RESUMO
BACKGROUND: Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. OBJECTIVE: Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). METHODS: This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. RESULTS: A total of 2 co-design workshops were held with 18 users-young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions-young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. CONCLUSIONS: The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C-a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.
RESUMO
La disforia de género o transexualismo es una condición que comprende a las personas que padecen profundo malestar o rechazo hacia el sexo biológico por cuanto se identifican con el sexo opuesto. Por lo tanto, se asocia a disfunción biopsicosocial y compromiso severo de la calidad de vida. En Colombia se han producido notables avances de índole constitucional y legislativa en las dos últimas décadas, los cuales son discutidos en la presente revisión. En el tratamiento multidisciplinario de los pacientes transexuales, el último paso corresponde a la cirugía de reasignación genital. El propósito de esta revisión es investigar el estado actual de la cirugía de reasignación genital enfocada en el contexto nacional.
Gender dysphoria or transsexualism is a condition that includes people who suffer from deep discomfort or rejection of biological sex because they identify with the opposite sex. Therefore, it is associated with biopsychosocial dysfunction and severe compromise of their quality of life. In Colombia there have been notable advances of a constitutional and legislative nature in the last two decades, which are discussed in the present review. In the multidisciplinary treatment of transgender patients, the last step corresponds to genital reassignment surgery. The purpose of this review is to investigate the current status of genital reassignment surgery within the national context.
