Dual Protection Messaging for Adolescents and Young Adults in the Setting of Over-the-Counter Hormonal Contraception: A Human-Centered Design Approach.

STUDY OBJECTIVE: To use human-centered design approaches to engage adolescents and young adults in the creation of messages focused on dual method use in the setting of over-the-counter hormonal contraception access DESIGN: Baseline survey and self-directed workbooks with human-centered design activities were completed. The workbooks were transcribed and analyzed using qualitative methods to determine elements of the communication model, including sender, receiver, message, media, and environment. SETTING: Indiana and Georgia PARTICIPANTS: People aged 14-21 years in Indiana and Georgia INTERVENTIONS: Self-directed workbooks MAIN OUTCOME MEASURES: Elements of the communication model, including sender, receiver, message, media, and environment RESULTS: We analyzed 54 workbooks, with approximately half from each state. Stakeholders self-identified as female (60.5%), white (50.9%), Hispanic (10.0%), sexually active (69.8%), and heterosexual (79.2%), with a mean age of 18 years. Most strongly agreed (75.5%) that they knew how to get condoms, but only 30.2% expressed the same sentiment about hormonal contraception. Exploration of the elements of the communication model indicated the importance of crafting tailored messages to intended receivers. Alternative terminology for dual protection, such as "Condom+____," was created. CONCLUSION: There is a need for multiple and diverse messaging strategies about dual method use in the context of over-the-counter hormonal contraception to address the various pertinent audiences as this discussion transitions outside of traditional clinical encounters. Human-centered design approaches can be used for novel message development.

Assessing Needs and Experiences of Preparing for Medical Emergencies Among Children With Cancer and Their Caregivers.

BACKGROUND: Caregivers of children with cancer can experience stress when seeking care in the emergency department (ED). We sought to assess how caregivers prepare for and manage a medical emergency that arises in the community setting. METHODS: A qualitative evaluation of ED visit preparations taken by children with cancer and their caregivers using self-reported interactive toolkits. Eligible participants included children with cancer (age: 11 to 21 y) currently receiving therapy for cancer diagnosis with an ED visit (besides initial diagnosis) within the previous 2 months and caregivers of same. Participants received a paper toolkit, which were structured as experience maps with several generative activities. Toolkits were transcribed, thematically coded, and iteratively analyzed using NVivo 12.0 software. RESULTS: A total of 25 toolkits were received (7 children, 18 caregivers), with about three quarters of participants living >1 hour from the treating institution. Several important common themes and areas for improvement emerged. Themes included struggles with decision-making regarding when and where to seek ED care, preparing to go to the ED, waiting during the ED visit, repetition of information to multiple providers, accessing of ports, and provider-to-provider and provider-to-caregiver/patient communication. CONCLUSIONS: The information gained from this study has the potential to inform a tool to support this population in planning for and managing emergent medical issues. This tool has the potential to improve patient and caregiver satisfaction, patient-centered outcomes, and clinical outcomes.

Creation of a Decision Support Tool for Expectant Parents Facing Threatened Periviable Delivery: Application of a User-Centered Design Approach.

BACKGROUND: Shared decision-making (SDM) is optimal in the context of periviable delivery, where the decision to pursue life-support measures or palliation is both preference sensitive and value laden. We sought to develop a decision support tool (DST) prototype to facilitate SDM by utilizing a user-centered design research approach. METHODS: We convened four patient and provider advisory boards with women and their partners who had experienced a surviving or non-surviving periviable delivery, pregnant women who had not experienced a prior preterm birth, and obstetric providers. Each 2-h session involved design research activities to generate ideas and facilitate sharing of values, goals, and attitudes. Participant feedback shaped the design of three prototypes (a tablet application, family story videos, and a virtual reality experience) to be tested in a final session. RESULTS: Ninety-five individuals (48 mothers/partners; 47 providers) from two hospitals participated. Most participants agreed that the prototypes should include factual, unbiased outcomes and probabilities. Mothers and support partners also desired comprehensive explanations of delivery and care options, while providers wanted a tool to ease communication, help elicit values, and share patient experiences. Participants ultimately favored the tablet application and suggested that it include family testimonial videos. CONCLUSION: Our results suggest that a DST that combines unbiased information and understandable outcomes with family testimonials would be meaningful for periviable SDM. User-centered design was found to be a useful method for creating a DST prototype that may lead to improved effectiveness, usability, uptake, and dissemination in the future, by leveraging the expertise of a wide range of stakeholders.

Phase I of the Detecting and Evaluating Childhood Anxiety and Depression Effectively in Subspecialties (DECADES) Study: Development of an Integrated Mental Health Care Model for Pediatric Gastroenterology.

BACKGROUND: Children with gastrointestinal symptoms have a very high rate of anxiety and depression. Rapid identification of comorbid anxiety and depression is essential for effective treatment of a wide variety of functional gastrointestinal disorders. OBJECTIVE: The objective of our study was to determine patient and parent attitudes toward depression, anxiety, and mental health screening during gastroenterology (GI) visits and to determine patient and parent preferences for communication of results and referral to mental health providers after a positive screen. METHODS: We augmented standard qualitative group session methods with patient-centered design methods to assess patient and parent preferences. We used a variety of specific design methods in these sessions, including card sorting, projective methods, experience mapping, and constructive methods. RESULTS: Overall, 11 families (11 patients and 14 parents) participated in 2 group sessions. Overall, patients and their parents found integrated mental health care to be acceptable in the subspecialty setting. Patients' primary concerns were for the privacy and confidentiality of their screening results. Patients and their parents emphasized the importance of mental health services not interfering with the GI visit and collaboration between the GI physician, psychologist, and primary care provider. CONCLUSIONS: Patients and their families are open to integrated mental health care in the pediatric subspecialty clinic. The next phase of the DECADES study will translate patient and parent preferences into an integrated mental health care system and test its efficacy in the pediatric GI office.

Interprofessional service-learning in a community setting: findings from a pilot study.

Interprofessional education is becoming more popular in higher education and service-learning has been a successful method to facilitate experiences that foster teamwork between professions. This report shares the results from an interprofessional service-learning project (ISLP) targeting students across eight disciplines (physician assistant, medicine, pharmacy, dietetic internship, physical therapy, master in health administration, nursing and biomedical science). The project used an existing resource, the South Carolina Area Health Education Consortium (SC-AHEC), to coordinate student learning across multiple regions and an established health promotion program curriculum for student outreach content. Participating students (n = 149) were evaluated to determine how the activity affected student appreciation and knowledge of their own and other professions, their interaction with other professional students, and student teamwork skills. Students found the most value in learning with students from other professions as part of the activity with lesser value placed on students increasing their knowledge about their profession's role in interprofessional work.