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BACKGROUND: COVID-19 vaccination is a global priority. Latin American countries have some of the highest COVID-19 death rates worldwide with vaccination hampered by a variety of reasons, including mis- and disinformation, vaccine hesitancy, and vaccine supply constraints. Addressing vaccine hesitancy through effective messages has been found to help increase vaccine uptake. Participatory processes could be used to co-design health messages for this purpose. OBJECTIVE: This article describes the methodology used to co-design evidence-based audio messages to be deployed in a cohort of individuals through an interactive voice response (IVR) mobile phone survey intervention, aimed towards increasing vaccination uptake in an adult population in Colombia. METHODS: Participants of the COVID-19 vaccination message co-design process included a sample of the general population of the country, representatives of the funder organisation, and research team members. The co-design process consisted of four phases: (1) formative quantitative and qualitative research, (2) message drafting based on the results of the formative research, (3) message content evaluation, and (4) evaluation of the voices to deliver the audio messages; and was informed by reflexive meetings. RESULTS: Three categories of evidence-based audio messages were co-designed, each corresponding to an arm of the mHealth intervention: (1) factual messages, (2) narrative messages, and (3) mixed messages. An additional fourth arm with no message was proposed for control. The iterative co-design process ended with a total of 14 audio messages recorded to be deployed via the intervention. CONCLUSIONS: Co-developing health messages in response to health emergencies is possible. Adopting more context-relevant, participatory, people-centred, and reflexive multidisciplinary approaches could help develop solutions that are more responsive to the needs of populations and public health priorities. Investing resources in message co-design is deemed to have a greater potential for influencing behaviours and improving health outcomes.

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To reduce the prevalence of youth injuries and fatalities in agricultural settings, safety professionals considered developing a guideline-focused intervention for how and when youth should conduct farm chores. In 1996, the process to create guidelines started, which then expanded to include professionals from the United States, Canada, and Mexico. This team used a consensus driven approach to develop the guidelines and launch the North American Guidelines for Children's Agricultural Tasks. By 2015, research related to the published guidelines indicated a need to incorporate new empirical evidence and develop dissemination plans based on new technologies. The process for updating the guidelines was supported by a 16-person steering committee and used content experts and technical advisors. The process yielded updated and new guidelines, now called Agricultural Youth Work Guidelines. This report responds to request for further details on the development and update of the guidelines and describes the genesis of the guidelines as an intervention, the process for creating guidelines, recognition of the need to update guidelines based on research, and the process for updating guidelines to assist in others engaged in similar types of interventions.

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In Chile, the prevalence of tobacco, alcohol and drug use among adolescents is very high. Decades of research indicate that parenting interventions reduce these risky behaviors. However, there are no parenting interventions validated in Chile to prevent adolescent substance use. This article reports the development of the ¡Vamos por Mas! (¡VxM!) program following the recommendations of the Medical Research Council's framework for designing and evaluating complex interventions. After identifying key intervention components, a preliminary version of a substance-use prevention program was designed. The preliminary intervention targeted families with adolescents in fifth and sixth grade and had four components: personalized feedback, in-person workshops, virtual engagement, and family support, to deliver positive-youth development and family-strengthening content. Then, students, guardians, school staff and community experts from different school systems (N = 111) evaluated the preliminary version of the program through a convergent parallel mixed methods study, including focus groups (N = 14) and surveys (N = 101). In general, all participants had positive perceptions of the program and valued its purpose, strategies, objectives and contents. Suggestions included expanding the purpose to promote healthy relationships, focusing on schools with low and intermediate socioeconomic vulnerability, including self-control content, removing the personalized feedback component and adding two additional components: school partnership and external supervision, among other improvements. With this information, the final version of the ¡VxM! program was developed. After a rigorous intervention development process, the ¡VxM! program is ready to be piloted and evaluated in a randomized trial.

Chile has high rates of tobacco, alcohol and drug use among adolescents. Parenting interventions have shown to reduce these risky behaviors. However, there are no parenting interventions validated in Chile to prevent adolescent substance use. This article reports the development of the ¡Vamos por Mas! (¡VxM!) program to strengthen family relations and prevent adolescent substance use following the recommendations of the Medical Research Council's framework for designing and evaluating complex interventions. In the first phase, key intervention components were identified. Then, a preliminary version of the intervention was designed. In the second phase, perceptions of key stakeholders were collected through focus groups (N = 14) and surveys (N = 101) including adolescents, guardians, school staff and community experts. These participants evaluated the preliminary version of the program and provided feedback. In the final phase of the intervention development process, stakeholder opinions were integrated into the proposal. The final version of the ¡VxM! program included five components: (i) school partnership, (ii) in-person workshops, (iii) virtual engagement, (iv) family support and (v) external supervision. This version is ready to be piloted to evaluate feasibility and preliminary efficacy, before being assessed in a randomized trial.

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INTRODUCTION: Hispanics are the largest minority group in the United States, constituting 18 % of the population. Mexicans are the largest Hispanic subgroup and are at disproportionate risk for overweight/obesity. Lifestyle interventions targeting dietary change and physical activity have resulted in significant weight loss in several large randomized clinical trials in the general population, but few studies have tailored interventions to Mexican Americans. We conducted a community needs assessment from 2018 to 2020 in accordance with Domenech-Rodriguez and Wieling's Cultural Adaptation Process (CAP) model to inform the development of SANOS (SAlud y Nutrición para todOS) (Health and Nutrition for All), a culturally-tailored, community-based diet and lifestyle education and counseling program that addresses overweight/obesity among U.S. Mexicans. METHODS: Five Spanish-language focus groups were conducted until thematic saturation with 31 overweight/obese Mexicans in New York City about their knowledge, priorities, and preferences regarding diet, exercise, and evidence-based strategies for behavioral change. A grounded theory approach was used to analyze the data. RESULTS: Five themes were identified: (1) A strong desire for tangible information related to diet and health, (2) Family as a primary motivator for behavior change, (3) Desire for group-based motivation and accountability to sustain intervention participation, (4) Belief in short-term goal setting to prevent loss of motivation, and (5) Time and workplace-related barriers to intervention adoption. CONCLUSIONS: Ecological factors such as the effect of acculturation on diet, family members' role in behavior change, and socioenvironmental barriers to healthy dietary practices and physical activity should be considered when adapting evidence-based treatments for Mexican Americans.

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OBJECTIVES: To develop a generalizable advance care planning (ACP) intervention for children, adolescents, and young adults with serious illness using a multistage, stakeholder-driven approach. STUDY DESIGN: We first convened an expert panel of multidisciplinary health care providers (HCPs), researchers, and parents to delineate key ACP intervention elements. We then adapted an existing adult guide for use in pediatrics and conducted focus groups and interviews with HCPs, parents, and seriously ill adolescents and young adults to contextualize perspectives on ACP communication and our Pediatric Serious Illness Communication Program (PediSICP). Using thematic analysis, we identified guide adaptations, preferred content, and barriers for Pedi-SICP implementation. Expert panelists then reviewed, amended and finalized intervention components. RESULTS: Stakeholders (34 HCPs, 9 parents, and 7 seriously ill adolescents and young adults) participated in focus groups and interviews. Stakeholders validated and refined the guide and PediSICP intervention and identified barriers to PediSICP implementation, including the need for HCP training, competing demands, uncertainty regarding timing, and documentation of ACP discussions. CONCLUSIONS: The finalized PediSICP intervention includes a structured HCP and family ACP communication occasion supported by a 3-part communication tool and bolstered by focused HCP training. We also identified strategies to ameliorate implementation barriers. Future research will determine the feasibility of the PediSICP and whether it improves care alignment with patient and family goals.

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This paper describes the development of the Irie Homes Toolbox, a violence prevention program targeting parents of children aged two to six years. The intervention was designed to complement an existing, teacher-training, violence prevention program, the Irie Classroom Toolbox, thus promoting an integrated approach across home and school settings. The Irie Homes Toolbox was developed through a four-stage process by integrating data from theory, formative research, and practice to ensure the intervention is acceptable, feasible, relevant, and effective in the context. The perspectives of Jamaican preschool teachers and parents of preschool children, who are the end users, were integrated into the design of the intervention throughout the development process. Stage one involved integrating theory and formative research to inform the initial intervention design. Stages two and three involved iterative cycles of design, implementation and evaluation of the intervention content, process of delivery, structure and materials. Stage four involved a further cycle of learning through a process evaluation conducted as part of a cluster-randomized controlled trial. Data from each of these four stages was used to inform the design and ongoing revisions of the toolbox with the aim of developing a low-cost, scalable and sustainable intervention for the Jamaican context. The resulting program is theory-informed and uses empirically derived content and behavior change principles operationalized for the context in which it will be delivered. The Irie Homes Toolbox is suitable for integration into the existing preschool provision in Jamaica, thus utilizing an existing service and existing staff and increasing the likelihood for wide-scale dissemination.

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Latinx immigrants and men, in particular, living in the US are disproportionally impacted by HIV. Despite these concerns, there is limited research on the development, implementation, and evaluation of community-based HIV education and HIV testing interventions. The current study describes such efforts within a historic Mexican immigrant enclave in Chicago. A mixed-methods case study was used to describe intervention development, as well as preliminary evaluation data. Community intervention components were refined through early focus groups, asset mapping, community networking and consultation with cultural advisors. We exceeded our activity goals. We were successful in reaching a segment of the population that is often overlooked and remains unaware of HIV and its risks. Incorporating social network approaches could facilitate reaching at-risk community groups. Demonstration projects require more time and resources (fiscal and technical) to develop, refine, evaluate and sustain community-level intervention components.

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Background: Co-creation is the process of involving stakeholders in the development of interventions. Although co-creation is becoming more widespread, reports of the process and lessons learned are scarce.Objective: To describe the process and lessons learned from using the COHESION manual, a co-creation methodology to develop interventions aimed at the improvement of diagnosis and/or management of chronic diseases at the primary healthcare level in a low-resource setting in Peru.Methods: Observational study to describe the use of the COHESION manual 'Moving from Research to Interventions: The COHESION Model' developed for a multi-country project in low- and middle-income countries for co-creation and the adaptations needed to customize it to the local context of rural communities in northern Peru.Results: The actual process of co-creation in Peru included co-creation-related questions in the formative research; an initial consultation with stakeholders at the micro, meso, and macro levels (e.g. community members, health workers, and policy-makers); the analysis of the collected data; a second consultation with each stakeholder group; the prioritization of intervention options; and finally the design of a theory of change for all activities included in the complex intervention. The complex intervention included: 1) offer training in specific diseases and soft skills to health workers, 2) create radio programs that promote chronic disease prevention and management plus empower patients to ask questions during their visits to primary health care (PHC) facilities, and 3) provide a small grant to the PHC for infrastructure improvement. Small adaptations to the COHESION manual were necessary for this co-creation process.Conclusion: This study provides a practical example of the process of co-creating complex interventions to increase access and quality of health care in a low-resource setting. The process, components, challenges and opportunities identified could be useful for other researchers who want to co-create interventions with beneficiaries in similar settings.

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[This corrects the article DOI: 10.3389/fpubh.2020.582961.].

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ABSTRACT Electronic health (eHealth) interventions have shown promising results in optimizing self-management and care for patients. eHealth offers a large range of solutions to be used by the patient, nurses and other health professionals when providing care and follow-up for patients, families, and communities. Nurses, as the largest group of health care providers, have a responsibility in the development, research and implementation of eHealth interventions. The aim of this article is to describe methods, frameworks and models for development and testing of eHealth interventions, including security and privacy considerations and methods for implementation into the health care service. To succeed with development, testing and implementation of eHealth interventions, the following steps could be addressed: 1) base the intervention on existing evidence when available, 2) include all relevant stakeholders in the development phase, 3) develop a business model at project start and plan for implementation, 4) establish usability, acceptability, compliance, and delivery of the intervention through a feasibility pilot prior to larger studies, 5) test for intervention effect by using an appropriate study design and perform process- and economic evaluation to supplement findings, and 6) use appropriate implementation strategies to implement efficient interventions and evaluate the implementation.

RESUMEN Las intervenciones de salud electrónica (eSalud o eHealth) han mostrado resultados prometedores en la optimización de la autogestión y el cuidado de los pacientes. La eSalud ofrece una amplia variedad de soluciones para ser utilizadas por el paciente, enfermeros y enfermeras; y otros profesionales de la salud a la hora de proporcionar atención y seguimiento a los pacientes, las familias y las comunidades. Los enfermeros y las enfermeras, como el grupo más numeroso de proveedores de atención de salud, son responsables del desarrollo, la investigación y la aplicación de las intervenciones en materia de salud electrónica. El objetivo de este artículo es describir los métodos, marcos de referencia y modelos para desarrollar y probar las intervenciones de salud electrónica, incluyendo las consideraciones de seguridad y privacidad y los métodos para su aplicación en la atención de salud. Para tener éxito en el desarrollo, prueba e implementación de las intervenciones de e-Salud se podrían considerar los siguientes pasos: 1) basar la intervención en la evidencia existente cuando esté disponible, 2) incluir a todas las partes interesadas en la fase de desarrollo, 3) desarrollar un modelo de negocio al inicio del proyecto y planificar la implementación, 4) establecer la usabilidad, aceptabilidad, cumplimiento y entrega de la intervención a través de una prueba piloto de factibilidad antes de realizar estudios de mayor alcance, 5) probar el efecto de la intervención mediante el uso de un diseño de estudio apropiado y llevar a cabo una evaluación económica y de proceso para complementar los hallazgos y 6) utilizar estrategias de implementación adecuadas para implementar intervenciones eficientes y evaluar la implementación.

RESUMO As intervenções de saúde eletrônica (eSaúde ou eHealth) mostraram resultados promissores na optimização do autogerenciamento e do cuidado aos pacientes. A eSaúde oferece uma amplia variedade de soluções a serem usados pelo paciente, enfermeiros e enfermeiras; e outros profissionais da saúde na prestação de cuidados e acompanhamento a pacientes, famílias e comunidades. Os enfermeiros e as enfermeiras, como o maior grupo de prestadores da atenção de saúde, são responsáveis do desenvolvimento, pesquisa e aplicação das intervenções eletrônicas em saúde. O objetivo deste artigo é descrever os métodos, quadros de referência e modelos para o desenvolvimento e teste das intervenções eletrônicas de saúde, incluindo as considerações de segurança e privacidade e métodos para sua aplicação na atenção da saúde. Para ter sucesso no desenvolvimento, teste e implementação das intervenções do eSaúde, as seguintes etapas podem ser consideradas: 1) basear a intervenção na evidência existente, quando estiver disponível, 2) incluir todas as partes interessadas na fase de desenvolvimento, 3) desenvolver um modelo de negócios no início do projeto e planejar a implementação, 4) estabelecer a usabilidade, aceitabilidade, conformidade e entrega da intervenção através de um teste piloto de factibilidade antes de realizar estudos maiores, 5) testar o efeito da intervenção através do uso de um desenho apropriado e realizar uma avaliação econômica e de processo para complementar as descobertas e 6) utilizar estratégias de implementação apropriadas para a implementação de intervenções eficientes e avaliar a implementação.

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ABSTRACT Electronic health (eHealth) interventions have shown promising results in optimizing self-management and care for patients. eHealth offers a large range of solutions to be used by the patient, nurses and other health professionals when providing care and follow-up for patients, families, and communities. Nurses, as the largest group of health care providers, have a responsibility in the development, research and implementation of eHealth interventions. The aim of this article is to describe methods, frameworks and models for development and testing of eHealth interventions, including security and privacy considerations and methods for implementation into the health care service. To succeed with development, testing and implementation of eHealth interventions, the following steps could be addressed: 1) base the intervention on existing evidence when available, 2) include all relevant stakeholders in the development phase, 3) develop a business model at project start and plan for implementation, 4) establish usability, acceptability, compliance, and delivery of the intervention through a feasibility pilot prior to larger studies, 5) test for intervention effect by using an appropriate study design and perform process- and economic evaluation to supplement findings, and 6) use appropriate implementation strategies to implement efficient interventions and evaluate the implementation.

RESUMEN Las intervenciones de salud electrónica (eSalud o eHealth) han mostrado resultados prometedores en la optimización de la autogestión y el cuidado de los pacientes. La eSalud ofrece una amplia variedad de soluciones para ser utilizadas por el paciente, enfermeros y enfermeras; y otros profesionales de la salud a la hora de proporcionar atención y seguimiento a los pacientes, las familias y las comunidades. Los enfermeros y las enfermeras, como el grupo más numeroso de proveedores de atención de salud, son responsables del desarrollo, la investigación y la aplicación de las intervenciones en materia de salud electrónica. El objetivo de este artículo es describir los métodos, marcos de referencia y modelos para desarrollar y probar las intervenciones de salud electrónica, incluyendo las consideraciones de seguridad y privacidad y los métodos para su aplicación en la atención de salud. Para tener éxito en el desarrollo, prueba e implementación de las intervenciones de e-Salud se podrían considerar los siguientes pasos: 1) basar la intervención en la evidencia existente cuando esté disponible, 2) incluir a todas las partes interesadas en la fase de desarrollo, 3) desarrollar un modelo de negocio al inicio del proyecto y planificar la implementación, 4) establecer la usabilidad, aceptabilidad, cumplimiento y entrega de la intervención a través de una prueba piloto de factibilidad antes de realizar estudios de mayor alcance, 5) probar el efecto de la intervención mediante el uso de un diseño de estudio apropiado y llevar a cabo una evaluación económica y de proceso para complementar los hallazgos y 6) utilizar estrategias de implementación adecuadas para implementar intervenciones eficientes y evaluar la implementación.

RESUMO As intervenções de saúde eletrônica (eSaúde ou eHealth) mostraram resultados promissores na optimização do autogerenciamento e do cuidado aos pacientes. A eSaúde oferece uma amplia variedade de soluções a serem usados pelo paciente, enfermeiros e enfermeiras; e outros profissionais da saúde na prestação de cuidados e acompanhamento a pacientes, famílias e comunidades. Os enfermeiros e as enfermeiras, como o maior grupo de prestadores da atenção de saúde, são responsáveis do desenvolvimento, pesquisa e aplicação das intervenções eletrônicas em saúde. O objetivo deste artigo é descrever os métodos, quadros de referência e modelos para o desenvolvimento e teste das intervenções eletrônicas de saúde, incluindo as considerações de segurança e privacidade e métodos para sua aplicação na atenção da saúde. Para ter sucesso no desenvolvimento, teste e implementação das intervenções do eSaúde, as seguintes etapas podem ser consideradas: 1) basear a intervenção na evidência existente, quando estiver disponível, 2) incluir todas as partes interessadas na fase de desenvolvimento, 3) desenvolver um modelo de negócios no início do projeto e planejar a implementação, 4) estabelecer a usabilidade, aceitabilidade, conformidade e entrega da intervenção através de um teste piloto de factibilidade antes de realizar estudos maiores, 5) testar o efeito da intervenção através do uso de um desenho apropriado e realizar uma avaliação econômica e de processo para complementar as descobertas e 6) utilizar estratégias de implementação apropriadas para a implementação de intervenções eficientes e avaliar a implementação.

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BACKGROUND: Unintended pregnancies can result in poorer health outcomes for women, children and families. Young people in low and middle income countries are at particular risk of unintended pregnancies and could benefit from innovative contraceptive interventions. There is growing evidence that interventions delivered by mobile phone can be effective in improving a range of health behaviours. This paper describes the development of a contraceptive behavioural intervention delivered by mobile phone for young people in Tajikistan, Bolivia and Palestine, where unmet need for contraception is high among this group. METHODS: Guided by Intervention Mapping, the following steps contributed to the development of the interventions: (1) needs assessment; (2) specifying behavioural change to result from the intervention; (3) selecting behaviour change methods to include in the intervention; (4) producing and refining the intervention content. RESULTS: The results of the needs assessment produced similar interventions across the countries. The interventions consist of short daily messages delivered over 4 months (delivered by text messaging in Palestine and mobile phone application instant messages in Bolivia and Tajikistan). The messages provide information about contraception, target attitudes that are barriers to contraceptive uptake and support young people in feeling that they can influence their reproductive health. The interventions each contain the same ten behaviour change methods, adapted for delivery by mobile phone. CONCLUSIONS: The development resulted in a well-specified, theory-based intervention, tailored to each country. It is feasible to develop an intervention delivered by mobile phone for young people in resource-limited settings.

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