Objective Many refugees in the United States emigrated from countries where the incidence of cervical cancer is high. Refugee women are unlikely to have been screened for cervical cancer prior to resettlement in the U.S. National organizations recommend cervical cancer screening for refugee women soon after resettlement. We sought to identify health and social service providers’ perspectives on promoting cervical cancer screening in order to inform the development of effective programs to increase screening among recently resettled refugees. Methods This study consisted of 21 in-depth key informant interviews with staff from voluntary refugee resettlement agencies, community based organizations, and healthcare clinics serving refugees in King County, Washington. Interview transcripts were analyzed to identify themes. Results We identified the following themes: 1) refugee women are unfamiliar with preventive care and cancer screening; 2) providers have concerns about the timing of cervical cancer education and screening; 3) linguistic and cultural barriers impact screening uptake; 4) provider factors and clinic systems facilitate promotion of screening; and 5) strategies for educating refugee women about screening. Conclusion Our findings suggest that refugee women are in need of health education on cervical cancer screening during early resettlement. Frequent messaging about screening could help ensure that women receive screening within the early resettlement period. Health education videos may be effective for providing simple, low literacy messages in women's native languages. Appointments with female clinicians and interpreters, as well as clinic systems that remind clinicians to offer screening at each appointment could increase screening among refugee women.
Background Digital therapeutics are growing as a solution to manage pain for patients; yet, they are underused in primary care where over half of the patients with chronic pain seek care. Little is known about how to successfully engage primary care providers in recommending digital therapeutics to their patients. Exploring provider motivations in chronic pain management would potentially help to improve their engagement and inform the development of digital therapeutics. Objective This study examined primary care providers’ motivations for chronic pain management, including their strategies and challenges, to inform the future development of chronic pain-related digital therapeutics tailored to primary care settings. Methods We conducted qualitative semistructured interviews with health care providers recruited from 3 primary care clinics in Washington and 1 clinic in Colorado between July and October 2021. The sample (N=11) included 7 primary care physicians, 2 behavioral health providers, 1 physician assistant, and 1 nurse. Most providers worked in clinics affiliated with urban academic health systems. Guided by the human-centered design approach and Christensen’s Job-to-be-Done framework, we asked providers their goals and priorities in chronic pain management, their experiences with challenges and strategies used to care for patients, and their perceptions of applying digital therapeutics in clinical practice. Transcripts were analyzed using a thematic analysis approach. Results We found that primary care providers were motivated but challenged to strengthen the patient-provider alliance, provide team-based care, track and monitor patients’ progress, and address social determinants of health in chronic pain management. Specifically, providers desired additional resources to improve patient-centered communication, pain education and counseling, and goal setting with patients. Providers also requested greater accessibility to multidisciplinary care team consultations and nonpharmacological pain treatments. When managing chronic pain at the population level, providers need infrastructure and systems to systematically track and monitor patients’ pain and provide wraparound health and social services for underserved patients. Recommendations on digital therapeutic features that might address provider challenges in achieving these motivations were discussed. Conclusions Given the findings, to engage primary care providers, digital therapeutics for chronic pain management need to strengthen the patient-provider alliance, increase access to nonpharmacological treatment options, support population health tracking and management, and provide equitable reach. Leveraging digital therapeutics in a feasible, appropriate, and acceptable way to aid primary care providers in chronic pain management may require multimodal features that address provider motivations at an individual care and clinic or system level.
BACKGROUND Digital therapeutics have been increasingly used to improve behavioral healthcare but are underutilized in primary care settings. OBJECTIVE This study explored primary care providers’ challenges and strategies in chronic pain management to identify needs and practice gaps for future development of chronic pain-related digital therapeutics tailored to primary care settings. METHODS Using a human-centered design approach, qualitative semi-structured interviews were conducted with healthcare providers (N = 11) recruited from four primary care clinics in Washington and Colorado between July and October 2021. Providers shared their goals and priorities in chronic pain management, experiences with challenges and strategies used to care for patients, and their perceptions of applying digital therapeutics in clinical practice. Transcripts were analyzed using a thematic analysis approach. RESULTS Our study found four themes related to provider needs: patient-provider alliance, team-based care, tracking and monitoring, and social determinants of health. Providers desired resources to improve chronic pain conversations, pain education and counseling, and goal setting with patients. Providers needed a greater accessibility to multidisciplinary care team consultations and non-pharmacological pain treatments. Healthcare system infrastructure was needed for providers to systematically track and monitor patients’ pain and provide wraparound health and social services for underserved patients. CONCLUSIONS Leveraging digital therapeutics in a feasible, appropriate and acceptable way to aid primary care providers in chronic pain management may require multimodal features that address provider needs at an individual care and clinic/system level.
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