Background Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. Objective The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. Methods We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. Results We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=–0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. Conclusions Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches.
Despite years of effort, reliable biometric identification of newborns and young children has remained elusive. In this paper, we review the importance of trusted identification methods, the biometric landscape for infants and adults, barriers and success stories, and we discuss specific failure modes particular to young children. We then describe our approach to infant identification using non-contact optical imaging of fingerprints. We detail our technology development history, including Human-Centered Design methods, various iterations of our platform, and how these iterations addressed failure modes in the identification process. We close with a brief description of our clinical trial of newborns and infants at an urban hospital in Mexico and report preliminary results that show high accuracy, with matching rates consistent with acceptable field-performance for reliable biometric identification in large populations.
Despite years of effort, reliable biometric identification of newborns and young children has remained elusive. In this paper, we review the importance of trusted identification methods, the biometric landscape for infants and adults, barriers and success stories, and we discuss specific failure modes particular to young children. We then describe our approach to infant identification using non-contact optical imaging of fingerprints. We detail our technology development history, including Human-Centered Design methods, various iterations of our platform, and how these iterations addressed failure modes in the identification process. We close with a brief description of our clinical trial of newborns and infants at an urban hospital in Mexico and report preliminary results that show high accuracy, with matching rates consistent with acceptable field-performance for reliable biometric identification in large populations.
Objectives: Toward common methods for system monitoring and evaluation, we proposed a key performance indicator framework and discussed lessons learned while implementing a statewide exposure notification (EN) system in California during the COVID-19 epidemic. Materials and Methods: California deployed the Google Apple Exposure Notification framework, branded CA Notify, on December 10, 2020, to supplement traditional COVID-19 contact tracing programs. For system evaluation, we defined 6 key performance indicators: adoption, retention, sharing of unique codes, identification of potential contacts, behavior change, and impact. We aggregated and analyzed data from December 10, 2020, to July 1, 2021, in compliance with the CA Notify privacy policy. Results: We estimated CA Notify adoption at nearly 11 million smartphone activations during the study period. Among 1 654 201 CA Notify users who received a positive test result for SARS-CoV-2, 446 634 (27%) shared their unique code, leading to ENs for other CA Notify users who were in close proximity to the SARS-CoV-2–positive individual. We identified at least 122 970 CA Notify users as contacts through this process. Contact identification occurred a median of 4 days after symptom onset or specimen collection date of the user who received a positive test result for SARS-CoV-2. Practice Implications: Smartphone-based EN systems are promising new tools to supplement traditional contact tracing and public health interventions, particularly when efficient scaling is not feasible for other approaches. Methods to collect and interpret appropriate measures of system performance must be refined while maintaining trust and privacy.
The race to develop safe and effective SARS-COV-2 vaccines has moved with unprecedented speed. There are now multiple vaccines that have received emergency use authorization from the United States Food and Drug Administration and a host of candidates positioned for approval worldwide. Attention has now turned to allocation, distribution and verification of these vaccines, yet this focus exposes that the underlying infrastructure for global delivery and monitoring is threadbare and unevenly distributed. This presents both a barrier and an opportunity to deploy sustainable infrastructure. Major global stakeholders must convene quickly, collaborate, and collectively invest in global standards, legal models, common vocabularies and interoperable biometric-supported digital health technologies. As the COVID-19 vaccine effort scales, governments, private sector, and NGOs have the chance to place lasting resources needed for equitable and effective delivery that can pay dividends into the future.
Purpose People living with Type 1 diabetes (T1D) are living longer than ever and facing the new “luxury” of the challenges of aging. While research is slowly expanding and addressing T1D physiology with regards to aging, there is little research addressing specific challenges and barriers to optimal care by those aging with T1D. To address this gap, this study employed human-centered design research to explore the gaps and barriers to care faced by people aging with T1D. Methods Researchers employed human-centered design methods of needfinding and user interviews and facilitated participatory workshops. In total, 27 people with T1D (PWT1D), 5 loved ones (partners of PWT1D), and 7 healthcare providers (HCPs) were engaged. Results Design artifacts were developed, including user personas that help visually articulate the different experiences of PWT1D and their unique needs as they age, as well as a prototype diabetes-specific advance directive that could be further refined to specifically aid those with Type 1 diabetes who are aging and requiring more interactions with the healthcare system. Initial user testing with people with T1D as well as healthcare providers demonstrated the need for such a diabetes advance directive tool or document. Conclusion This work supports the conclusion that additional focus and scientific enquiry should be given to the needs of people aging with Type 1 diabetes, with a goal of improving the experience of all people with T1D when interacting with their care providers or with the healthcare system as a whole.
Building on technological advances and existing currents of a healthcare system in flux, the COVID‐19 pandemic has brought about perhaps the most rapid transformation in human health and healthcare seen in our times. Even as new opportunities such as telemedicine, remote care, and rapid precision health practices are poised to improve access and care for populations, the increasing sophistication of this transformation has brought with it new levels of complexity, fragmentation, and silos. The singular outcome of this system is the vast number of novel ways for miscommunication, loss of information in transition, and breakdowns in the cognitive continuity of care. We refer to these failure modes as “dropping the patient” and adopt a mantra of “don't drop the patient” which examines our emerging health system in the context of patient‐centered continuity. In this light, we investigate bright spots and pitfalls, and we offer insights from Human Factors Engineering, Human Centered Design, and Human System Integration, which provide tools and methods to codesign and codevelop continuous and resilient services that are inclusive, sustainable, and effective.
Background: As the COVID-19 global pandemic continues, digital exposure notification systems are increasingly used to support traditional contact tracing and other preventive strategies Likewise, a plethora of COVID-19 mobile apps have emerged Objective: To characterize the global landscape of pandemic related mobile apps, including digital exposure notification and contact tracing tools Data Sources and Methods: The following queries were entered into the Google search engine: (*country name* COVID app) OR (COVID app *country name*) OR (COVID app *country name*+) OR (*country name*+ COVID app)′ The App Store, Google Play, and official government websites were then accessed to collect descriptive data for each app Descriptive data were qualified and quantified using standard methods COVID-19 Exposure Notification Systems (ENS) and non-Exposure Notification products were categorized and summarized to provide a global landscape review Results: Our search resulted in a global count of 224 COVID-19 mobile apps, in 127 countries Of these 224 apps, 128 supported exposure notification, with 75 employing the Google Apple Exposure Notification (GAEN) app programming interface (API)′ Of the 75 apps using the GAEN API, 15 apps were developed using Exposure Notification Express, a GAEN turnkey solution COVID-19 apps that did not include exposure notifications (n=96) focused on COVID-19 Self-Assessment (35′4%), COVID-19 Statistics and Information (32′3%), and COVID-19 Health Advice (29′2%) Conclusions: The digital response to COVID-19 generated diverse and novel solutions to support non-pharmacologic public health interventions More research is needed to evaluate the extent to which these services and strategies were useful in reducing viral transmission
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