Market segmentation of South African adolescent girls and young women to inform HIV prevention product marketing strategy: A mixed methods study.

The uptake of and adherence to HIV prevention products in South Africa has not achieved widespread success. This study aimed to develop a holistic understanding of the psychographics of adolescent girls and young women in South Africa, a primary audience for HIV prevention products, in order to inform market segmentation and marketing strategies. Extensive ethnographic analyses were complemented with a survey (n = 1,500) centered on personal care product journeys. Clustering and qualitative methods yielded six segments with measurable differences, and revealed common themes surrounding empowerment and self-determination, patriarchy, and misinformation risk. The findings enable targeted approaches for HIV prevention product campaigns.

Electronic Health Record Implementation Findings at a Large, Suburban Health and Human Services Department.

OBJECTIVE: Evaluate an electronic health record (EHR) implementation across a large public health department to better understand and improve implementation effectiveness of EHRs in public health departments. DESIGN: A survey based on Consolidated Framework for Implementation Research constructs was administered to staff before and after implementation of an EHR. SETTING: Large suburban county department of health and human services that provides clinical, behavioral, social, and oral health services. PARTICIPANTS: Staff across 4 program areas completed the survey prior to EHR implementation (n = 331, June 2014) and 3 months post-EHR final implementation (n = 229, December 2015). INTERVENTION: Electronic health record MAIN OUTCOME MEASURES:: Constructs were validated using confirmatory factor analysis and included information strengths and information gaps in the current environment; EHR impacts; ease of use; future use intentions; usefulness; knowledge of system; and training. Paired t tests and Wilcoxon signed rank tests of a matched sample were performed to compare the pre-/postrespondent scores. RESULTS: A majority of user perceptions and expectations showed a significant (P < .05) decline 3 months postimplementation as compared with the baseline with variation by service area and construct. Staff perceived the EHR to be less useful and more complex, provide fewer benefits, and reduce information access shortly after implementation. CONCLUSIONS: Electronic health records can benefit public health practices in many ways; however, public health departments will face significant challenges incorporating EHRs, which are typically designed for non-public health settings, into the public health workflow. Electronic health record implementation recommendations for health departments are provided. When implementing an EHR in a public health setting, health departments should provide extensive preimplementation training opportunities, including EHR training tailored to job roles, competencies, and tasks; assess usability and specific capabilities at a more granular level as part of procurement processes and consider using contracting language to facilitate usability, patient safety, and related evaluations to enhance effectiveness and efficiencies and make results public; apply standard terminologies, processes, and data structures across different health department service areas using common public health terminologies; and craft workforce communication campaigns that balance potential expected benefits with realistic expectations.

A Quantitative Framework to Identify and Prioritize Opportunities in Biomedical Product Innovation: A Proof-of-Concept Study.

Importance: Prioritization and funding for health initiatives, including biomedical innovation, may not consistently target unmet public health needs. Objective: To (1) develop a quantitative, databased framework to identify and prioritize opportunities for biomedical product innovation investments based on a multicriteria decision-making model (MCDM) that includes comprehensive measures of public health burden and health care costs, and (2) pilot test the model. Design, Setting, and Participants: The Department of Health and Human Services (HHS) convened public and private experts to develop a model, select measures, and complete a longitudinal pilot study to identify and prioritize opportunities for investment in biomedical product innovations that have the greatest public health benefit. Cross-sectional and longitudinal data (2012-2019) for 13 pilot medical disorders were obtained from the Institute for Health Metrics Global Burden of Disease database (IHME GBD) and the National Center for Health Statistics (NCHS). Main Outcome Measures: The main outcome measure was an overall gap score reflecting high public health burden (composite measure of mortality, prevalence, years lived with disability, and health disparities), or high health care costs (composite measure of total, public, and out-of-pocket health spending) relative to low biomedical innovation. Sixteen innovation metrics were selected to reflect the pipeline of biomedical products from research and development to market approval. A higher score indicates a greater gap. Normalized composite scores were calculated for public health burden, cost, and innovation investment using the MCDM Technique for Order of Preference by Similarity to Ideal Solution method. Results: Among the 13 conditions tested in the pilot study, diabetes (0.61), osteoarthritis (0.46), and drug-use disorders (0.39) had the highest overall gap score reflecting high public health burden, or high health care costs relative to low biomedical innovation in these medical disorders. Chronic kidney disease (0.05), chronic obstructive pulmonary disease (0.09), and cirrhosis and other liver diseases (0.10) had the least amount of biomedical product innovation despite similar public health burden and health care cost scores. Conclusions: In this cross-sectional pilot study, we developed and implemented a data-driven, proof-of-concept model that can help identify, quantify, and prioritize opportunities for biomedical product innovation. Quantifying the relative alignment between biomedical product innovation, public health burden, and health care cost may help identify and prioritize investments that can have the greatest public health benefit.

Engagement and Outcomes Associated with Contextual Annotation Features of a Digital Health Solution.

BACKGROUND: Digital health solutions targeting diabetes self-care are popular and promising, but important questions remain about how these tools can most effectively help patients. Consistent with evidence of the salutary effects of note-taking in education, features that enable annotation of structured data entry might enhance the meaningfulness of the interaction, thereby promoting persistent use and benefits of a digital health solution. METHOD: To examine the potential benefits of note-taking, we explored how patients with type 2 diabetes used annotation features of a digital health solution and assessed the relationship between annotation and persistence in engagement as well as improvements in glycated hemoglobin (A1C). Secondary data from 3142 users of the BlueStar digital health solution collected between December 2013 and June 2017 were analyzed, with a subgroup of 372 reporting A1C lab values. RESULTS: About a third of patients recorded annotations while using the platform. Annotation themes largely reflected self-management behaviors (diet, physical activity, medication adherence) and well-being (mood, health status). Early use of contextual annotations was associated with greater engagement over time and with greater improvements in A1C. CONCLUSIONS: Our research provides preliminary evidence of the benefits of annotation features in a digital health solution. Future research is needed to assess the causal impact of note-taking and the moderating role of thematic content reflected in notes.

Individual differences in regulatory mode moderate the effectiveness of a pilot mHealth trial for diabetes management among older veterans.

mHealth tools to help people manage chronic illnesses have surged in popularity, but evidence of their effectiveness remains mixed. The aim of this study was to address a gap in the mHealth and health psychology literatures by investigating how individual differences in psychological traits are associated with mHealth effectiveness. Drawing from regulatory mode theory, we tested the role of locomotion and assessment in explaining why mHealth tools are effective for some but not everyone. A 13-week pilot study investigated the effectiveness of an mHealth app in improving health behaviors among older veterans (n = 27) with poorly controlled Type 2 diabetes. We developed a gamified mHealth tool (DiaSocial) aimed at encouraging tracking of glucose control, exercise, nutrition, and medication adherence. Important individual differences in longitudinal trends of adherence, operationalized as points earned for healthy behavior, over the course of the 13-week study period were found. Specifically, low locomotion was associated with unchanging levels of adherence during the course of the study. In contrast, high locomotion was associated with generally stronger adherence although it exhibited a quadratic longitudinal trend. In addition, high assessment was associated with a marginal, positive trend in adherence over time while low assessment was associated with a marginal, negative trend. Next, we examined the relationship between greater adherence and improved clinical outcomes, finding that greater adherence was associated with greater reductions in glycated hemoglobin (HbA1c) levels. Findings from the pilot study suggest that mHealth technologies can help older adults improve their diabetes management, but a "one size fits all" approach may yield suboptimal outcomes.