Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment

Despite the proliferation of eHealth interventions, such as web portals, for health information dissemination or the use of mobile apps and wearables for health monitoring, research has shown that underserved groups do not benefit proportionately from these eHealth interventions. This is largely because of usability issues and the lack of attention to the broader structural, physical, and psychosocial barriers to technology adoption and use. The objective of this paper is to draw lessons from a decade of experience in designing different user-centered eHealth interventions (eg, web portals and health apps) to inform future work in leveraging technology to address health disparities. We draw these lessons from a series of interventions from the work we have done over 15 years in the Viswanath laboratory at the Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, focusing on three projects that used web portals and health apps targeted toward underserved groups. The projects were the following: Click to Connect, which was a community-based eHealth intervention that aimed to improve internet skills and health literacy among underserved groups by providing home access to high-speed internet, computer, and internet training classes, as well as a dedicated health web portal with ongoing technical support; PLANET MassCONECT, which was a knowledge translation project that built capacity among community-based organizations in Boston, Lawrence, and Worcester in Massachusetts to adopt evidence-based health promotion programs; and Smartphone App for Public Health, which was a mobile health research that facilitated both participatory (eg, surveys) and passive data (eg, geolocations and web-browsing behaviors) collection for the purpose of understanding tobacco message exposure in individuals’ built environment. Through our work, we distilled five key principles for researchers aiming to design eHealth interventions for underserved groups. They are as follows: develop a strategic road map to address communication inequalities (ie, a concrete action plan to identify the barriers faced by underserved groups and customize specific solutions to each of them), engage multiple stakeholders from the beginning for the long haul, design with usability—readability and navigability—in mind, build privacy safeguards into eHealth interventions and communicate privacy–utility tradeoffs in simplicity, and strive for an optimal balance between open science aspirations and protection of underserved groups.

How LAM Sector Can Improve Quality of Life for Underserved Groups via a Whole Person Approach

A Whole Person Approach (WPA) can be used in various parts of LAM (Libraries, Archives, and Museums) sector to provide effective services for underserved groups of society to achieve civic engagement with the communities it serves. WPA is a relatively new theoretical framework in the fields of social science and healthcare. It highlights the necessity and importance of having a holistic view in dealing with different life matters and challenges. This chapter focuses on the special services that LAM sector can offer to facilitate the way towards achieving the goal of enhanced civic engagement, as serving the unserved groups of society is an urgent priority for the sector. Several Creative strategies will be discussed that can be implemented in the current services to make sure the special needs of communities that a sector serves are considered and met. A limitation of this chapter is that it is not a case study, nor is it based on field experiences. It is in fact a critical exploration of the concepts to facilitate in building a theory in an interdisciplinary perspective.

Telepsychology

Telepsychology, until recently, was slow-moving and half-heartedly acknowledged in the mental health profession. There is increasing scholarly discourse on the digital therapeutic space. This shift to a digital paradigm means re-evaluating the profession's identity. This chapter considers telepsychology in relation to social justice. It highlights access for underserved groups and the digital divide that limits a substantial population from accessing online services. It identifies the need to integrate telepsychology in community psychology interventions, a significant framework to challenge systemic inequalities in mental health. It outlines the inadequacy of the profession to support needs of diversity in the field and considers if telehealth is one way to bring a shift in the homogenous identity of the profession. Telepsychology has the potential to amplify adherence to social justice principles; however, this requires evolved responses on individual, institutional, and systemic levels to bring unconventional but substantial changes in training, research, and regulatory guidelines.

Expanding Arizona’s Dementia Capable System

Currently, 5.8 million US adults live with Alzheimer’s disease (ADRD); the number is expected to double by 2050. Arizona will experience the greatest percent increase in ADRD by 2025. This project targeted three underserved groups in order to expand Arizona’s dementia capable system: people living alone with ADRD; people with Down Syndrome or another intellectual/developmental disability (DS/IDD) aging with ADRD and their family caregivers; and people with ADRD and their caregivers in the Latino community. This presentation describes the development and delivery of the project’s educational workshops, case management services, and evidence-based programs. Over 2,220 participants have participated in workshops to date with the largest percentage being case managers, care coordinators, and discharge planners. Evaluations have been extremely positive with 86.1% being “very likely” to recommend the project to others. The presentation concludes with findings and lessons learned regarding the delivery of the project’s evidence-based programs and case management services.

Citywide Inclusive Sanitation Guidance Note: Addressing Gender Equality and Social Inclusion in Urban Sanitation Projects

This guidance note underscores why addressing gender equality and social inclusion (GESI) is fundamental to the success of citywide inclusive sanitation (CWIS) project success. Equity and inclusion is one of the four elements of CWIS. As such, CWIS projects need activities to target specific unserved and underserved groups, including women and children, ethnic minorities, the urban poor, and persons with disabilities. This guidance note is part of a series that aims to share essential knowledge to embed CWIS principles in planning and delivering sanitation services to ADB developing member countries. These learning materials were prepared by ADB’s Water Sector Group and structured along the ADB project processing cycle.

“Lessons Learned” Preventing Recurrent Ischemic Strokes through Secondary Prevention Programs: A Systematic Review

Recurrent ischemic strokes are a cause of significant healthcare burdens globally. Patients with uncontrolled vascular risk factors are more likely to develop recurrent ischemic strokes. This study aims to compile information gained from current secondary prevention programs. A pre-defined literature search strategy was applied to PubMed, SCOPUS, CINAHL, and Google Scholar databases, and studies from 1997 to 2020 were evaluated for quality, study aims, and outcomes. The search produced 1175 articles (1092 after duplicates were removed) and titles were screened; 55 titles were retained for the full-text analysis. Of the remaining studies, 31 were retained for assessment, five demonstrated long-term effectiveness, eight demonstrated short-term effectiveness, and 18 demonstrated no effectiveness. The successful studies utilized a variety of different techniques in the categories of physical fitness, education, and adherence to care plans to reduce the risk of recurrent strokes. The lessons we learned from the current prevention programs included (1) offer tailored care for underserved groups, (2) control blood pressure, (3) provide opportunities for medication dosage titration, (4) establish the care plan prior to discharge, (5) invest in supervised exercise programs, (6) remove barriers to accessing care in low resource settings, and (7) improve the transition of care.

Factors Associated With, and Mitigation Strategies for, Healthcare Disparities Faced by Patients With Headache Disorders

ObjectiveTo review the contemporary issues of healthcare disparities in Headache Medicine with regard to race/ethnicity, socioeconomic status and geography and propose solutions for addressing these disparities.MethodsAn internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in Headache Medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with this group of 16 experts from a range of headache subspecialties.ResultsTaken together, a multitude of factors including racism, socioeconomic status and insurance status and geographical disparities contribute to the inequities that exist within the healthcare system when treating headache disorders. Interventions such as improving public education, advocacy, optimizing telemedicine, engaging in community outreach to educate primary care providers, training providers in cultural sensitivity and competence and implicit bias, addressing health literacy and developing recruitment strategies to increase representation of underserved groups within headache research are proposed as solutions to ameliorate disparities.ConclusionNeurologists have a responsibility to provide and deliver equitable care to all. It is important that disparities in the management of headache disorders are identified and addressed.

Demand for Family Planning Satisfied With Modern Methods in Urban Malawi: CHAID Analysis to Identify Predictors and Women Underserved With Family Planning Services

Introduction: Family planning progress under the SDGs is measured with a novel indicator, demand for family planning satisfied with modern methods (mDFPS), which provides a better indication of modern contraceptive coverage than unmet need and contraceptive prevalence rate. Yet, few studies have examined the predictors of mDFPS and the sub-groups of women with unsatisfied mDFPS in urban Saharan Africa. The objective of this study was to examine the predictors of mDFPS in urban Malawi and to identify the sub-groups of urban women underserved with modern contraceptives.Methods: The study analysed data from the 2015–16 Malawi Demographic and Health survey. The sample was comprised of 2,917 women in urban Malawi who had a demand for family planning services. We used a Chi-square (χ2) Automatic Interaction Detector (CHAID) model to address the study objectives.Results: The results show that the number of living children a woman had was the most significant predictor of mDFPS. Women with one or more children, who were of Chewa, Lomwe, or Tumbuka ethnic origin and who resided in the central region had the highest mDFPS (87%). On the other hand, women with no children, and who were not exposed to FP information on television, had the lowest mDFPS (41%). Among women in union, ethnicity was the best predictor of mDFPS. Ngoni, Yao, and other ethnic minority women in union who were aged 15–19 and 40 years and above and those who were Catholic, SDA/Baptist, or Muslim had the lowest mDFPS (36%).Conclusion: This study demonstrates significant intra-urban disparities in demand for FP satisfied with modern contraceptives in Malawi. There is a need for policymakers and reproductive health practitioners to recognise these disparities and to prioritise the underserved groups identified in this study.

Islamic Finance, Small and Medium Enterprises and Job Creation in Turkey: An Empirical Evidence (2009-2017)

The aim of this paper is to investigate if Islamic finance can solve the funding problem of SMEs and facilitate access to finance for SMEs, and how can these last participate in job creation in Turkey in order to face the problem of unemployment. The paper adopts a Vector Autoregressive model (VAR) based on monthly data (2009-2017). The results revealed that Islamic finance is a golden opportunity and a sufficient alternative financial source for SMEs. In addition, as SMEs can reduce unemployment by contributing to the labor market. This study contributes to the existing literature by presenting a promising financing tool to the prospective borrowers of SMEs (farmers, underserved groups, and small entrepreneurs) which is Islamic financing. This alternative can be an effective tool for both muslim and non-muslim countries in regard that conventional finance is more expensive and SMEs are unable to pay high interest rates. It would also help in establishing low unemployment levels. This paper suggested that Islamic banks and Islamic financial institutions should converge more on the SMEs by providing funding to SMEs which would lead to boosting production and economic development.