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.

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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

Implementation Science Communications ◽

10.1186/s43058-020-00102-9 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Noah S. Triplett ◽

Sean Munson ◽

Anne Mbwayo ◽

Teresia Mutavi ◽

Bryan J. Weiner ◽

...

Keyword(s):

Mixed Methods ◽

Mobile Technology ◽

Qualitative Interviews ◽

Pilot Trial ◽

Scale Up ◽

Task Shifting ◽

Self Report ◽

Human Centered Design ◽

Lay Counselors ◽

Link Type

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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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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Reducing Sedentary Time for Obese Older Adults: Protocol for a Randomized Controlled Trial (Preprint)

10.2196/preprints.8883 ◽

2017 ◽

Author(s):

Dori E Rosenberg ◽

Amy K Lee ◽

Melissa Anderson ◽

Anne Renz ◽

Theresa E Matson ◽

...

Keyword(s):

Older Adults ◽

Behavioral Interventions ◽

Sedentary Time ◽

Controlled Trial ◽

Pilot Trial ◽

Self Report ◽

Sitting Time ◽

Future Research ◽

Innovative Strategy ◽

Novel Approaches

BACKGROUND Older adults have high rates of obesity and are prone to chronic health conditions. These conditions are in part due to high rates of sedentary time (ST). As such, reducing ST could be an innovative strategy for improving health outcomes among obese older adults. To test this theory, we developed a novel, technology-enhanced intervention to reduce sitting time (I-STAND) and pilot tested it to assess the feasibility, acceptability, and preliminary effects of the intervention on ST and biometric outcomes. OBJECTIVE The current paper aims to describe the rationale, design, and methods of the I-STAND sitting reduction pilot trial. METHODS Older adults with obesity (n=60) were recruited from a large health care system and randomized to receive I-STAND or a healthy living intervention. I-STAND combined personal coaching with a technology-enhanced intervention (Jawbone UP band) to cue breaks from sitting. Participants completed self-report and biometric assessments at baseline and 3 months. Additional qualitative results were collected from a subset of I-STAND participants (n=22) to further inform the feasibility and acceptability of the interventions. The primary outcome was total hours of daily sitting time measured by the activPAL device. Secondary outcomes included sit-to-stand transitions, bouts of sitting longer than 30 minutes, physical function, blood pressure, fasting glucose, cholesterol, and depressive symptoms. RESULTS Study enrollment has ended and data processing is underway. CONCLUSIONS Data from randomized trials on sitting reduction are needed to inform novel approaches to health promotion among older adults with obesity. Our trial will help fill this gap. The methods used in our study can guide future research on using technology-based devices to assess or prompt sedentary behavior reduction, or those interested in behavioral interventions targeting obese older adults with novel approaches CLINICALTRIAL ClinicalTrials.gov: NCT02692560; https://clinicaltrials.gov/ct2/show/NCT02692560 (Archived by WebCite at http://www.webcitation.org/6wppLTWAl)

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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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Students’ Motivation for Sport Activity and Participation in University Sports: A Mixed-Methods Study

BioMed Research International ◽

10.1155/2018/9524861 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Katharina Diehl ◽

Anna Katharina Fuchs ◽

Katharina Rathmann ◽

Jennifer Hilger-Kolb

Keyword(s):

Physical Activity ◽

Mixed Methods ◽

Sedentary Behavior ◽

Online Survey ◽

Qualitative Interviews ◽

Sport Activity ◽

Future Research ◽

Future Health ◽

Five Factors ◽

Quantitative Results

Background. Physical activity among students is essential for complimenting sedentary behavior and for individuals’ future health. This study investigates reasons for sport engagement among students and addresses the utilization of university sports programs (USP) by employing a mixed-methods approach. Methods. The NuPhA-Study consists of a quantitative online survey (n=689) followed by qualitative interviews (n=20). In the survey, we assessed reasons for sport activity using a 24-item battery and USP utilization. Quantitative results were further explored using qualitative data to check for completeness of the predefined items (content validity) and to identify opportunities to improve participating in USP. Results. A factor analysis grouped the 24 items into five factors (life balance/fitness/body image/contact with others/fun). Our qualitative study explained these in more detail and revealed missing aspects. 47.6% of students participated in USP. Potential improvements for USP include program maintenance during the semester break and temporal harmonization with the classes. Discussion. The qualitative component identified additional reasons for sport activity that were not addressed by the item battery, which provides critical implications for developing item batteries for future research. Our results may help to generate a more target-group-oriented approach to increase physical activity among students, which will reduce sedentary behavior and future disease burden.

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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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Mood, Activity Participation, and Leisure Engagement Satisfaction (MAPLES): A randomised controlled feasibility study for low mood in acquired brain injury

10.21203/rs.2.23122/v1 ◽

2020 ◽

Author(s):

Andrea Kusec ◽

Fionnuala C. Murphy ◽

Polly V. Peers ◽

Cara Lawrence ◽

Emma Cameron ◽

...

Keyword(s):

Brain Injury ◽

Positive Reinforcement ◽

Pilot Trial ◽

Acquired Brain Injury ◽

Self Report ◽

Future Research ◽

Post Intervention ◽

Activity Engagement ◽

Low Mood ◽

Activity Planning

Abstract Background: Acquired brain injury (ABI) affects approximately 79.3 million individuals annually and is linked with elevated rates of depression and low mood. Existing methods for treating depression in ABI have shown mixed efficacy. Behavioural Activation (BA) is a potentially promising intervention. Its premise is that individuals with low mood avoid planning and engaging in activities due to low expectations of a positive outcome. Consequently, their exposure to positive reinforcement is reduced, exacerbating low mood. BA aims to break this cycle by encouraging activity planning and engagement. It is unknown whether cognitive demands of traditional BA may undermine efficacy in ABI. Here we assess the feasibility and acceptability of two groups designed to increase activity engagement. In the Activity Planning Group (traditional BA) the importance of meaningful and positive activity will be discussed and participants encouraged to plan/engage in activities in everyday life. The Activity Engagement Group (experiential BA) instead focuses on engagement in positive experiences (crafts, games, discussion) within the group. The primary aims are to evaluate the feasibility and acceptability of the two groups in ABI. A secondary aim is to explore relative efficacy of the groups compared to an equivalent period of waitlist controls. Method: This study outlines a parallel-arm feasibility pilot trial for individuals with low mood and ABI that compares a traditional vs experiential BA group vs. waitlist controls. Adults (>18 years) will be recruited from local ABI services and randomised to condition. Feasibility and acceptability will be assessed via recruitment, retention, attendance, and participant feedback. Groups will be compared (pre- and post-intervention and 1 month follow-up) by assessing self-reported activity engagement. Secondary outcomes include self-report measures of depression, anxiety, post-traumatic distress related to the ABI, motivation, participation, and sense of control over one’s life.Ethics and Dissemination: The trial has been approved by the Health Research Authority of the NHS in the UK (East of England – Cambridge Central, REF: 18/EE/0305). Results will inform future research on interventions for mood in ABI and be disseminated broadly via peer-reviewed journals, conference presentations, and social media.

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