Poster Presentations

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Original Research *Exploring Values in Technology-Supported Collaborative Results Dissemination: An Alaska Native Health Research Inquiry* Lisa Dirks, University of Washington Abstract: Community-level health research results dissemination is often neglected or done ineffectively. Although there is an expectation for research community collaboration and engagement with Indigenous communities, few empirical studies have explored this engagement in relation to research results dissemination. This study explores stakeholder perspectives on technology-facilitated collaboration in health research results dissemination in an Alaska Native context. This study involves a value sensitive design conceptual and empirical investigation of stakeholder values for collaborative dissemination. Six participants were engaged in a participatory design process to develop sketches and scenarios related to Alaska Native community-researcher collaborative research results dissemination. Participatory design sketches and participant interviews were analyzed using a value-based coding scheme. Study findings highlight the importance of community norms and context in developing interactive dissemination systems for collaboration with Native communities. Awareness of context includes understanding local culture and power dynamics both within the community and between researcher and community. Transparency is tied directly to clear communication which encourages active dialogue potentially providing a variety of ways to communicate.
*Neurological assessments without clinical supervision for a rare disease* Vineet Pandey, Harvard University K.Z. Gajos, Harvard University N.C. Khan, Harvard Medical School A.S. Gupta, Harvard Medical School Abstract: Telemedicine has become mainstream. Many telemedicine tools rely on clinician availability and expertise to perform remote consultation and diagnosis. However, the number of trained experts—like clinicians—is small; this is one of many challenges that are amplified for rare diseases compared to other disorders. To improve health equity in our societies across people with different disorders, we propose building telemedicine tools that tackle the bottleneck of limited clinician availability. Furthermore, a rare disease community might not be a homogeneous group across abilities, socio-economic status, and more. To support the range of people within a community, we suggest building processes and tools with such variation in mind. In this paper, we provide an overview of the success of the Hevelius system in producing high-quality clinical severity scores for a neurological rare disease community. People use the tool from home with no clinical supervision. Additionally, we provide case studies of our efforts to improve access, adoption, and adherence for our tool across different members of a rare disease community. With our lessons and questions, we invite feedback from the WISH community in envisioning how to design sociotechnical systems that support telemedicine health experiences without clinician involvement.
*Exploring Access to and Use of Pre- and Post-natal Care Information, Services and Technology in Ilorin, Nigeria* Akolade Asipade, Auburn University J.O. Thomas, Auburn University Abstract: Access to adequate healthcare service and information is among the factors suggested to be associated with the high maternal mortality in sub-Sahara Africa. International human rights law includes fundamental commitments of states to enable women and adolescent girls to survive pregnancy and childbirth as part of their enjoyment of sexual and reproductive health. Yet nearly 265,000 women die due to complications of pregnancy and childbirth each year in sub-Sahara Africa alone. One of the most critical interventions for safe motherhood is ensuring that women (even in the most remote areas) have access to and are well informed of pre- and post-natal care information and services. This paper describes the first step in the interactive design process of the MTOTO-BEBE user interface which provides access to pre- and post-natal information and enables Ilorin women to share their own motherhood experiences. We carried out a preliminary study to understand the service system of women living in Ilorin, the factors that impact their access to and use of pre- and post-natal care services and information and their use of technology.
*Applying Equity Theory to Inform the Usability Evaluation of a Tablet-based Dialysis Patient Intervention to Prevent Intradialytic Hypotension* Matthew Willis, University of Michigan L.B. Hein, University of Michigan T. Veinot, University of Michigan Z. Hu, K. Zheng, University of California, Irvine R. Saran, University of Michigan J. Bragg-Gresham, University of Michigan M. Argentina, National Kidney Foundation S. Krein, University of Michigan B. Gillespie, University of Michigan Abstract: Hemodialysis patients receive dialysis thrice weekly for about four hours per session. Intradialytic hypotension (IDH)—low blood pressure during hemodialysis—is a serious but common complication of hemodialysis. Activating patients towards IDH prevention may reduce their risk of IDH. Therefore, we developed a patient-facing, tablet-based intervention that includes theory-informed educational modules and motivational interviewing-based mentoring from patient peers via videoconference. To create equal opportunities for chronically ill patients to engage in this digital health intervention, we use equity theory to articulate patients’ usability needs and inform interaction design. We detail three interaction challenges, common in chronically ill and older populations, concerning distress caused by lack of mobility, lack of feedback, and lack of visibility and device familiarity. We offer design considerations to ameliorate these challenges with the goal of removing distress from the patients’ intervention interaction experience.
*Shared Understanding in Care Coordination for Children’s Behavioral Health* Olivia Richards, University of Michigan G. Marcu, University of Michigan A.W. Choi, Georgia Institute of Technology Abstract: Care coordination involves crossing boundaries to connect services in support of the health and well-being of an individual. In this paper, we describe how care coordination depends on the ability to develop shared understanding of care goals and progress. A distributed group of professionals and non-professional caregivers need to share information to provide consistent and holistic support across settings. We conducted fieldwork comprising of 20 interviews and 51 hours of observation, in parallel, across three different programs focused on children's behavioral health. From this empirical investigation of practices used by distributed care teams, we generated a conceptual framework of shared understanding in care coordination. The framework illustrates barriers to shared understanding, as well as nine practices that contribute to its development via two key mechanisms: (1) building relationships across boundaries, and (2) sharing actionable information.
*Representativeness of Participants of Clinical Trials of Chronic Conditions: Comparison with a Large Observational Dataset of Patients Being Seen for Long-Term Care* Ilia Rattsev, Johns Hopkins University C.O. Taylor, Johns Hopkins University Abstract: Inclusion of diverse groups of participants in clinical trials is an important clinical issue. Randomized controlled trials use strict eligibility criteria, recruiting groups that are not always representative of general population. Observational datasets can provide larger sample of patients with more diverse demographic profile. We selected three clinical trials of patients managing chronic conditions and compared their demographics to samples obtained from an observational dataset of individuals being seen for long-term care. In clinical trials, the proportion of females was higher than males, ranging from 64.2% to 85% of the sample. All trials primarily recruited participants from one racial group: either Black or White. The eligible patients in the observational dataset were mainly Black (66.1%) and women (55.3%). Each clinical trial recruited participants with a well defined demographic profile, while the observational dataset was more balanced in terms of demographics. Thus, for interventions used in real-world clinical settings, observational datasets may be a complementary source to assess those interventions in groups underrepresented in clinical trials.
Works in Progress and Provocations *Addressing the Need for Remote Patient Monitoring Applications in Appalachian Areas* Alyssa Donawa, University of Kentucky Abstract: There is a need to address the urban-rural disparities in healthcare regarding equal access and quality of care. Due to higher rates of chronic disease, reduced access to providers, and continue to experience a decline in rural hospitals, it is imperative that Appalachian cancer patients adopt the use of health information technology (HIT). The NCCN Distress Thermometer and Problem List (DT) is under-utilized, not patient-centered, does not consider provider needs, and is outdated in the current digital landscape. Digitizing patient distress screening poses advantages, such as allowing for more frequent screenings, removing geographical barriers, and rural patient autonomy. In this paper, we discuss how knowledge gained from patient-centered design led to the underpinnings of developing a rural remote patient monitoring app that provides delightful and insightful experiences to users.
*The Case for Point-of-Care Diagnostics to Improve Healthcare Access Within the LGBTQIA+ Community* E. Celeste Welch, Brown University Abstract: Point-of-Care (POC) Diagnostics is a field involving the transportation of medical devices and diagnostic tests out of the hospital and to the patient, wherever they may be. POCD utilizes innovation on multiple fronts to create miniaturized, portable devices. Many members of the LGBTQIA+ community, specifically the transgender community, have limited access to healthcare. This leads to inappropriate home dosing of hormones and a plethora of negative side effects. These side effects are commonly missed or ignored, but can cause acute and chronic health conditions that shorten lifespan and quality of life. Even for those that have access to healthcare, trans-specifc healthcare monitoring needs remain poorly understood by the majority of medical professionals. It is clear that inexpensive POC devices are needed for trans-specific monitoring and health education.
*Examining the Relationship Between Health, Weather, and Information to Reduce Health Inequities* Yasemin Akdas, Vanderbilt University Medical Center Abstract: This research centers around investigating the following question: how weather information resources (WIR) can be used effectively by Black Americans to improve health? Towards this goal, we will explore (1) how Black Americans think of weather and its relation to health, and (2) how information on a specific WIR app is used for disease management and health promotion among Black Americans. To investigate these questions, we will conduct focus groups and usability testing. We anticipate that this study will contribute to the usability of WIR focused on health promotion and health equity.
*Seeing Beyond Patient-Centeredness: Searching for a Signal of Bias and Empathy in Patient-Provider Interaction* Steven Rick, UC San Diego C. Emmenegger, UC San Diego C.E. Schairer, UC San Diego A. Andreiu, UC San Diego S. Fleet, UC San Diego K. Sladek, UC San Diego J. Ricketts, UC San Diego N. Weibel, UC San Diego C. Apodaca, University of Washington R. Casanova-Perez, University of Washington C. Lane, University of Washington E. Beneteau, University of Washington D. Vidyarthi, University of Washington J. Sabin, University of Washington W. Pratt, University of Washington A. Hartzler, University of Washington Abstract: While doctors may practice patient-centered care, many still have their own hidden biases which manifest in various forms of health inequity. To facilitate ongoing work that seeks to make the biases driving these inequities more visible, we are developing a qualitative coding methodology for understanding point-of-care interaction between patients and providers. We report on our progress, highlighting techniques being used, and reflect on how this can be further adopted by others studying equity in healthcare.
*Understanding Healthcare-Focused Human Trafficking Interventions in the Greater Nashville Area to Inform Future Protocols and Tools* Michelle Gomez, Vanderbilt University K.M. Unertl, Vanderbilt University Abstract: Human trafficking often goes unnoticed by healthcare providers, despite frequent interactions of victims with healthcare settings. We plan to interview people at Vanderbilt University Medical Center and the Nashville community involved in anti-human trafficking work. The goal is to investigate the processes and technology currently used to identify human trafficking victims. The study will provide data needed to map existing approaches to combatting human trafficking, with the longer-term goal of developing innovative socio-technical interventions.
*Patients' perspectives on implicit bias in clinical interactions with healthcare providers* Regina Casanova-Perez, University of Washington C. Apodaca, University of Washington J. Sabin, University of Washington A. Hartzler, University of Washington C. Lane, University of Washington D. Vidyarthi, University of Washington E. Beneteau, University of Washington W. Pratt, University of California San Diego S.R. Rick, University of California San Diego N. Weibel, University of California San Diego C. Emmenegger, University of California San Diego C. Schairer, University of California San Diego Abstract: Implicit bias negatively impacts health and healthcare, causing health inequities; however, we know little about patients' experiences and perspectives with bias. We are investigating a new approach to reduce implicit bias in healthcare by improving patient-provider communication in primary care. To inform the design of our approach, we are interviewing patients about their experiences with bias or feeling unheard during clinic visits. We ask patients for solutions to improve patient-provider communication based on their experiences. We present patients' prominent experiences and solutions collected to date that are insightful into implicit bias in patient-provider communication.
*My Healthcare System Helped Me Connect to Broadband* Jessica Ruff, Case Western Reserve University P.J. Greco, Case Western Reserve University J.M. Ruff MetroHealth Health System B. Silvers, MetroHealth Health System P.J. Greco, DigitalC D. Baunach, DigitalC Abstract: The concept of the digital divide was popularized by President Clinton nearly twenty years ago, yet it remains, and many would say it is expanding. The MetroHealth Health System created an institute to tackle social determinants of health (SDOH), one of which is broadband access. In partnership with a local internet service provider, the system is making strides towards the goal of connecting at least 1000 households over the next five years. If healthcare systems are going to transition from sick care to promotion of health and wellbeing, we must begin to address SDOH - and broadband access can help get us there.
*What might WISH gain from de-centering interactive systems?* Andrew Berry, University of Washington Abstract: We are living in precarious times: pandemic, police violence, rising economic inequality, threats to democracy. Many of us are responding by learning about our positions relative to interlocking systems of domination, and this growth is leading many of us to change course in our research. This paper aims to provoke conversation within the WISH community about our collective growth: what might we gain from de-centering interactive systems?
*IBM-Watson Health Design Justice Initiative: Addressing Racial Health Disparities with Industry Digital Health Products* Andrea Barbarin, IBM-Watson Health R. Veal, C. Cooper, IBM-Watson Health D. Ndindjock, IBM-Watson Health Abstract: This Work in Progress submission describes the IBM-Watson Health Design Justice Initiative, a volunteer, grassroots effort that seeks to address racial health disparities through IBM-Watson Health’s digital health products. We share the strategy used to garner support from executive leadership and engage our cross-disciplinary colleagues, as well as describe our progress to date and planned future work. Although our initiative is carried out within IBM-Watson Health, it provides a perspective on how to approach similar projects in other business organizations.

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