Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India.

INTRODUCTION: Human-centered design (HCD) refers to a diverse suite of interactive processes that engage end users in the development of a desired outcome. We showcase how 2 global mental health research teams applied HCD to develop mobile health tools, each directed at reducing treatment gaps in underserved populations. CASE STUDY 1: Refugees face higher risks for mental health problems, yet these communities face structural and cultural barriers that reduce access to and use of services. To address these challenges, the Research Program on Children and Adversity at the Boston College School of Social Work, in partnership with resettled refugee communities in the northeastern United States, used codesign methodology to digitally adapt delivery of the Family Strengthening Intervention for Refugees-a program designed to improve mental health and family functioning among resettled families. We describe how codesign methods support the development of more feasible, acceptable, and sustainable interventions. CASE STUDY 2: Sangath, an NGO in India focused on mental health services research, in partnership with Harvard Medical School, designed and evaluated a digital training program for community health workers to deliver an evidence-based, brief psychological treatment for depression as part of primary care in Madhya Pradesh, India. We describe how HCD was applied to program development and discuss our approach to scaling up training and capacity-building to deliver evidence-based treatment for depression in primary care. IMPLICATIONS: HCD involves a variety of techniques that can be flexibly adapted to engage end users in the conceptualization, implementation, scale-up, and sustainment of global mental health interventions. Community solutions generated using HCD offer important benefits for key stakeholders. We encourage widespread adoption of HCD within global mental health policy, research, and practice, especially for addressing mental health disparities with underserved populations.

Post-Consumer textile waste and disposal: Differences by socioeconomic, demographic, and retail factors.

The amount of post-consumer textile waste (PCTW) generated annually in the United States has increased nearly ten-fold since the 1960s to exceed more than 34 billion pounds annually. Of the waste generated, 66% is sent to landfills, 19% is combusted with energy recovery, and only 15% is recycled. When left to decompose in landfills, PCTW decomposes, producing harmful leachates and greenhouse gases including methane. In this study, we used publicly available data from 67 counties in the state of Florida from 2014 to 2019 to assess how PCTW generation and recycling behaviors differ by area-level demographic, socioeconomic, and retail characteristics. We also used publicly available data on landfills to determine whether these same factors were associated with having more landfills per capita in a county. This study provides preliminary evidence that people living in areas with higher incomes, that are more racially segregated, and that have more clothing stores generate significantly more textile waste than people in other areas. In contrast, there were more landfills per capita in areas with lower incomes and fewer landfills per capita in areas that were more racially segregated.Textile recycling occurred at relatively uniform rates across counties. Taken together, these findings support the understanding that textile waste represents an issue of environmental injustice; wealthier communities contribute more PCTW to landfills, which are more commonly located in communities with lower socioeconomic status. Multipronged solutions are needed to produce relevant behavior change, including efforts and policies that seek to reduce textile consumption and increase textile recycling at the individual and societal level.