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User-Centered Design of a Preference-Driven Patient Activation Tool for Optimizing Depression Treatment in Integrated Primary Care Settings (The Transform DepCare Study).
Dauber-Decker, Katherine L; Serafini, Maria A; Monane, Rachel; Grossman Liu, Lisa; Sales, Alyssa; Mizhquiri Barbecho, Jennifer; Diamond, Meredith E; Levy, Sera; King, D 'Arcy; McGinn, Thomas; Bakken, Suzanne; Moise, Nathalie.
Afiliación
  • Dauber-Decker KL; Northwell, New Hyde Park, NY, USA.
  • Serafini MA; Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
  • Monane R; Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Grossman Liu L; Health Design Lab, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
  • Sales A; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
  • Mizhquiri Barbecho J; Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
  • Diamond ME; Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • Levy S; Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
  • King D'; Department of Psychology, State University of New York at Buffalo, Buffalo, NY, USA.
  • McGinn T; Department of Clinical Psychology, Fielding Graduate University, Santa Barbara, CA, USA.
  • Bakken S; Medicine Department, Baylor College of Medicine, Houston, TX, USA.
  • Moise N; Columbia University School of Nursing, Columbia University Irving Medical Center, New York, NY, USA.
J Gen Intern Med ; 2024 Jun 05.
Article en En | MEDLINE | ID: mdl-38839708
ABSTRACT

BACKGROUND:

Few patient engagement tools incorporate the complex patient experiences, contexts, and workflows that limit depression treatment implementation.

OBJECTIVE:

Describe a user-centered design (UCD) process for operationalizing a preference-driven patient activation tool.

DESIGN:

Informed by UCD and behavior change/implementation science principles, we designed a preference-driven patient activation prototype for engaging patients in depression treatment. We conducted three usability cycles using different recruitment/implementation approaches near live/live testing in primary care waiting rooms (V1-2) and lab-based think aloud testing (V3) oversampling older, low-literacy, and Spanish-speaking patients in the community and via EHR algorithms. We elicited clinician and "heuristic" expert input. MAIN

MEASURES:

We administered the system usability scale (SUS) all three cycles and pre-post V3, the patient activation measure, decisional conflict scale, and depression treatment barriers. We employed descriptive statistics and thematically analyzed observer notes and transcripts for usability constructs.

RESULTS:

Overall, 43 patients, 3 clinicians, and 5 heuristic (a usability engineering method for identifying usability problems) experts participated. Among patients, 41.9% were ≥ 65 years old, 79.1% female, 23.3% Black, 62.8% Hispanic, and 55.8% Spanish-speaking and 46.5% had ≤ high school education. We described V1-3 usability (67.2, 77.3, 81.8), treatment seeking (92.3%, 87.5%, 92.9%), likelihood/comfort discussing with clinician (76.9%, 87.5%, 100.0%), and pre vs. post decisional conflict (23.7 vs. 15.2), treatment awareness (71.4% vs. 92.9%), interest in antidepressants (7.1% vs. 14.3%), and patient activation (66.8 vs. 70.9), with fewer barriers pertaining to cost/insurance, access/coordination, and self-efficacy/stigma/treatment efficacy. Key themes included digital literacy, understandability, high acceptability for aesthetics, high usefulness of patient/clinician videos, and workflow limitations. We adapted manual entry/visibility/content; added patient activation and a personalized algorithm; and proposed flexible, care manager delivery leveraging clinic screening protocols.

DISCUSSION:

We provide an example of leveraging UCD to design/adapt a real-world, patient experience and workflow-aligned patient activation tool in diverse populations.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Gen Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Gen Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos