ConverSense: An Automated Approach to Assess Patient-Provider Interactions using Social Signals.

Patient-provider communication influences patient health outcomes, and analyzing such communication could help providers identify opportunities for improvement, leading to better care. Interpersonal communication can be assessed through "social-signals" expressed in non-verbal, vocal behaviors like interruptions, turn-taking, and pitch. To automate this assessment, we introduce a machine-learning pipeline that ingests audio-streams of conversations and tracks the magnitude of four social-signals: dominance, interactivity, engagement, and warmth. This pipeline is embedded into ConverSense, a web-application for providers to visualize their communication patterns, both within and across visits. Our user study with 5 clinicians and 10 patient visits demonstrates ConverSense's potential to provide feedback on communication challenges, as well as the need for this feedback to be contextualized within the specific underlying visit and patient interaction. Through this novel approach that uses data-driven self-reflection, ConverSense can help providers improve their communication with patients to deliver improved quality of care.

Designing Communication Feedback Systems To Reduce Healthcare Providers' Implicit Biases In Patient Encounters.

Healthcare providers' implicit bias, based on patients' physical characteristics and perceived identities, negatively impacts healthcare access, care quality, and outcomes. Feedback tools are needed to help providers identify and learn from their biases. To incorporate providers' perspectives on the most effective ways to present such feedback, we conducted semi-structured design critique sessions with 24 primary care providers. We found that providers seek feedback designed with transparent metrics indicating the quality of their communication with a patient and trends in communication patterns across visits. Based on these metrics and trends, providers want this feedback presented in a dashboard paired with actionable, personalized tips about how to improve their communication behaviors. Our study provides new insights for interactive systems to help mitigate the impact of implicit biases in patient-provider communication. New systems that build upon these insights could support providers in making healthcare more equitable, particularly for patients from marginalized communities.

Opportunities for incorporating intersectionality into biomedical informatics.

Many approaches in biomedical informatics (BMI) rely on the ability to define, gather, and manipulate biomedical data to support health through a cyclical research-practice lifecycle. Researchers within this field are often fortunate to work closely with healthcare and public health systems to influence data generation and capture and have access to a vast amount of biomedical data. Many informaticists also have the expertise to engage with stakeholders, develop new methods and applications, and influence policy. However, research and policy that explicitly seeks to address the systemic drivers of health would more effectively support health. Intersectionality is a theoretical framework that can facilitate such research. It holds that individual human experiences reflect larger socio-structural level systems of privilege and oppression, and cannot be truly understood if these systems are examined in isolation. Intersectionality explicitly accounts for the interrelated nature of systems of privilege and oppression, providing a lens through which to examine and challenge inequities. In this paper, we propose intersectionality as an intervention into how we conduct BMI research. We begin by discussing intersectionality's history and core principles as they apply to BMI. We then elaborate on the potential for intersectionality to stimulate BMI research. Specifically, we posit that our efforts in BMI to improve health should address intersectionality's five key considerations: (1) systems of privilege and oppression that shape health; (2) the interrelated nature of upstream health drivers; (3) the nuances of health outcomes within groups; (4) the problematic and power-laden nature of categories that we assign to people in research and in society; and (5) research to inform and support social change.

Massive open online courses: learning opportunities about global health for Latin American countries / Cursos en línea abiertos y masivos: oportunidad de aprendizaje sobre salud global en Latinoamérica

INTRODUCTION: Massive open online courses provide the opportunity to train health professionals and researchers from Latin America in global health. OBJETIVES: To determine the global offer of massive open online courses in global health and the characteristics of their content. MATERIAL AND METHODS: We examined massive open online course platforms to compile the global health offerings. The search had no time restriction and was last conducted in November, 2021. The search strategy only included the descriptor "global health". We obtained the characteristics of the courses, their content, and the global health domain covered. These data were analyzed using descriptive statistics, reporting absolute and relative frequencies. RESULTS: Our search strategy identified 4,724 massive open online courses. Of these, only 92 were related to global health. Most of these courses (n=44; 47.8%) were offered through Coursera. More than half (n=50; 54.4%) of the MOOCs were conducted by U.S.A. institutions and in English language (n=90; 97.8%). Most courses focused on "globalization of health and healthcare" (n=24; 26.1%), followed by the domains "capacity building" (n=16; 17.4%), "global burden of disease" and "social and environmental determinants of health" (n=15; 16.3%). CONCLUSIONS: We found a high offer of massive open online courses on global health. These courses covered the global health competencies required for health professionals.

Introducción: Los cursos en línea, masivos y abiertos, brindan la oportunidad de formar profesionales e investigadores en Latinoamérica sobre salud global. Objetivos: Determinar la oferta global de los cursos en línea, masivos y abiertos, sobre salud global y conocer las características de su contenido. Materiales y métodos. Se examinaron las plataformas especializadas en cursos en línea, masivos y abiertos, para recopilar aquellos sobre salud global. La búsqueda no tuvo restricción de tiempo y se realizó por última vez en noviembre de 2021. La estrategia de búsqueda solo incluyó el descriptor "global health". Posteriormente, se obtuvieron las características del curso, su contenido y el dominio abordado de salud global. Estos datos fueron analizados descriptivamente, y se reportaron frecuencias absolutas y relativas. Materiales y métodos: Se examinaron las plataformas especializadas en cursos en línea, masivos y abiertos, para recopilar aquellos sobre salud global. La búsqueda no tuvo restricción de tiempo y se realizó por última vez en noviembre de 2021. La estrategia de búsqueda solo incluyó el descriptor "global health". Posteriormente, se obtuvieron las características del curso, su contenido y el dominio abordado de salud global. Estos datos fueron analizados descriptivamente, y se reportaron frecuencias absolutas y relativas. Resultados: La estrategia de búsqueda identificó 4.724 cursos en línea, masivos y abiertos. De ellos, solo 92 estaban relacionados con salud global. La mayoría de estos cursos (n=44; 47,8 %) se ofrecieron mediante la plataforma Coursera. Más de la mitad de los cursos (n=50; 54,4 %) fueron realizados por instituciones de Estados Unidos y en idioma inglés (n=90; 97,8 %). La mayor parte de los cursos se centró en la "globalización de la salud y la asistencia sanitaria" (n=24; 26,1 %), seguido de los dominios "fortalecimiento de capacidades" (n=16; 17,4 %), "carga global de enfermedad" y "determinantes sociales y ambientales de la salud" (n=15; 16,3 %). Conclusiones: Se encontró una importante oferta de cursos en línea, masivos y abiertos, sobre salud global. Estos cursos abordaron las competencias de la salud global que se requieren para los profesionales sanitarios.

Cursos en línea abiertos y masivos: oportunidad de aprendizaje sobre salud global en Latinoamérica / Massive open online courses: learning opportunities about global health for Latin American countries

Introducción. Los cursos en línea, masivos y abiertos, brindan la oportunidad de formar profesionales e investigadores en Latinoamérica sobre salud global. Objetivos. Determinar la oferta global de los cursos en línea, masivos y abiertos, sobre salud global y conocer las características de su contenido. Materiales y métodos. Se examinaron las plataformas especializadas en cursos en línea, masivos y abiertos, para recopilar aquellos sobre salud global. La búsqueda no tuvo restricción de tiempo y se realizó por última vez en noviembre de 2021. La estrategia de búsqueda solo incluyó el descriptor "global health". Posteriormente, se obtuvieron las características del curso, su contenido y el dominio abordado de salud global. Estos datos fueron analizados descriptivamente, y se reportaron frecuencias absolutas y relativas. Resultados. La estrategia de búsqueda identificó 4.724 cursos en línea, masivos y abiertos. De ellos, solo 92 estaban relacionados con salud global. La mayoría de estos cursos (n=44; 47,8 %) se ofrecieron mediante la plataforma Coursera. Más de la mitad de los cursos (n=50; 54,4 %) fueron realizados por instituciones de Estados Unidos y en idioma inglés (n=90; 97,8 %). La mayor parte de los cursos se centró en la "globalización de la salud y la asistencia sanitaria" (n=24; 26,1 %), seguido de los dominios "fortalecimiento de capacidades" (n=16; 17,4 %), "carga global de enfermedad" y "determinantes sociales y ambientales de la salud" (n=15; 16,3 %). Conclusiones. Se encontró una importante oferta de cursos en línea, masivos y abiertos, sobre salud global. Estos cursos abordaron las competencias de la salud global que se requieren para los profesionales sanitarios.

Introduction. Massive open online courses provide the opportunity to train health professionals and researchers from Latin America in global health. Objective. To determine the global offer of massive open online courses in global health and the characteristics of their content. Material and methods. We examined massive open online course platforms to compile the global health offerings. The search had no time restriction and was last conducted in November, 2021. The search strategy only included the descriptor "global health". We obtained the characteristics of the courses, their content, and the global health domain covered. These data were analyzed using descriptive statistics, reporting absolute and relative frequencies. Results. Our search strategy identified 4,724 massive open online courses. Of these, only 92 were related to global health. Most of these courses (n=44; 47.8%) were offered through Coursera. More than half (n=50; 54.4%) of the MOOCs were conducted by U.S.A. institutions and in English language (n=90; 97.8%). Most courses focused on "globalization of health and healthcare" (n=24; 26.1%), followed by the domains "capacity building" (n=16; 17.4%), "global burden of disease" and "social and environmental determinants of health" (n=15; 16.3%). Conclusions. We found a high offer of massive open online courses on global health. These courses covered the global health competencies required for health professionals.

Improving physical activity among prostate cancer survivors through a peer-based digital walking program.

Physical activity is important for prostate cancer survivors. Yet survivors face significant barriers to traditional structured exercise programs, limiting engagement and impact. Digital programs that incorporate fitness trackers and peer support via social media have potential to improve the reach and impact of traditional support. Using a digital walking program with prostate cancer survivors, we employed mixed methods to assess program outcomes, engagement, perceived utility, and social influence. After 6 weeks of program use, survivors and loved ones (n=18) significantly increased their average daily step count. Although engagement and perceived utility of using a fitness tracker and interacting with walking buddies was high, social media engagement and utility were limited. Group strategies associated with social influence were driven more by group attraction to the collective task of walking than by interpersonal bonds. Findings demonstrate the feasibility of a digital walking program to improve physical activity and extend the reach of traditional support.

Imagining Improved Interactions: Patients' Designs To Address Implicit Bias.

Implicit biases may negatively influence healthcare providers' behaviors toward patients from historically marginalized communities, impacting providers' communication style, clinical decision-making, and delivery of quality care. Existing interventions to mitigate negative experiences of implicit biases are primarily designed to increase recognition and management of stereotypes and prejudices through provider-facing tools and resources. However, there is a gap in understanding and designing interventions from patient perspectives. We conducted seven participatory co-design workshops with 32 Black, Indigenous, People of Color (BIPOC), Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ+), and Queer, Transgender, Black, Indigenous, People of Color (QTBIPOC) individuals to design patient-centered interventions that help them address and recover from provider implicit biases in primary care. Participants designed four types of solutions: accountability measures, real-time correction, patient enablement tools, and provider resources. These informatics interventions extend the research on implicit biases in healthcare through inclusion of valuable, firsthand patient perspectives and experiences.

Maybe they had a bad day: how LGBTQ and BIPOC patients react to bias in healthcare and struggle to speak out.

OBJECTIVE: People who experience marginalization, including Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, Plus (ie, all other marginalized genders and sexual orientations) people (LGBTQ+) experience discrimination during healthcare interactions, which negatively impacts patient-provider communication and care. Yet, scarce research examines the lived experience of unfair treatment among patients from marginalized groups to guide patient-centered tools that improve healthcare equity. MATERIALS AND METHODS: We interviewed 25 BIPOC and/or LGBTQ+ people about their experiences of unfair treatment and discrimination when visiting healthcare providers. Through thematic analysis, we describe participants' immediate reactions and longer-term consequences of those experiences. RESULTS: We identified 4 ways that participants reacted to discrimination in the moment: Fighting, Fleeing, Excusing, and Working Around Bias. Long-term consequences reflect 6 ways they coped: Delaying or Avoiding Care, Changing Healthcare Providers, Self-prescribing, Covering Behaviors, Experiencing Health Complications, and Mistrusting Healthcare Institutions. DISCUSSION: By describing how patients react to experiences of unfair treatment and discrimination, our findings enhance the understanding of health disparities as patients cope and struggle to speak out.To combat these problems, we identify 3 future directions for informatics interventions that improve provider behavior, support patient advocacy, and address power dynamics in healthcare. CONCLUSIONS: BIPOC and LGBTQ+ patients' perspectives on navigating unfair treatment and discrimination in healthcare offers critical insight into their experiences and long-term consequences of those experiences. Understanding the circumstances and consequences of unfair treatment, discrimination, and the impact of bias through this patient-centered lens is crucial to inform informatics technologies that promote health equity.

Battling Bias in Primary Care Encounters: Informatics Designs to Support Clinicians.

Although clinical training in implicit bias is essential for healthcare equity, major gaps remain both for effective educational strategies and for tools to help identify implicit bias. To understand the perspectives of clinicians on the design of these needed strategies and tools, we conducted 21 semi-structured interviews with primary care clinicians about their perspectives and design recommendations for tools to improve patient-centered communication and to help mitigate implicit bias. Participants generated three types of solutions to improve communication and raise awareness of implicit bias: digital nudges, guided reflection, and data-driven feedback. Given the nuance of implicit bias communication feedback, these findings illustrate innovative design directions for communication training strategies that clinicians may find acceptable. Improving communication skills through individual feedback designed by clinicians for clinicians has the potential to improve healthcare equity.

Broken down by bias: Healthcare biases experienced by BIPOC and LGBTQ+ patients.

Bias toward historically marginalized patients affects patient-provider interactions and can lead to lower quality of care and poor health outcomes for patients who are Black, Indigenous, People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender and Gender Diverse (LGBTQ+). We gathered experiences with biased healthcare interactions and suggested solutions from 25 BIPOC and LGBTQ+ people. Through qualitative thematic analysis of interviews, we identified ten themes. Eight themes reflect the experience of bias: Transactional Care, Power Inequity, Communication Casualties, Bias-Embedded Medicine, System-level problems, Bigotry in Disguise, Fight or Flight, and The Aftermath. The remaining two themes reflect strategies for improving those experiences: Solutions and Good Experiences. Characterizing these themes and their interconnections is crucial to design effective informatics solutions that can address biases operating in clinical interactions with BIPOC and LGBTQ+ patients, improve the quality of patient-provider interactions, and ultimately promote health equity.

Design of digital walking programs that engage prostate cancer survivors: Needs and preferences from focus groups.

The majority of prostate cancer survivors do not meet physical activity (PA) recommendations. Although technology has shown to promote PA, engagement has been a challenge. This mixed method study characterizes survivors' needs and preferences for digital walking programs Through focus groups and surveys, we engaged prostate cancer support groups to describe PA motivators and barriers, interest in improving PA, and preferences for design features of a future digital walking program. Identified motivators (peers, positive thinking) and barriers (health issues) reflect PA needs that impact engagement. The most preferred features include: (1) well-curated, specific content, (2) individualized feedback from trusted sources, (3) moderated peer discussion, and (4) support from small teams and peer mentors. These findings inform digital PA programs that survivors will find engaging and can promote PA.