ABSTRACT
Rationale & Objective: Stigma contributes to ineffective treatment for pain among individuals with kidney failure on dialysis, particularly with buprenorphine pain treatment. To address stigma, we adapted a Design Sprint, an industry-developed structured exercise where an interdisciplinary group works over 5 days to clarify the problem, identify and choose a solution, and build and test a prototype. Study Design: Adapted Design Sprint which clarified the problem to be solved, proposed solutions, and created a blueprint for the selected solution. Settings & Participants: Five individuals with pain and kidney disease receiving dialysis, 5 physicians (nephrology, palliative care, and addiction medicine) and 4 large dialysis organization leaders recruited for specific expertise or experience. Conducted through online platform (Zoom) and virtual white board (Miro board). Analytical Approach: Descriptions of the Design Sprint adaptations and processes. Results: To facilitate patient comfort, a patient-only phase included four 90-minute sessions over 2-weeks, during which patient participants used a mapping process to define the critical problem and sketch out solutions. In a physician-only phase, consisting of two 120-minute sessions, participants accomplished the same tasks. During a combined phase of two 120-minute sessions, patients, physicians, and large dialysis organization representatives vetted and developed solutions from earlier phases, leading to an intervention blueprint. Videoconferencing technology allowed for geographically diverse representation and facilitated participation from patients experiencing medical illness. The electronic whiteboard permitted interactive written contributions and voting on priorities instead of only verbal discussion, which may privilege physician participants. A skilled qualitative researcher facilitated the sessions. Limitations: Challenges included the time commitment of the sessions, absences owing to illness or emergencies, and technical difficulties. Conclusions: An adapted Design Sprint is a novel method of efficiently and rapidly incorporating multiple stakeholders to develop solutions for clinical challenges in kidney disease. Plain Language Summary: Stigma contributes to ineffective treatment for pain among individuals with kidney failure on dialysis, particularly when using buprenorphine, an opioid pain medicine with a lower risk of sedation used to treat addiction. To develop a stigma intervention, we adapted a Design Sprint, an industry-developed structured exercise where an interdisciplinary group works over 5 days to clarify the problem, identify and choose a solution, and build and test a prototype. We conducted 3 sprints with (1) patients alone, (2) physicians alone, and (3) combined patients, physicians, and dialysis organization representatives. This paper describes the adaptations and products of sprints as a method for gathering diverse stakeholder voices to create an intervention blueprint efficiently and rapidly.
ABSTRACT
Study Objectives: Social media (SM) use has been positively associated with disturbed sleep among young adults. However, previous studies have not elucidated the specific importance of SM use immediately before bed. We aimed to determine the independent association of SM use during the 30 minutes before bed and disturbed sleep while controlling for covariates including total SM use throughout the day. Methods: We assessed a nationally representative sample of 1763 US young adults aged 19-32. Participants estimated to what extent they used SM in the 30 minutes before bed. We assessed sleep disturbance using the brief Patient-Reported Outcomes Measurement Information System (PROMIS®) Sleep Disturbance measure. After testing the proportional odds assumption, we used ordered logistic regression to compute the independent association between SM use before bed and sleep disturbance controlling for covariates, including total SM use. Results: Compared with those who rarely or very rarely check SM in the 30 minutes before bed, those who often or very often check SM at that time had an adjusted odds ratio of 1.62 (95% confidence interval = 1.31-2.34) for increased sleep disturbance. Additionally, we found a significant linear trend in the odds ratios between the frequency of checking SM in the 30 minutes before bed and increased sleep disturbance (p = .007). Results were consistent in all sensitivity analyses. Conclusions: SM use in the 30 minutes before bed is independently associated with disturbed sleep among young adults. Future work should use qualitative and experimental methods to further elucidate the directionality of-and mechanisms underlying-this association.