Applying human-centered design to maximize acceptability, feasibility, and usability of mobile technology supervision in Kenya: a mixed methods pilot study protocol

Abstract Background Although research continues to support task-shifting as an effective model of delivering evidence-based practices (EBPs), little scholarship has focused how to scale up and sustain task-shifting in low- and middle-income countries, including how to sustainably supervise lay counselors. Ongoing supervision is critical to ensure EBPs are delivered with fidelity; however, the resources and expertise required to provide ongoing supervision may limit the potential to scale up and sustain task shifting. Opportunities may exist to leverage mobile technology to replace or supplement in-person supervision in low-resource contexts, but contextual variables, such as network connectivity and lay counselor preferences surrounding mobile technology, must be examined and considered when designing and implementing mobile technology supervision. Methods This study builds from an existing randomized trial in Kenya, wherein teachers and community health volunteers have been trained to provide trauma-focused cognitive behavioral therapy as lay counselors. The study will use an iterative and mixed methods approach, with qualitative interviews and a Human-Centered Design (HCD) workshop informing a non-randomized pilot trial. Semi-structured interviews will be conducted with lay counselors and supervisors to understand how mobile technology is currently being used for supervision and determine the barriers and facilitators to mobile technology supervision. Data from these interviews will inform an HCD workshop, where lay counselors and supervisors “re-design” supervision to most effectively leverage mobile technology. Workshop participants will also participate in focus groups to gather perceptions on the use of HCD techniques. The final outcome of the workshop will be a set of refined workflows, which will be tested in a mixed method, nonrandomized pilot with newly trained lay counselors and existing supervisors. The pilot trial will evaluate the acceptability, feasibility, and usability of mobile technology supervision through self-report questionnaires as well as perceptions of effectiveness through qualitative interviews with a subset of lay counselors and all supervisors. Discussion This study will provide a launching point for future research on supervision and methods to engage stakeholders to design and tailor interventions and implementation supports to fit low-resourced contexts. Trial registration The parent trial from which this study builds was registered on ClinicalTrials.gov on August 9, 2017 (NCT03243396).

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Applying Human-centered Design to Maximize Acceptability, Feasibility, and Usability of Mobile Technology Supervision in Kenya: A Mixed Methods Pilot Study Protocol

10.21203/rs.3.rs-106898/v1 ◽

2020 ◽

Author(s):

Noah Triplett ◽

Sean Munson ◽

Anne Mbwayo ◽

Teresia Mutavi ◽

Bryan Weiner ◽

...

Keyword(s):

Mixed Methods ◽

Mobile Technology ◽

Qualitative Interviews ◽

Pilot Trial ◽

Scale Up ◽

Task Shifting ◽

Self Report ◽

Future Research ◽

Human Centered Design ◽

Lay Counselors

Abstract Background: Although research continues to support task-shifting as an effective model of delivering evidence-based practices (EBPs), little scholarship has focused how to scale up and sustain task-shifting in low- and middle-income countries, including how to sustainably supervise lay counselors. Ongoing supervision is critical to ensure EBPs are delivered with fidelity; however, the resources and expertise required to provide ongoing supervision may limit the potential to scale up and sustain task shifting. Opportunities may exist to leverage mobile technology to replace or supplement in-person supervision in low-resource contexts, but contextual variables, such as network connectivity and lay counselor preferences surrounding mobile technology, must be examined and considered when designing and implementing mobile technology supervision.Methods: This study builds from an existing randomized trial in Kenya, wherein teachers and community health volunteers have been trained to provide trauma-focused cognitive behavioral therapy as lay counselors. The study will use an iterative and mixed methods approach, with qualitative interviews and a Human-Centered Design (HCD) workshop informing a non-randomized pilot trial. Semi-structured interviews will be conducted with lay counselors and supervisors to understand how mobile technology is currently being used for supervision and determine the barriers and facilitators to mobile technology supervision. Data from these interviews will inform an HCD workshop, where lay counselors and supervisors “re-design” supervision to most effectively leverage mobile technology. Workshop participants will also participate in focus groups to gather perceptions on the use of HCD techniques. The final outcome of the workshop will be a set of refined workflows, which will be tested in a mixed method, nonrandomized pilot with newly trained lay counselors and existing supervisors. The pilot trial will evaluate the acceptability, feasibility, and usability of mobile technology supervision through self-report questionnaires as well as perceptions of effectiveness through qualitative interviews with a subset of lay counselors and all supervisors.Discussion: This study will provide a launching point for future research on supervision and methods to engage stakeholders to design and tailor interventions and implementation supports to fit low-resourced contexts.

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Children Learning About Second-hand Smoke (CLASS II): a mixed methods process evaluation of a school-based intervention

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00853-9 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Cath Jackson ◽

Rumana Huque ◽

Farid Ahmed ◽

Shammi Nasreen ◽

Sarwat Shah ◽

...

Keyword(s):

Mixed Methods ◽

Process Evaluation ◽

Qualitative Interviews ◽

Pilot Trial ◽

Scale Up ◽

Second Hand Smoke ◽

Framework Analysis ◽

Second Hand Smoke Exposure ◽

Fidelity Assessment ◽

School Day

Abstract Background Children are vulnerable to the effects of second-hand smoke exposure. Creating smoke-free homes is an effective strategy to limit exposure. We developed a smoke-free intervention (SFI) using children as a catalyst for change and teaching skills to negotiate a smoke-free home. In this paper, we present the process evaluation conducted within a pilot trial. Methods This was a mixed-methods study comprising qualitative interviews and quantitative fidelity assessment of SFI delivery. Interviews in the six intervention schools were conducted with six headteachers and 12 teachers. These explored experiences of delivering the SFI, perceived impact, barriers and facilitators to success, and ideas for improvement and for scaling up. The data were analysed using framework analysis. Delivery of the SFI was observed and fidelity scores calculated. Results The SFI was acceptable to headteachers and teachers. Fidelity scores ranged from 27/40 to 37/40. Didactic components were more fully implemented than interactive components. Time to complete the sessions, timing in the school day and school calendar were key challenges. Embedding the SFI into the curriculum was a potential solution. Conclusions These findings provide useful information to finalise the content and delivery and inform the scale-up of the SFI for our definitive trial, which is now underway. Trial registration ISRCTN68690577

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Children Learning About Second-hand Smoke (CLASS II): a mixed methods process evaluation of a school-based intervention

10.21203/rs.2.24626/v1 ◽

2020 ◽

Author(s):

Cath Jackson ◽

Rumana Huque ◽

Farid Ahmed ◽

Shammi Nasreen ◽

Sarwat Shah ◽

...

Keyword(s):

Mixed Methods ◽

Process Evaluation ◽

Qualitative Interviews ◽

Pilot Trial ◽

Scale Up ◽

Second Hand Smoke ◽

Framework Analysis ◽

Second Hand Smoke Exposure ◽

Fidelity Assessment ◽

School Day

Abstract Background Children are vulnerable to the effects of second-hand smoke exposure. Creating smoke-free homes is an effective strategy to limit exposure. We developed a smoke free intervention (SFI) to use children as a catalyst for change and teach skills to negotiate a smoke-free home. In this paper we present the process evaluation conducted within a pilot trial. Methods This was a mixed-methods study comprising qualitative interviews and quantitative fidelity assessment of SFI delivery. Interviews in the six intervention schools were conducted with six headteachers and 12 teachers. These explored experiences of delivering the SFI, perceived impact, barriers and facilitators to success, ideas for improvement and for scaling up. The data were analysed using framework analysis. Delivery of the SFI was observed and fidelity scores calculated. Results The SFI was acceptable to headteachers and teachers. It was generally well delivered, with teachers adapting some components for their students. Time to complete the sessions, timing in the school day and school calendar were key challenges. Embedding the SFI into the curriculum was a potential solution. Conclusions These findings provide useful information to finalise the content, delivery, and to inform the scale-up of the SFI for our definitive trial, which is now underway.

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‘Oh, she is just a nurse’ Re-imagining the role of the nursing workforce in Uganda after a decade of ART scale-up (2004-2014)

10.21203/rs.3.rs-15525/v1 ◽

2020 ◽

Author(s):

Henry Zakumumpa

Keyword(s):

Mixed Methods ◽

Disease Management ◽

Scale Up ◽

Task Shifting ◽

Health Facilities ◽

Hiv Care ◽

Scope Of Practice ◽

Nursing Workforce ◽

Hiv Disease

Abstract Background The expanding roles and increasing importance of the nursing workforce in health services delivery in resource-limited settings is not adequately documented and sufficiently recognized in the current literature. Drawing upon the theme of 2020 as the international year of the nurse and midwife, we set out to describe how the role of nurses had expanded tremendously in health facilities in Uganda during the era of anti-retroviral therapy (ART) scale-up between 2004 and 2014.Methods A mixed-methods study was conducted in two phases. Phase One entailed a cross-sectional health facility survey (n=195) to assess the extent to which human resource management strategies (such as task shifting) were common. Phase Two entailed qualitative case-studies of 16 (of the 195) health facilities for an in-depth understanding of the strategies adopted (e.g. nurse-centred HIV care). We adopted a qualitatively-led mixed methods approach whereby core thematic analyses were supported by descriptive statistics.Results We found that nurses were the most represented cadre of health workers involved in the overall leadership of HIV clinics across Uganda. Most of nurse-led HIV clinics were based in rural settings although this trend was fairly even across all settings (rural/urban/peri-urban). A number of health facilities in our sample (n=36) deliberately adopted nurse-led HIV care models. Nurses were empowered to be multi-skilled with a wide range of competencies across the HIV care continuum right from HIV testing to mainstream clinical HIV disease management. In several facilities, nursing cadre were the backbone of ART service delivery. A select number of facilities devised differentiated models of task shifting from physicians to doctors to nurses in which the latter handled patients who were stable on ART.Conclusion Overall, our study reveals a wide expansion in the scope-of-practice of nurses during the initial ART scale-up phase in Uganda. Nurses were thrust in roles of HIV disease management that were traditionally the preserve of medical doctors. Our study underscores the importance of reforming regulatory frameworks governing nursing workforce scope of practice in Uganda such as the need for evolving a policy on task shifting which is currently lacking in Uganda.

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Characteristics and Experiences of Parents of Children with Learning and Attention Disabilities and Autism Spectrum Disorder: A Mixed Methods Study

The Family Journal ◽

10.1177/10664807211052304 ◽

2021 ◽

pp. 106648072110523

Author(s):

Emma Chad-Friedman ◽

Karen A. Kuhlthau ◽

Rachel A. Millstein ◽

Giselle K. Perez ◽

Christina M. Luberto ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Mixed Methods ◽

Pilot Trial ◽

Autism Spectrum ◽

Stress And Coping ◽

Spectrum Disorder ◽

Self Report ◽

Management Interventions ◽

Children With Asd ◽

And Coping

Parents of children with learning and attention disorders (LAD) and autism spectrum disorder (ASD) experience chronic parenting stress due to the challenges in raising a child with special needs. We used a mixed methods design to examine characteristics and experiences of stress and coping among parents of children with LAD and ASD. We conducted 20 semi-structured focus group interviews with parents of children with LAD ( n = 11) and ASD ( n = 9) and administered a battery of self-report measures of stress and coping to parents of LAD ( n = 53) and ASD ( n = 51) enrolled in a pilot trial. Qualitative findings showed that parents of children with LAD and ASD largely experienced similar sources of stress, but with different intensities due to their children's different difficulties. Quantitative findings reflected high levels of distress among parents of children with LAD and ASD, with parents of children with ASD demonstrating higher distress and poorer overall sleep quality. Stressors experienced by parents of children with ASD arose from more overt challenges associated with having a child with more visible challenges. Parents of children with LAD experienced more subtle challenges of having a child who is less overtly impaired. Findings will aid in the development of targeted stress management interventions.

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Feasibility and acceptability of an enhanced cognitive behavioural therapy programme for parent–child dyads with anxiety disorders: a mixed-methods pilot trial protocol

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00846-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Samantha Galea ◽

Chloe A. Salvaris ◽

Marie B. H. Yap ◽

Peter J. Norton ◽

Katherine A. Lawrence

Keyword(s):

Mixed Methods ◽

Anxiety Disorders ◽

Cognitive Behavioural Therapy ◽

Controlled Trial ◽

Pilot Trial ◽

Behavioural Therapy ◽

Self Report ◽

Trial Registration ◽

Cognitive Behavioural ◽

Parent Child

Abstract Background Cognitive behavioural therapy (CBT) is the most widely recognised and efficacious psychological therapy for the treatment of anxiety disorders in children and adults. However, suboptimal remission rates indicate room for improvement in treatments, particularly when both children and their parents have anxiety disorders. Bidirectional transmission and maintenance of anxiety within parent–child dyads could be better targeted by CBT, to improve treatment outcomes for children and parents with anxiety disorders. This study aimed to develop and evaluate the feasibility and acceptability of a concurrent parent–child enhanced CBT intervention that targets the individual’s anxiety disorder(s), as well as the bidirectional factors that influence and maintain anxiety in the dyad. Methods Feasibility and acceptability of the proposed CBT protocol will be evaluated in an open-label pilot trial of the intervention utilising qualitative and quantitative data collection. Ten parent–child dyad participants (n = 20) with anxiety disorders will be recruited for the proposed intervention. The intervention is based on an empirically supported 10-week CBT programme for anxiety disorders in adults, adapted to be delivered to parent–child dyads concurrently, and to target anxious modelling and overprotective behaviours through joint observational exposures. Intervention feasibility will be explored by pre-post symptom change on a range of clinician- and self-report measures to determine preliminary indications of participants’ intervention response and effect size calculations to estimate sample size for a future definitive randomised controlled trial (RCT). Additional feasibility measures will include recruitment rates, completion rates, and adherence to programme requirements. To explore participant acceptability of the intervention, qualitative interviews will be conducted with five parent–child dyads who complete the intervention (n = 10), along with five parent–child dyads with anxiety symptoms who express interest in the intervention (n = 10). Acceptability measures will include prospective and retrospective quantitative self-report and qualitative interview data. Discussion This pilot trial will utilise a mixed-methods design to determine the feasibility and acceptability of delivering an enhanced CBT intervention for the concurrent treatment of parent–child dyads with anxiety disorders. The results of this trial will inform the development and implementation of a future definitive randomised clinical trial to evaluate intervention efficacy. Trial registration Australian and New Zealand Clinical Trials Registry, ANZCTR1261900033410. Prospectively registered: pre-results. Registered 04 March 2019.

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‘She Can’t Support Me Because She’s so Old’: A Mixed-Methods Study of Support Experiences and Needs in Adult Child–Parent Dyads at the End of Life

OMEGA - Journal of Death and Dying ◽

10.1177/00302228211008748 ◽

2021 ◽

pp. 003022282110087

Author(s):

Franziska A. Herbst ◽

Laura Gawinski ◽

Nils Schneider ◽

Stephanie Stiel

Keyword(s):

Mixed Methods ◽

End Of Life ◽

Family Caregivers ◽

Adult Children ◽

Qualitative Interviews ◽

Terminally Ill ◽

Adult Child ◽

Self Report ◽

Children And Parents ◽

Parent Caregivers

Little is known about support experiences and needs in the dyads of (1) terminally ill adult children and their parent caregivers and (2) terminally ill parents and their adult child caregivers. The current study aimed at investigating the experiences and needs of adult children and parents in end of life situations regarding their provision and receipt of support. The study employed a convergent parallel mixed-methods design, combining explorative qualitative interviews with the quantitative self-report Berlin Social Support Scales. Sixty-five patients (dyad 1: 19; dyad 2: 46) and 42 family caregivers (dyad 1: 13; dyad 2: 29) participated in the study (02/2018–11/2019). Results show that ill adult children felt less (well) supported than ill parents. Parent caregivers were often limited in the support they could provide, due to their age and health conditions. Hypotheses were deduced from patients’ and family caregivers’ notions to inform dyad-specific recommendations for support interventions.

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Determining Emotional Tone and Verbal Behavior in Patients With Tinnitus and Hyperacusis: An Exploratory Mixed-Methods Study

American Journal of Audiology ◽

10.1044/2019_aja-18-0136 ◽

2019 ◽

Vol 28 (3) ◽

pp. 660-672

Author(s):

Suzanne H. Kimball ◽

Toby Hamilton ◽

Erin Benear ◽

Jonathan Baldwin

Keyword(s):

Mixed Methods ◽

Verbal Behavior ◽

Coping Strategies ◽

Mixed Methods Study ◽

Self Report ◽

Anxiety And Depression ◽

Negative Consequences ◽

Emotional Tone ◽

Explanatory Mixed Methods ◽

Quantitative Results

Purpose The purpose of this study was to evaluate the emotional tone and verbal behavior of social media users who self-identified as having tinnitus and/or hyperacusis that caused self-described negative consequences on daily life or health. Research Design and Method An explanatory mixed-methods design was utilized. Two hundred “initial” and 200 “reply” Facebook posts were collected from members of a tinnitus group and a hyperacusis group. Data were analyzed via the LIWC 2015 software program and compared to typical bloggers. As this was an explanatory mixed-methods study, we used qualitative thematic analyses to explain, interpret, and illustrate the quantitative results. Results Overall, quantitative results indicated lower overall emotional tone for all categories (tinnitus and hyperacusis, initial and reply), which was mostly influenced by higher negative emotion. Higher levels of authenticity or truth were found in the hyperacusis sample but not in the tinnitus sample. Lower levels of clout (social standing) were indicated in all groups, and a lower level of analytical thinking style (concepts and complex categories rather than narratives) was found in the hyperacusis sample. Additional analysis of the language indicated higher levels of sadness and anxiety in all groups and lower levels of anger, particularly for initial replies. These data support prior findings indicating higher levels of anxiety and depression in this patient population based on the actual words in blog posts and not from self-report questionnaires. Qualitative results identified 3 major themes from both the tinnitus and hyperacusis texts: suffering, negative emotional tone, and coping strategies. Conclusions Results from this study suggest support for the predominant clinical view that patients with tinnitus and hyperacusis have higher levels of anxiety and depression than the general population. The extent of the suffering described and patterns of coping strategies suggest clinical practice patterns and the need for research in implementing improved practice plans.

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Application of the Non-adoption, Abandonment, Scale-up, Spread and, Sustainability (NASSS) Framework to evaluate the role of technology in the Pathways to Comorbidity Care (PCC) implementation project to improve management of comorbid substance use and mental disorders

10.31234/osf.io/t9rs4 ◽

2020 ◽

Author(s):

MariaGabriela Uribe Guajardo ◽

Andrew James Baillie ◽

Eva Louie ◽

Vicki Giannopoulos ◽

Katie Wood ◽

...

Keyword(s):

Substance Use ◽

Clinical Supervision ◽

Mental Health Problems ◽

Scale Up ◽

Structured Interview ◽

Barriers And Facilitators ◽

Self Report ◽

Evidence Based ◽

Face To Face ◽

Drug And Alcohol

Abstract (250 words)In substance use treatment settings, there is a high prevalence of comorbid mental health problems. Yet an integrated approach for managing comorbidity, implementation of evidence-based intervention in drug and alcohol settings remains problematic. Technology can help the adoption of evidence-based practice and successfully implement effective treatment health care pathways. This study sought to examine aspects of electronic resources utilisation (barriers and facilitators) by clinicians participating in the PCC training. MethodA self-report questionnaire and a semi-structured interview was designed to measure overall satisfaction with the PCC portal and e-resources available throughout the 9-month intervention for participating clinicians. An adapted version of the ‘Non-adoption, Abandonment, Scale-up, Spread and, Sustainability’ (NASSS) framework was used to facilitate discussion in regards to the study findings. ResultsA total of 20 clinicians from drug and alcohol services responded to all the measures. Facilitators of portal use included: i. clinician acceptance of the PCC portal; ii. guidance from the clinical supervisor or clinical champion that encouraged the use of e-resources. Some of the barriers included: i. complexity of the illness (condition), ii. clinicians’ preference (adopter system) for face-to-face resources and training modes (e.g. clinical supervision, clinical champion workshops), and iii. lack of face-to-face training on how to use the portal (technology and organisation).ConclusionBased on the NASSS framework, we were able to identify several barriers and facilitators including such as the complexity of the illness, lack of face-to-face training and clinician preference for training mediums. Recommendations include ongoing consultation of clinicians to assist in the development of tailored e-health resources and offering in-house training on how to operate and effectively utilise these resources.

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Inducing moral elevation in veterans with PTSD: An experimental investigation using a mixed methods approach

Journal of Experimental Psychopathology ◽

10.1177/2043808720982415 ◽

2021 ◽

Vol 12 (1) ◽

pp. 204380872098241

Author(s):

Adam P. McGuire ◽

Joseph Mignogna

Keyword(s):

Mixed Methods ◽

State Level ◽

Self Report ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Trauma Narrative ◽

Study Task ◽

Level Elevation ◽

Moral Elevation ◽

Psychosocial Benefits

Moral elevation is a positive emotion described as feeling inspired by others’ virtuous actions. Elevation has several psychosocial benefits, some of which may be relevant to trauma-related distress; however, past studies have primarily examined elevation in nonclinical, civilian populations or in naturalistic studies. This experimental study used mixed methods to assess if veterans with post-traumatic stress disorder (PTSD) experience elevation when exposed to elevation stimuli in a controlled setting. Participants included 47 veterans with significant PTSD symptoms. Following baseline measures and a written trauma narrative, veterans were randomized to an elevation or amusement condition where they viewed two videos intended to elicit the condition emotion. Veterans also provided a written journal response describing their reaction to the videos. Self-report measures were administered after each study task to assess state-level elevation and amusement. Veterans randomized to the elevation condition reported significantly higher levels of elevation after videos compared to veterans in the amusement condition. Qualitative results offered further support for differences between groups and identified unique themes related to the experience of elevation. Overall, findings indicate it is possible to induce elevation in veterans with significant PTSD symptoms. Additionally, qualitative results highlight specific benefits of elevation and potential targets for treatment integration and future exploration.

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