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Community telehealth programs (CTPs) enable low-income older adults to receive telehealth services in community settings (e.g., retirement homes). The Telehealth Intervention Program for Seniors (TIPS) is a CTP that provides vital sign monitoring services managed by remote nurses. TIPS has successfully recruited and retained Limited English Proficient (LEP) participants, but lack of language services might hinder LEP participants' equitable access to care. We conducted a two-part mixed-methods study. We first qualitatively analyzed 40 nurse notes to identify challenges nurses encounter gathering information due to language barriers and the workarounds they employed to address these. We then tested our qualitative findings on 23,975 nurse notes to quantify and compare how these challenges and workarounds scale between LEP and English-proficient TIPS participants. We present future research implications beyond low-hanging solutions, such as automated translation services, and discuss how novel technological solutions can support and ameliorate nurse workarounds and caregiver burden.
There are increasing concerns that digital interventions in healthcare settings could be better designed for scalable and sustained use. Implementation science is the scientific study of how to embed evidence-based interventions in practice. Calls to integrate implementation science and Human-Centred Design methods have focused on integrating design methods within implementation science processes. By contrast, we present a novel approach to integrating implementation science within Human-Centred Design for digital health interventions. Our approach leverages the socio-technical Nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework within the distinct phases of the Double Diamond process. To illustrate our proposal we demonstrate its application in the redesign of a brief health promotion intervention to reduce the risk of alcohol-attributable breast cancer in women attending routine mammography. We discuss reflections on the approach and implications for future research that targets implementation within design.
Remote patient monitoring is becoming increasingly instrumental to healthcare delivery but can substantially hamper the interpersonal communication that underlies standard clinical practice. In this work, we explore the benefits imparted to patients, clinicians, and researchers by an asynchronous messaging feature within a platform called COVIDFree@Home. We created COVIDFree@Home to assist the healthcare system in a large metropolitan city in North America during the COVID-19 pandemic. Clinicians used COVIDFree@Home to monitor the self-reported symptoms and vital signs of over 350 COVID-19 patients post-infection. Using thematic analysis of user-initiated messages, we found the messaging feature helped maintain protocol adherence while allowing patients to ask questions about their health and clinicians to convey empathetic care. This feedback cycle also led to higher quality data for hospitalization prediction, as the revisions significantly improved the AUROC of a machine learning model trained on demographic variables, vital signs data, and self-reported symptoms from 0.53 to 0.59.
Rehabilitation therapies are widely employed to assist people with motor impairments in regaining control over their affected body parts. Nevertheless, factors such as fatigue and low self-efficacy can hinder patient compliance during extensive rehabilitation processes. Utilizing hand redirection in virtual reality (VR) enables patients to accomplish seemingly more challenging tasks, thereby bolstering their motivation and confidence. While previous research has investigated user experience and hand redirection among able-bodied people, its effects on motor-impaired people remain unexplored. In this paper, we present a VR rehabilitation application that harnesses hand redirection. Through a user study and semi-structured interviews, we examine the impact of hand redirection on the rehabilitation experiences of people with motor impairments and its potential to enhance their motivation for upper limb rehabilitation. Our findings suggest that patients are not sensitive to hand movement inconsistency, and the majority express interest in incorporating hand redirection into future long-term VR rehabilitation programs.
This study addresses two currently open questions about how behaviors of online community members influence others' responses to misinformation. First, in contrast to prior work, it directly measures norm perception to address whether (1) norm perception actually acts as a mediator, (2) others' behaviors directly influence individuals' responses to misinformation, (3) both direct and mediated effects occur. Second, it investigates norm perceptions about a behavior that is not readily observable in online communities, but is prone to misinformation, specifically, vaccination. To do so, it experimentally manipulates the prevalence of communicating about vaccination (an unobservable behavior) within an online community. The results demonstrate no evidence of a direct effect---the causal relationship between prevalence of communicating a behavior and intentions to respond to misinformation only occurs via norm perception as a mediator. The paper highlights implications of these findings for designing community-centered interventions to influence perceived norms, thereby mitigating misinformation spread and impacts.