Human-centered design in the context of social determinants of health in maternity care: methods for meaningful stakeholder engagement.

PURPOSE: The screening process for social determinants of health (SDoH) includes questions regarding life circumstances and barriers to accessing health care. For patients, these questions may be intrusive, biased, and potentially risky. This article describes human-centered design methods to engage birthing parents and health care team members around SDoH screening and referral in maternity care. METHODS: Three phases of qualitative research with birthing parents, health care teams, and hospital administrators were conducted in the United States. Shadowing, interviews, focus groups, and participatory workshops addressed the explicit and tacit concerns of the stakeholders regarding SDoH during maternity care. RESULTS: Birthing parents wanted to be informed of the purpose of the clinic collecting SDoH information and how this information is used. Health care teams want to feel they are providing reliable and quality resources to their patients. They would like greater transparency that administrators are acting on SDoH data and the information is reaching people that can assist patients. CONCLUSION: As clinics implement patient-centered strategies for addressing SDoH in maternity care, it is important to include patients' perspectives. This human-centered design approach advances understanding of knowledge and emotional needs around SDoH and offers insights to meaningful engagement around sensitive health data.

Evaluation of Patient Access to Spanish-Language-Concordant Care on a Postpartum Unit.

OBJECTIVE: To evaluate patient access to Spanish-language-concordant care on a postpartum unit and to identify facilitators and barriers to the use of interpretation services. DESIGN: Mixed-methods research study, comprising a cross-sectional chart review from September to December 2019 and semistructured interviews from June to December 2020. SETTING/LOCAL PROBLEM: A tertiary academic medical center in the southeastern United States where individuals with limited English proficiency are at risk for poor health outcomes when they are unable to communicate with clinicians in their preferred language. PARTICIPANTS: We conducted a chart review of 50 randomly selected birthing parent-newborn couplets and interviews with 14 inpatient health care team members. MEASUREMENTS: The chart review examined patient characteristics, health care team composition including Spanish language proficiency, length of stay, number of interpreter requests, and time between clinician interpreter requests and interpreter arrival on the unit. Interviews evaluated facilitators and barriers to interpreter use. RESULTS: Access to a clinician certified in medical Spanish or an interpreter was offered to 12 of 50 (24%) couplets upon admission to the unit and to 7 of 50 (14%) of couplets for daily maternal and newborn medical rounds. Clinicians reported long and unpredictable wait times to access interpreters, which led them to rely on hand gestures, broken Spanish, and smartphone apps to "get by" when communicating with patients without certified interpretation services. Participants described low usage of interpreters for "noncritical" encounters. CONCLUSION: Interpreters and other forms of Spanish-language-concordant care were underused on the postpartum unit. This deviation from national standards may put families at risk for harm. Recommendations from this study include advancing a culture of respectful care, improving the interpreter request workflow, addressing safe staffing, facilitating direct patient access to interpreters, and providing ongoing evaluation and support.

Screening and Referral for Social Determinants of Health: Maternity Patient and Health Care Team Perspectives.

Objective: To identify patient and health care team perspectives on screening and referral for Social Determinants of Health (SDoH) in maternity care. Methods: This human-centered design study was conducted in a prenatal clinic and in the surrounding community of a university teaching hospital in the Southeastern United States. Qualitative data were collected through semistructured interviews and focus groups between March 2019 and February 2020, with findings shared in-person with participants for feedback. Results: A total of 19 English- and Spanish-speaking patients and 11 health care team members participated. Participants suggested that all patients should be screened as part of integrated health assessments, early in care and periodically, but only when protocols are in place for addressing needs-immediate or ongoing. They expressed concerns that disclosure of SDoH screening data might exacerbate already existing biases, negatively impact care, or be used to harm them. Patients wanted proactive transparency about the purpose of SDoH screening, and to know who would have access to their data, when and how it would be used, and how long it would be stored. Patients expressed concern about confidentiality and stigma, and wanted their health care team to normalize seeking help, and acknowledge that birthing people's circumstances change over time. Patients and health care team responded that patient-provider communication should be respectful, be antiracist, and demonstrate respect for patient autonomy. Conclusion: Patients and health care team members recommended that SDoH resource information be accessible to all patients regardless of endorsed needs.

Barriers and facilitators to adoption of soft copy interpretation from the user perspective: Lessons learned from filmless radiology for slideless pathology.

BACKGROUND: Adoption of digital images for pathological specimens has been slower than adoption of digital images in radiology, despite a number of anticipated advantages for digital images in pathology. In this paper, we explore the factors that might explain this slower rate of adoption. MATERIALS AND METHOD: Semi-structured interviews on barriers and facilitators to the adoption of digital images were conducted with two radiologists, three pathologists, and one pathologist's assistant. RESULTS: Barriers and facilitators to adoption of digital images were reported in the areas of performance, workflow-efficiency, infrastructure, integration with other software, and exposure to digital images. The primary difference between the settings was that performance with the use of digital images as compared to the traditional method was perceived to be higher in radiology and lower in pathology. Additionally, exposure to digital images was higher in radiology than pathology, with some radiologists exclusively having been trained and/or practicing with digital images. The integration of digital images both improved and reduced efficiency in routine and non-routine workflow patterns in both settings, and was variable across the different organizations. A comparison of these findings with prior research on adoption of other health information technologies suggests that the barriers to adoption of digital images in pathology are relatively tractable. CONCLUSIONS: Improving performance using digital images in pathology would likely accelerate adoption of innovative technologies that are facilitated by the use of digital images, such as electronic imaging databases, electronic health records, double reading for challenging cases, and computer-aided diagnostic systems.