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Generative Participatory Design Methodology to Develop Electronic Health Interventions: Systematic Literature Review.

ABSTRACT: BACKGROUND:Generative participatory design (PD) may help in developing electronic health (eHealth) interventions. PD is characterized by the involvement of all stakeholders in creative activities. This is different from the traditional user-centered design, where users are less involved. When looking at PD from a research through design perspective, it is important to summarize the reasons for choosing a certain form of generative PD to further develop its methodology. However, the scientific literature is currently unclear about which forms of PD are used to develop eHealth and which arguments are used to substantiate the decision to use a certain form of generative PD. OBJECTIVE:This study aimed to explore the reporting and substantiation of generative PD methodologies in empirical eHealth studies published in scientific journals to further develop PD methodology in the field of eHealth. METHODS:A systematic literature review following the Cochrane guidelines was conducted in several databases (EMBASE, MEDLINE Ovid, Web of Science, and CINAHL EBSCOhost). Data were extracted on the recruitment and management of stakeholders, the use of tools, and the use of outcome measures. RESULTS:Of the 3131 studies initially identified, 69 were selected for qualitative synthesis. The reporting was very variable, depending to a large extent on whether the study stated that reporting on the PD process was a major aim. The different levels of reporting and substantiation of the choices of a recruitment strategy, stakeholder management, and tools and outcome measures are presented. Only a few authors explicitly used arguments directly related to PD guiding principles such as democratic, mutual learning, tacit and latent knowledge, and collective creativity. Even though PD principles were not always explicitly discussed in the method descriptions of the studies, they were implicitly present, mostly in the descriptions of the use of PD tools. The arguments used to substantiate the choices made in stakeholder management, PD tools, and the type of outcome measures adopted point to the involvement of PD principles. CONCLUSIONS:Studies that have used a PD research methodology to develop eHealth primarily substantiate the choice of tools made and much less the use of stakeholders and outcome measures.

SUBMITTER: Vandekerckhove P

PROVIDER: S-EPMC7215492 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Generative Participatory Design Methodology to Develop Electronic Health Interventions: Systematic Literature Review.

Vandekerckhove Pieter P de Mul Marleen M Bramer Wichor M WM de Bont Antoinette A AA

Journal of medical Internet research 20200427 4

<h4>Background</h4>Generative participatory design (PD) may help in developing electronic health (eHealth) interventions. PD is characterized by the involvement of all stakeholders in creative activities. This is different from the traditional user-centered design, where users are less involved. When looking at PD from a research through design perspective, it is important to summarize the reasons for choosing a certain form of generative PD to further develop its methodology. However, the scien ...[more]

PMID: 32338617

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Project description:BackgroundMobile health (mHealth) interventions are increasingly being designed to facilitate health-related behavior change. Integrating insights from behavioral science and design science can help support the development of more effective mHealth interventions. Behavioral Design (BD) and Design Thinking (DT) have emerged as best practice approaches in their respective fields. Until now, little work has been done to examine how BD and DT can be integrated throughout the mHealth design process.ObjectiveThe aim of this scoping review was to map the evidence on how insights from BD and DT can be integrated to guide the design of mHealth interventions. The following questions were addressed: (1) what are the main characteristics of studies that integrate BD and DT during the mHealth design process? (2) what theories, models, and frameworks do design teams use during the mHealth design process? (3) what methods do design teams use to integrate BD and DT during the mHealth design process? and (4) what are key design challenges, implementation considerations, and future directions for integrating BD and DT during mHealth design?MethodsThis review followed the Joanna Briggs Institute reviewer manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Studies were identified from MEDLINE, PsycINFO, Embase, CINAHL, and JMIR by using search terms related to mHealth, BD, and DT. Included studies had to clearly describe their mHealth design process and how behavior change theories, models, frameworks, or techniques were incorporated. Two independent reviewers screened the studies for inclusion and completed the data extraction. A descriptive analysis was conducted.ResultsA total of 75 papers met the inclusion criteria. All studies were published between 2012 and 2021. Studies integrated BD and DT in notable ways, which can be referred to as "Behavioral Design Thinking." Five steps were followed in Behavioral Design Thinking: (1) empathize with users and their behavior change needs, (2) define user and behavior change requirements, (3) ideate user-centered features and behavior change content, (4) prototype a user-centered solution that supports behavior change, and (5) test the solution against users' needs and for its behavior change potential. The key challenges experienced during mHealth design included meaningfully engaging patient and public partners in the design process, translating evidence-based behavior change techniques into actual mHealth features, and planning for how to integrate the mHealth intervention into existing clinical systems.ConclusionsBest practices from BD and DT can be integrated throughout the mHealth design process to ensure that mHealth interventions are purposefully developed to effectively engage users. Although this scoping review clarified how insights from BD and DT can be integrated during mHealth design, future research is needed to identify the most effective design approaches.

Project description:BACKGROUND:Electronic mental (e-mental) health care for depression aims to overcome barriers to and limitations of face-to-face treatment. Owing to the high and growing demand for mental health care, a large number of such information and communication technology systems have been developed in recent years. Consequently, a diverse system landscape formed. OBJECTIVE:This literature review aims to give an overview of this landscape of e-mental health systems for the prevention and treatment of major depressive disorder, focusing on three main research questions: (1) What types of systems exist? (2) How technologically advanced are these systems? (3) How has the system landscape evolved between 2000 and 2017? METHODS:Publications eligible for inclusion described e-mental health software for the prevention or treatment of major depressive disorder. Additionally, the software had to have been evaluated with end users and developed since 2000. After screening, 270 records remained for inclusion. We constructed a taxonomy concerning software systems, their functions, how technologized these were in their realization, and how systems were evaluated, and then, we extracted this information from the included records. We define here as functions any component of the system that delivers either treatment or adherence support to the user. For this coding process, an elaborate classification hierarchy for functions was developed yielding a total of 133 systems with 2163 functions. The systems and their functions were analyzed quantitatively, with a focus on technological realization. RESULTS:There are various types of systems. However, most are delivered on the World Wide Web (76%), and most implement cognitive behavioral therapy techniques (85%). In terms of content, systems contain twice as many treatment functions as adherence support functions, on average. Furthermore, autonomous systems, those not including human guidance, are equally as technologized and have one-third less functions than guided ones. Therefore, lack of guidance is neither compensated with additional functions nor compensated by technologizing functions to a greater degree. Although several high-tech solutions could be found, the average system falls between a purely informational system and one that allows for data entry but without automatically processing these data. Moreover, no clear increase in the technological capabilities of systems showed in the field, between 2000 and 2017, despite a marked growth in system quantity. Finally, more sophisticated systems were evaluated less often in comparative trials than less sophisticated ones (OR 0.59). CONCLUSIONS:The findings indicate that when developers create systems, there is a greater focus on implementing therapeutic treatment than adherence support. Although the field is very active, as evidenced by the growing number of systems developed per year, the technological possibilities explored are limited. In addition to allowing developers to compare their system with others, we anticipate that this review will help researchers identify opportunities in the field.

Project description:ObjectiveAnalysis of participatory approaches to developing health interventions for migrants and how approaches embody core participatory principles of inclusivity and democracy.DesignA systematic review of original articles. Electronic searches within the databases MEDLINE, Embase, Global Health and PsychINFO (from inception-November 2020).Eligibility criteria for study selectionOriginal peer-reviewed articles reporting research to develop and implement a health intervention for migrants, incorporating participatory approaches. We defined migrants as foreign-born individuals. Only articles reporting the full research cycle (inception, design, implementation, analysis, evaluation, dissemination) were included.Data extractionWe extracted information related to who was involved in research (migrants or other non-academic stakeholders), the research stage at which they were involved (inception, design, implementation, analysis, evaluation, dissemination), the method of their involvement and how this aligned with the core principles of participatory research-categorising studies as exhibiting active or pseudo (including proxy and indirect) participation.Results1793 publications were screened, of which 28 were included in our analysis. We found substantial variation in the application of participatory approaches in designing health interventions targeting migrants: across 168 individual research stages analysed across the 28 studies, we recorded 46 instances of active participation of migrants, 30 instances of proxy participation and 24 instances of indirect participation. All studies involved non-academic stakeholders in at least one stage of the research, only two studies exhibited evidence of active participation of migrants across all research stages. Evidence is limited due to the variability of terms and approaches used.ConclusionsImportant shortfalls in the meaningful inclusion of migrants in developing health interventions exist, suggesting a more rigorous and standardised approach is warranted to better define and deliver participatory research and improve quality.RegistrationThis review followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and is registered on the Open Science Framework (osf.io/2bnz5).

Project description:BACKGROUND:When health service providers (HSP) plan to develop electronic health (eHealth) resources for health service users (HSU), the latter's involvement is essential. Typically, however, HSP, HSU, and technology developers engaged to produce the resources lack expertise in participatory design methodologies suited to the eHealth context. Furthermore, it can be difficult to identify an established method to use, or determine how to work stepwise through any particular process. OBJECTIVE:We sought to summarize the evidence about participatory methods and frameworks used to engage HSU in the development of eHealth resources from the beginning of the design process. METHODS:We searched for studies reporting participatory processes in initial development of eHealth resources from 2006 to 2016 in 9 bibliographic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, Emcare, Cochrane Library, Web of Science, ACM Guide to Computing Literature, and IEEE Xplore. From 15,117 records initially screened on title and abstract for relevance to eHealth and early participatory design, 603 studies were assessed for eligibility on full text. The remaining 90 studies were rated by 2 reviewers using the Mixed Methods Appraisal Tool Version 2011 (Pluye et al; MMAT) and analyzed with respect to health area, purpose, technology type, and country of study. The 30 studies scoring 90% or higher on MMAT were included in a detailed qualitative synthesis. RESULTS:Of the 90 MMAT-rated studies, the highest reported (1) health areas were cancer and mental disorders, (2) eHealth technologies were websites and mobile apps, (3) targeted populations were youth and women, and (4) countries of study were the United States, the United Kingdom, and the Netherlands. Of the top 30 studies the highest reported participatory frameworks were User-Centered Design, Participatory Action Research Framework, and the Center for eHealth Research and Disease Management (CeHRes) Roadmap, and the highest reported model underpinning development and engagement was Social Cognitive Theory. Of the 30 studies, 4 reported on all the 5 stages of the CeHRes Roadmap. CONCLUSIONS:The top 30 studies yielded 24 participatory frameworks. Many studies referred to using participatory design methods without reference to a framework. The application of a structured framework such as the CeHRes Roadmap and a model such as Social Cognitive Theory creates a foundation for a well-designed eHealth initiative that ensures clarity and enables replication across participatory design projects. The framework and model need to be clearly articulated and address issues that include resource availability, responsiveness to change, and the criteria for good practice. This review creates an information resource for future eHealth developers, to guide the design of their eHealth resource with a framework that can support further evaluation and development. TRIAL REGISTRATION:PROSPERO CRD42017053838; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=53838.

Project description:BackgroundCardiovascular disease (CVD) is the leading cause of death worldwide. Despite strong evidence supporting the benefits of cardiac rehabilitation (CR), over 80% of eligible patients do not participate in CR. Digital health technologies (ie, the delivery of care using the internet, wearable devices, and mobile apps) have the potential to address the challenges associated with traditional facility-based CR programs, but little is known about the comprehensiveness of these interventions to serve as digital approaches to CR. Overall, there is a lack of a systematic evaluation of the current literature on digital interventions for CR.ObjectiveThe objective of this systematic literature review is to provide an in-depth analysis of the potential of digital health technologies to address the challenges associated with traditional CR. Through this review, we aim to summarize the current literature on digital interventions for CR, identify the key components of CR that have been successfully addressed through digital interventions, and describe the gaps in research that need to be addressed for sustainable and scalable digital CR interventions.MethodsOur strategy for identifying the primary literature pertaining to CR with digital solutions (defined as technology employed to deliver remote care beyond the use of the telephone) included a consultation with an expert in the field of digital CR and searches of the PubMed (MEDLINE), Embase, CINAHL, and Cochrane databases for original studies published from January 1990 to October 2018.ResultsOur search returned 31 eligible studies, of which 22 were randomized controlled trials. The reviewed CR interventions primarily targeted physical activity counseling (31/31, 100%), baseline assessment (30/31, 97%), and exercise training (27/31, 87%). The most commonly used modalities were smartphones or mobile devices (20/31, 65%), web-based portals (18/31, 58%), and email-SMS (11/31, 35%). Approximately one-third of the studies addressed the CR core components of nutrition counseling, psychological management, and weight management. In contrast, less than a third of the studies addressed other CR core components, including the management of lipids, diabetes, smoking cessation, and blood pressure.ConclusionsDigital technologies have the potential to increase access and participation in CR by mitigating the challenges associated with traditional, facility-based CR. However, previously evaluated interventions primarily focused on physical activity counseling and exercise training. Thus, further research is required with more comprehensive CR interventions and long-term follow-up to understand the clinical impact of digital interventions.

Project description:BackgroundSeveral tools have been developed for health care professionals to monitor the physical activity of their patients, but most of these tools have been considering only the needs of users in North American and European countries and applicable for only specific analytic tasks. To our knowledge, no research study has utilized the participatory design (PD) approach in the Middle East region to develop such tools, involving all the stakeholders in the product development phases, and no clear use cases have been derived from such studies that could serve future development in the field.ObjectiveThis study aims to develop an interactive visualization tool (ActiVis) to support local health care professionals in monitoring the physical activity of their patients measured through wearable sensors, with the overall objective of improving the health of the Qatari population.MethodsWe used PD and user-centered design methodologies to develop ActiVis, including persona development, brainwriting, and heuristic walkthrough as part of user evaluation workshops; and use cases, heuristic walkthrough, interface walkthrough, and survey as part of expert evaluation sessions.ResultsWe derived and validated 6 data analysis use cases targeted at specific health care professionals from a collaborative design workshop and an expert user study. These use cases led to improving the design of the ActiVis tool to support the monitoring of patients' physical activity by nurses and family doctors. The ActiVis research prototype (RP) compared favorably with the Fitbit Dashboard, showing the importance of design tools specific to end users' needs rather than relying on repurposing existing tools designed for other types of users. The use cases we derived happen to be culturally agnostic, despite our assumption that the local Muslim and Arabic culture could impact the design of such visualization tools. At last, taking a step back, we reflect on running collaborative design sessions in a multicultural environment and oil-based economy.ConclusionsBeyond the development of the ActiVis tool, this study can serve other visualization and human-computer interaction designers in the region to prepare their design projects and encourage health care professionals to engage with designers and engineers to improve the tools they use for supporting their daily routine. The development of the ActiVis tool for nurses, and other visualization tools specific to family doctors and clinician researchers, is still ongoing and we plan to integrate them into an operational platform for health care professionals in Qatar in the near future.

Project description:BACKGROUND:Health literacy describes the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health. Suboptimal health literacy is common and is believed to impact up to 60% of Australians. Co-design is a participatory approach to the development of interventions that brings together to staff and patients to design local solutions to local problems. The aim of this study is to describe a staff and patient co-design process that will lead to the development of health literacy interventions in response to identified health literacy needs of hospital patients. METHODS:A mixed methods, two-step sequential explanatory design. Step 1: hospitalised patients surveyed and data analysed using hierarchical cluster analysis to establish health literacy profiles. Step 2: clusters presented as vignettes to patients and clinicians to co-design interventions to address needs. RESULTS:Eight health literacy clusters were identified from surveys. Seven patients attended two patient workshops and 23 staff attended two staff workshops. Three key themes were identified: organisational, provider-patient, and patient self-care. Within these, five sub-themes emerged: "Good quality communication during hospital stay", "Social support for health", "A good discharge", "Care across the continuum" and "Accessing quality information when home". Fifteen potential interventions were produced, including changes to message design and delivery, staff training in assessing for understanding, social support to improve understanding, improving communication consistency across the care continuum, and strategic dissemination of web-based resources. CONCLUSION:This study identified fifteen strategies to address health literacy needs of a hospital population. Implementation and evaluation will identify sets of strategies that have the maximum patient, clinician and organisational benefit. This approach allows for the development of locally-driven, contextually-appropriate interventions to address health literacy needs.

Project description:BackgroundElectronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities.ObjectiveThis systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups.MethodsA systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis.ResultsA total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions.ConclusionsThe findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.

Project description:BackgroundConnected mental health, which refers to the use of technology for mental health care and technology-based therapeutic solutions, has become an established field of research. Biofeedback is one of the approaches used in connected mental health solutions, which is mainly based on the analysis of physiological indicators for the assessment and management of the psychological state. Biofeedback is recommended by many therapists and has been used for conditions including depression, insomnia, and anxiety. Anxiety is associated with several physiological symptoms, including muscle tension and breathing issues, which makes the inclusion of biofeedback useful for anxiety detection and management.ObjectiveThe aim of this study was to identify interventions using biofeedback as a part of their process for anxiety management and investigate their perceived effectiveness.MethodsA systematic literature review of publications presenting empirically evaluated biofeedback-based interventions for anxiety was conducted. The systematic literature review was based on publications retrieved from IEEE Digital Library, PubMed, ScienceDirect, and Scopus. A preliminary selection of papers was identified, examined, and filtered to include only relevant publications. Studies in the final selection were classified and analyzed to extract the modalities of use of biofeedback in the identified interventions, the types of physiological data that were collected and analyzed and the sensors used to collect them. Processes and outcomes of the empirical evaluations were also extracted.ResultsAfter final selection, 13 publications presenting different interventions were investigated. The interventions addressed either primarily anxiety disorders or anxiety associated with health issues such as migraine, Parkinson disease, and rheumatology. Solutions combined biofeedback with other techniques including virtual reality, music therapy, games, and relaxation practices and used different sensors including cardiovascular belts, wrist sensors, or stretch sensors to collect physiological data such as heart rate, respiration indicators, and movement information. The interventions targeted different cohorts including children, students, and patients. Overall, outcomes from the empirical evaluations yielded positive results and emphasized the effectiveness of connected mental health solutions using biofeedback for anxiety; however, certain unfavorable outcomes, such as interventions not having an effect on anxiety and patients' preferring traditional therapy, were reported in studies addressing patients with specific physical health issues.ConclusionsThe use of biofeedback in connected mental health interventions for the treatment and management of anxiety allows better screening and understanding of both psychological and physiological patient information, as well as of the association between the two. The inclusion of biofeedback could improve the outcome of interventions and boost their effectiveness; however, when used with patients suffering from certain physical health issues, suitability investigations are needed.

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Generative Participatory Design Methodology to Develop Electronic Health Interventions: Systematic Literature Review.

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Generative Participatory Design Methodology to Develop Electronic Health Interventions: Systematic Literature Review.

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