircraft can visually detect the usually much smaller UAVs only very late or not at all, which is why UAVs are required to avoid manned aircraft in lower airspace by most regulations. For the task of collision avoidance, the UAV pilot needs appropriate traffic awareness. While operating UAVs within the visual line of sight (VLOS), the UAV pilot can monitor the surrounding traffic himself, but operation beyond the visual line of sight (BVLOS) requires an additional airspace observer or a supporting detect-and-avoid system. In this work, a traffic display concept supporting UAV pilots is derived and proposed using the human-centered design process. Commonly used collision avoidance displays of manned and unmanned aviation are reviewed and the user context for the proposed traffic display is introduced. An online survey is conducted to gather user preferences for several 2D graphical elements of the traffic display. 25 experienced UAV pilots participated in the survey. The data is analyzed using Gwet’s AC1\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$AC_1$$\\end{document} agreement coefficient. Overall, fair agreement can be observed with individual coefficients for different 2D graphical elements ranging from poor to almost perfect agreement. With a developed heuristic, preferred 2D graphical elements are extracted and combinations reviewed to derive a complete traffic display design. The proposed traffic display design, based on user preferences, will be implemented for further evaluation in human-in-the-loop experiments.

A Closed-Loop Falls Monitoring and Prevention App for Multiple Sclerosis Clinical Practice: Human-Centered Design of the Multiple Sclerosis Falls InsightTrack.

Falls are common in people with multiple sclerosis (MS), causing injuries, fear of falling, and loss of independence. Although targeted interventions (physical therapy) can help, patients underreport and clinicians undertreat this issue. Patient-generated data, combined with clinical data, can support the prediction of falls and lead to timely intervention (including referral to specialized physical therapy). To be actionable, such data must be efficiently delivered to clinicians, with care customized to the patient's specific context. This study aims to describe the iterative process of the design and development of Multiple Sclerosis Falls InsightTrack (MS-FIT), identifying the clinical and technological features of this closed-loop app designed to support streamlined falls reporting, timely falls evaluation, and comprehensive and sustained falls prevention efforts. Stakeholders were engaged in a double diamond process of human-centered design to ensure that technological features aligned with users' needs. Patient and clinician interviews were designed to elicit insight around ability blockers and boosters using the capability, opportunity, motivation, and behavior (COM-B) framework to facilitate subsequent mapping to the Behavior Change Wheel. To support generalizability, patients and experts from other clinical conditions associated with falls (geriatrics, orthopedics, and Parkinson disease) were also engaged. Designs were iterated based on each round of feedback, and final mock-ups were tested during routine clinical visits. A sample of 30 patients and 14 clinicians provided at least 1 round of feedback. To support falls reporting, patients favored a simple biweekly survey built using REDCap (Research Electronic Data Capture; Vanderbilt University) to support bring-your-own-device accessibility-with optional additional context (the severity and location of falls). To support the evaluation and prevention of falls, clinicians favored a clinical dashboard featuring several key visualization widgets: a longitudinal falls display coded by the time of data capture, severity, and context; a comprehensive, multidisciplinary, and evidence-based checklist of actions intended to evaluate and prevent falls; and MS resources local to a patient's community. In-basket messaging alerts clinicians of severe falls. The tool scored highly for usability, likability, usefulness, and perceived effectiveness (based on the Health IT Usability Evaluation Model scoring). To our knowledge, this is the first falls app designed using human-centered design to prioritize behavior change and, while being accessible at home for patients, to deliver actionable data to clinicians at the point of care. MS-FIT streamlines data delivery to clinicians via an electronic health record-embedded window, aligning with the 5 rights approach. Leveraging MS-FIT for data processing and algorithms minimizes clinician load while boosting care quality. Our innovation seamlessly integrates real-world patient-generated data as well as clinical and community-level factors, empowering self-care and addressing the impact of falls in people with MS. Preliminary findings indicate wider relevance, extending to other neurological conditions associated with falls and their consequences.

Energy Consumption Displays in Electric Vehicles: Differential Effects on Estimating Consumption and Experienced Energy Dynamics Awareness.

The effects of three prototypical designs of energy consumption displays on energy-specific situation awareness were examined. Energy efficiency is crucial for the sustainability of technical systems. However, without accurate situation awareness of energy dynamics (energy dynamics awareness, EDA) it can be challenging for humans to optimize the use of energy resources of electric vehicles (EVs) through their behavior. We examined three prototypical energy display designs that varied by their informational value to support EDA. Furthermore, we investigated the differential effects on EDA measured by (1) a newly constructed scale (experienced EDA), (2) estimating energy consumption, and (3) identifying efficient trips in an online experiment. Participants (N = 82) watched standardized driving scenes (videos) of EV trips presenting the energy displays. We found a strong effect of display type on experienced EDA, with the trace display being the most supportive. The EDA scale showed excellent internal consistency. The consumption estimation and efficient trip identification indicators were not affected by the display type. The study indicates that experienced EDA is immediately affected by displays with higher information value, but performance might need more time and training. More research is needed to investigate the cognitive processes related to EDA and to examine how distinct display elements enhance EDA. Results from this research can be used as guidance for the design of energy displays, especially in EVs. The EDA scale can be used as an evaluation measure in the human-centered design process of energy displays.

Using human-centered design to develop and implement a pediatric mental health care access program.

In 2019, the University of California at San Francisco (UCSF) launched the Child and Adolescent Psychiatry Portal (CAPP), a pediatric mental health care access (PMHCA) program providing remote mental health consultation services to pediatric primary care providers (PCPs) throughout Northern and Central California. The development and implementation of CAPP was guided by Human-Centered Design (HCD), an iterative, rapid-paced innovation process focusing on stakeholders' needs and experiences, which shaped the development of CAPP's programs. The resulting key programmatic elements are designed for pediatric workforce development: (1) PCP consultation with a child and adolescent psychiatrist via a telephone warmline; and (2) training and education for providers. CAPP has grown rapidly since its launch, having enrolled 1,714 providers from 257 practices spread across 36 counties and provided 3,288 consults on 2,703 unique lives as of August 2023. Preliminary evaluation findings indicate high PCP satisfaction with CAPP's services, despite continued challenges of integrating behavioral health into primary care. Throughout the HCD and implementation process, multidisciplinary partnerships have proven critical in providing end-user input to inform and improve program design. This growing network of partnerships, developed through the cultivation of personal relationships and trust over time, has also proven essential for CAPP's rapid growth and sustainability. Overall, this Community Case Study highlights the critical role of partnerships and the importance of taking a people-centered approach, as captured in CAPP's motto, "Connecting for Care."

Adolescent perspectives on peripartum mental health prevention and promotion from Kenya: Findings from a design thinking approach.

In Kenya, approximately one in five girls aged 15-19 years old are pregnant or already a mother. Adolescent girls and young women experience significant mental health vulnerabilities during the pregnancy and postpartum periods, leading to poor antenatal and postnatal care attendance and inferior infant and maternal health outcomes. Pregnant adolescents often experience stigma and disenfranchisement due to their pregnancy status and at the same time lack access to mental health support within health settings, schools, religious institutions, and communities. This paper presents the results of qualitative interviews embedded within the human-centered design (HCD) process used to adapt the Helping Adolescents Thrive (HAT) program for Kenyan peripartum adolescents including young fathers. This qualitative study used two phases. First, a HAT advisory group participated in a series of four workshops to help identify and articulate mental health promotion needs and deepened the team's understanding of youth-centered thinking. Second, qualitative interviews were conducted with 39 pregnant and parenting adolescents to understand their perspectives on mental health prevention and promotion. Pregnant and parenting adolescents articulated different needs including poor support, stigma, and psychological disturbances. Parenting adolescents reported disturbed relationships, managing motherhood, poor health, and social empowerment. Participants highlighted sources of stress including economic challenges, fear of delivery, strained relationships, rejection, and stigma. Participants described psychological disturbances such as feeling stressed, worthless, withdrawn, and suicidal. Coping mechanisms reported by participants included engaging in domestic activities, hobbies, and social networking. Peers, family and spirituality were identified as important sources of support, as well as school integration, livelihoods, support groups and mentorships. Findings from this study can be used to strengthen and adapt HAT program, policy and practice for mental health prevention and promotion for pregnant and parenting adolescents.

Abstract A032: Collaborative work groups – authentic community collaboration to reduce Wisconsin’s breast and lung cancer disparities

Abstract Authentic community collaboration creates space for a deeper understanding between researchers and community partners and is critical to solving cancer disparities. Collaborative Work Groups (CWG), a program of the Community Cancer Science Network (CCSN) at the Medical College of Wisconsin Cancer Center, brings researchers and community partners in collaboration to address breast and lung cancer disparities statewide using a transdisciplinary approach to understand cancer disparities and create solutions that are grounded in three principles: deep equity, systems thinking, and an integration of biology-to-policy perspectives. CWGs have been actively engaged since the Spring of 2022 in several Wisconsin communities working to uncover the complex factors that drive breast and lung cancer disparities at the local level. Guided by a human-centered design process, the groups are defining the local scope of the problem, integrating diverse perspectives into root cause analyses, and designing solutions that will target the disparities. As part of data gathering to inform community level priorities, three CWGs collaborated to host a World Café event, a methodology for facilitating a large group dialogue, focused on breast cancer disparities. The CWGs invited community members, breast cancer survivors and co-survivors, health care providers, allied health professionals, and breast cancer advocacy organizations from three different counties to attend. Approximately 80 attendees gathered at small tables centered around various topics associated with breast cancer disparities including mammography access and process, social factors, co-morbidities, screening, insurance, and treatment. At each table, attendees discussed the topic and recorded their thoughts on a large notepad, and after 20 minutes switched to a different topic table and added on to previous contributions. Following the three rounds, a representative of each table reported the findings to the entire group. A graphic recorder captured the discussion, table notes were preserved, and attendees provided feedback on the meeting. Open coding validated the graphic recorder. Results of the World Café provided CWGs with data on community priorities. The meeting demonstrated two key values of the CWG: reliance on transdisciplinary relationships to nurture collaboration and the prioritization of building capacity with the community to lead local efforts to improve health outcomes. This dynamic was exemplified as staff of local community organizations were involved at every level of the event, including conceptualization, planning, facilitation, and evaluation. A World Café event is an effective methodology for collecting robust data on solutions for multi-county efforts. CWGs can contribute to eliminating cancer disparities in communities through a human centered design process that integrates diverse sectors with knowledge of biology, behavior, and the socio-cultural and physical environments, and creates an equitable voice for all participants to contribute to designing viable solutions. Citation Format: Staci Young, David Frazer, Tim Meister, Tobi Cawthra, Laura Pinsoneault, Jada Proctor, Kailey Taebel, Felicia Fairfield, Claire Piehowski, Melinda Stolley. Collaborative work groups – authentic community collaboration to reduce Wisconsin’s breast and lung cancer disparities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A032.

Co-Designing an Initiative to Increase Shared Access to Older Adults' Patient Portals: Stakeholder Engagement.

The patient portal is a widely available secure digital platform offered by care delivery organizations that enables patients to communicate electronically with clinicians and manage their care. Many organizations allow patients to authorize family members or friends-"care partners"-to share access to patient portal accounts, thus enabling care partners to receive their own identity credentials. Shared access facilitates trilateral information exchange among patients, clinicians, and care partners; however, uptake and awareness of this functionality are limited. We partnered with 3 health care organizations to co-design an initiative that aimed to increase shared access registration and use and that can be implemented using existing patient portals. In 2020, we undertook a rigorous selection process to identify 3 geographically diverse health care organizations that had engaged medical informatics teams and clinical champions within service delivery lines caring for older adults. We prioritized selecting organizations that serve racially and socioeconomically diverse populations and possess sophisticated reporting capabilities, a stable patient portal platform, a sufficient volume of older adult patients, and active patient and family advisory councils. Along with patients and care partners, clinicians, staff, and other stakeholders, the study team co-designed an initiative to increase the uptake of shared access guided by either an iterative, human-centered design process or rapid assessment procedures of stakeholders' inputs. Between February 2020 and April 2022, 73 stakeholder engagements were conducted with patients and care partners, clinicians and clinic staff, medical informatics teams, marketing and communications staff, and administrators, as well as with funders and thought leaders. We collected insights regarding (1) barriers to awareness, registration, and use of shared access; (2) features of consumer-facing educational materials to address identified barriers; (3) features of clinician- and staff-facing materials to address identified barriers; and (4) approaches to fit the initiative into current workflows. Using these inputs iteratively via a human-centered design process, we produced brochures and posters, co-designed organization-specific web pages detailing shared access registration processes, and developed clinician and staff talking points about shared access and staff tip sheets that outline shared access registration steps. Educational materials emphasized the slogan "People remember less than half of what their doctors say," which was selected from 9 candidate alternatives as resonating best with the full range of the initiative's stakeholders. The materials were accompanied by implementation toolkits specifying and reinforcing workflows involving both in-person and telehealth visits. Meaningful and authentic stakeholder engagement allowed our deliberate, iterative, and human-centered co-design aimed at increasing the use of shared access. Our initiative has been launched as a part of a 12-month demonstration that will include quantitative and qualitative analysis of registration and use of shared access. Educational materials are publicly available at Coalition for Care Partners.

A Community-Based, Mobile Electronic Medical Record System App for High-Quality, Integrated Antiretroviral Therapy in Lilongwe, Malawi: Design Process and Pilot Implementation.

Differentiated service delivery (DSD) increases antiretroviral therapy (ART) access in sub-Saharan Africa by moving clients out of congested ART clinics to communities for care. However, DSD settings challenge provider adherence to complex, chronic care treatment guidelines and have burdensome systems for client monitoring and evaluation (M&E), reducing data for decision-making. Electronic medical record systems (EMRS) improve client outcomes and reduce M&E workload. Traditional EMRS cannot operate in most DSD settings with unreliable power and poor connectivity. This study aims to detail the human-centered design (HCD) process of developing a mobile EMRS for community-based DSD services in Lilongwe, Malawi. Lighthouse Trust (LT) operates 2 Ministry of Health (MoH) clinics in Lilongwe, Malawi, with a combined total of >35,000 ART clients. LT's real-time, point-of-care EMRS collects complex client M&E data and provides decision-making support, ensuring adherence to integrated HIV and tuberculosis guidelines that optimize client and program outcomes. LT's EMRS scaled to all large MoH ART clinics. LT also implements a nurse-led community-based ART program (NCAP), a DSD model to provide ART and rapid assessment for 2400 stable LT clients in the community. LT, alongside collaborators, from the University of Washington's International Training and Education Center for Health and technology partner, Medic, used the open-source Community Health Toolkit (CHT) and HCD to develop an open-source, offline-first, mobile EMRS-like app, "community-based ART retention and suppression" (CARES). CARES aims to bring EMRS-like provider benefits to NCAP's DSD clients. CARES design took approximately 12 months and used an iterative process of highly participatory feedback sessions with provider, data manager, and M&E team inputs to ensure CARES optimization for the NCAP and LT settings. The CARES mobile EMRS prototype supports NCAP providers with embedded prompts and alerts to ensure adherence to integrated MoH ART guidelines, aiming to improve the quality of client care. CARES facilitates improved data quality and flow for NCAP M&E, aiming to reduce data gaps between community and clinic settings. The CARES pilot demonstrates the potential of a mobile, point-of-care EMRS-like app that could benefit NCAP clients, providers, and program teams with integrated client care and complete M&E data for decision-making. CARES challenges include app speed, search features to align longitudinal records, and CARES to EMRS integration that supports timely care alerts. Leveraging the CHT and HCD processes facilitated the design of a locally specified and optimized mobile app with the promise to bring EMRS-like benefits to DSD settings. Moving from the CARES prototype to routine NCAP implementation should result in improved client care and strengthened M&E while reducing workload. Our transparent and descriptive process shares the progress and pitfalls of the CARES design and development, helping others in this digital innovation area to learn from our experiences at this stage.

Operationalizing the principles of patient engagement through a Patient Advisory Council: Lessons and recommendations.

Inclusiveness, Support, Mutual Respectand Co-Build are the four pillars of patient engagement according to the Strategy for Patient-Oriented Research (SPOR). The aim of this manuscript is to describe the operationalization of these principles through the creation of a Patient Advisory Council (PAC) for the research study titled 'Re-Purposing the Ordering of Routine laboratory Tests (RePORT)'. Researchers collaborated with the Alberta SPOR SUPPORT Unit (AbSPORU) Patient Engagement Team to create a diverse PAC. Recruitment was intentional and included multiple perspectives and experiences. PAC meetings were held monthly, and patient research partners received support to function as co-chairs of the PAC. Patient research partners were offered training, supportand tailored modalities of compensation to actively engage with the PAC. Regular member check-ins occurred through reflexivity and a formal evaluation of PAC member engagement. The PAC included between 9 and 11 patient research partners, principal investigator, research study coordinator, improvement scientist, resident physician and support members from the AbSPORU team. Twelve monthly PAC meetings were held during the first phase of the project. The PAC made course-changing contributions to study design including study objectives, recruitment poster, interview guide and development of codes for thematic analysis. Patient research partners largely felt that their opinions were valued. Diversity in the PAC membership enhanced access to diverse patient participants. Furthermore, support for co-chairs and patient research partner members enabled active engagement in research. In addition, a culture of mutual respect facilitated patient partner engagement, and co-design approaches yielded rich research outputs. Collaboration between research teams and Patient Engagement Teams can promote effective patient engagement through a PAC. Deliberate and flexible strategies are needed to manage the PAC to create an ecology of Inclusiveness, Support, Mutual Respect, and Co-Build for meaningful patient engagement. Patient research partners were involved in the decision to write this manuscript and collaborated equitably in the conception and development of this manuscript, including providing critical feedback. Patient research partners were active members of the PAC and informed the research project design, participant recruitment strategies, data collection and analysis, and will be involved in the implementation and dissemination of results. They are currently involved in the co-development of a patient engagement strategy using a Human-Centered Design process.

Project APRED: A web-based data analytics platform for supporting community disaster resilience

In this paper, we introduce the Analysis Platform for Risk, Resilience, and Expenditure in Disasters (APRED)—a disaster-analytic platform developed for crisis practitioners and economic developers across the United States (US). APRED provides practitioners with a centralized platform for exploring disaster resilience and vulnerability profiles of all counties across the US. The platform comprises five sections including: (1) Disaster Resilience Index, (2) Business Vulnerability Index, (3) Disaster Declaration History, (4) County Profile, and (5) Storm History sections. We further describe our end-to-end human-centered design and engineering process that involved contextual inquiry, community-based participatory design, and rapid prototyping with the support of US Economic Development Administration representatives and regional economic developers across the US. Findings from our study revealed that distributed cognition, content heuristic, shareability, and human-centered systems are crucial considerations for developing data-intensive visualization platforms for resilience planning. We discuss the implications of these findings and inform future research on developing sociotechnical visualization platforms to support resilience planning.