Human-centered implementation research: a new approach to develop and evaluate implementation strategies for strengthening referral networks for hypertension in western Kenya

Background Human-centered design (HCD) is an increasingly recognized approach for engaging stakeholders and developing contextually appropriate health interventions. As a component of the ongoing STRENGTHS study (Strengthening Referral Networks for Management of Hypertension Across the Health System), we report on the process and outcomes of utilizing HCD to develop the implementation strategy prior to a cluster-randomized controlled trial. Methods We organized a design team of 15 local stakeholders to participate in an HCD process to develop implementation strategies. We tested prototypes for acceptability, appropriateness, and feasibility through focus group discussions (FGDs) with various community stakeholder groups and a pilot study among patients with hypertension. FGD transcripts underwent content analysis, and pilot study data were analyzed for referral completion and reported barriers to referral. Based on this community feedback, the design team iteratively updated the implementation strategy. During each round of updates, the design team reflected on their experience through FGDs and a Likert-scale survey. Results The design team developed an implementation strategy consisting of a combined peer navigator and a health information technology (HIT) package. Overall, community participants felt that the strategy was acceptable, appropriate, and feasible. During the pilot study, 93% of referrals were completed. FGD participants felt that the implementation strategy facilitated referral completion through active peer engagement; enhanced communication between clinicians, patients, and health administrators; and integrated referral data into clinical records. Challenges included referral barriers that were not directly addressed by the strategy (e.g. transportation costs) and implementation of the HIT package across multiple health record systems. The design team reflected that all members contributed significantly to the design process, but emphasized the need for more transparency in how input from study investigators was incorporated into design team discussions. Conclusions The adaptive process of co-creation, prototyping, community feedback, and iterative redesign aligned our implementation strategy with community stakeholder priorities. We propose a new framework of human-centered implementation research that promotes collaboration between community stakeholders, study investigators, and the design team to develop, implement, and evaluate HCD products for implementation research. Our experience provides a feasible and replicable approach for implementation research in other settings. Trial registration Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015,

Community Stakeholder-Driven Technology Solutions Towards Rural Health Equity: A Concept Mapping Study

Background Promoting inclusive health and social care for rural populations requires new community-focused innovations, technological infrastructure, creative design thinking, and multi-stakeholder collaboration. Technology holds great potential for promoting health equity for rural populations, who have more chronic illnesses than their urban counterparts but less access to services. Yet, more participatory research approaches are needed to gather community-driven health technology solutions. The purpose of this research was to collaboratively identify and prioritize action strategies for using technology to promote rural health equity through community stakeholder engagement. Methods Concept mapping, a quantitative statistical technique, embedded within a qualitative approach, was used to surface and synthesize technological solutions towards rural health equity from community stakeholders in three steps: 1. idea generation; 2. sorting and rating feasibility/importance; and 3. group interpretation. Purposeful recruitment strategies were used to recruit key stakeholders and organizational representatives from targeted rural communities. Results Overall, 34 rural community stakeholders participated in the concept mapping process. In Step 1, 84 ideas were generated that were reduced to a pool of 30. Multi-dimensional scaling and cluster analysis resulted in a 6-cluster map representing how technological solutions can contribute toward rural health equity. The clusters of ideas included technological solutions and applications, but also ideas to make healthcare more accessible regardless of location, training and support in the use of technology, ensuring digital tools are simplified for ease of use, technologies to support collaboration among healthcare professionals, and ideas for overcoming challenges to data sharing across health systems/networks. Each cluster included ideas and priority areas that were rated as equally important and feasible. Key themes included organizational and individual level solutions, and the development of new technologies while connecting patients to these technologies. Conclusions The concept mapping exercise enabled rural community stakeholders to co-identify technological solutions toward rural health equity. Overall, the grouping of solutions revealed that technological applications require not only access, but also support and collaboration. Concept mapping is a tool that can engage rural community stakeholders in the identification of technological solutions for promoting rural health equity.

Human-Centered Implementation Research: A New Approach to Develop and Evaluate Implementation Strategies for Strengthening Referral Networks for Hypertension in western Kenya

BackgroundHuman-centered design (HCD) is an increasingly recognized approach for engaging stakeholders and developing contextually appropriate health interventions. As a component of the ongoing STRENGTHS study (Strengthening Referral Networks for Management of Hypertension Across the Health System), we report on the process and outcomes of utilizing HCD to develop the implementation strategy prior to a cluster-randomized controlled trial.MethodsWe organized a design team of 15 local stakeholders to participate in an HCD process to develop implementation strategies. We tested prototypes for acceptability, appropriateness, and feasibility through focus group discussions (FGDs) with various community stakeholder groups and a pilot study among patients with hypertension. FGD transcripts underwent content analysis, and pilot study data were analyzed for referral completion and reported barriers to referral. Based on this community feedback, the design team iteratively updated the implementation strategy. During each round of updates, the design team reflected on their experience through FGDs and a Likert-scale survey.ResultsThe design team developed an implementation strategy consisting of a combined peer navigator and a health information technology (HIT) package. Overall, community participants felt that the strategy was acceptable, appropriate, and feasible. During the pilot study, 93% of referrals were completed. FGD participants felt that the implementation strategy facilitated referral completion through active peer engagement; enhanced communication between clinicians, patients, and health administrators; and integrated referral data into clinical records. Challenges included referral barriers that were not directly addressed by the strategy (e.g. transportation costs) and implementation of the HIT package across multiple health record systems. The design team reflected that all members contributed significantly to the design process, but emphasized the need for more transparency in how input from study investigators was incorporated into design team discussions.ConclusionsThe adaptive process of co-creation, prototyping, community feedback, and iterative redesign aligned our implementation strategy with community stakeholder priorities. We propose a new framework of human-centered implementation research that promotes collaboration between community stakeholders, study investigators, and the design team to develop, implement, and evaluate HCD products for implementation research. Our experience provides a feasible and replicable approach for implementation research in other settings.Trial registration: Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015, https://clinicaltrials.gov/ct2/show/NCT02501746

Assessment of Trinidad community stakeholder perspectives on the use of yeast interfering RNA-baited ovitraps for biorational control of Aedes mosquitoes

Dengue, Zika, chikungunya and yellow fever viruses continue to be a major public health burden. Aedes mosquitoes, the primary vectors responsible for transmitting these viral pathogens, continue to flourish due to local challenges in vector control management. Yeast interfering RNA-baited larval lethal ovitraps are being developed as a novel biorational control tool for Aedes mosquitoes. This intervention circumvents increasing issues with insecticide resistance and poses no known threat to non-target organisms. In an effort to create public awareness of this alternative vector control strategy, gain stakeholder feedback regarding product design and acceptance of the new intervention, and build capacity for its potential integration into existing mosquito control programs, this investigation pursued community stakeholder engagement activities, which were undertaken in Trinidad and Tobago. Three forms of assessment, including paper surveys, community forums, and household interviews, were used with the goal of evaluating local community stakeholders’ knowledge of mosquitoes, vector control practices, and perceptions of the new technology. These activities facilitated evaluation of the hypothesis that the ovitraps would be broadly accepted by community stakeholders as a means of biorational control for Aedes mosquitoes. A comparison of the types of stakeholder input communicated through use of the three assessment tools highlighted the utility and merit of using each tool for assessing new global health interventions. Most study participants reported a general willingness to purchase an ovitrap on condition that it would be affordable and safe for human health and the environment. Stakeholders provided valuable input on product design, distribution, and operation. A need for educational campaigns that provide a mechanism for educating stakeholders about vector ecology and management was highlighted. The results of the investigation, which are likely applicable to many other Caribbean nations and other countries with heavy arboviral disease burdens, were supportive of supplementation of existing vector control strategies through the use of the yeast RNAi-based ovitraps.

An Evaluation of the Sagarmatha National Park Forestry Project (Snpfp), Khumbu, Nepal: A Community Stakeholder Approach

This study adopts a community stakeholder approach to analyze the stakeholders' perceptions on foreign aid and NGO-driven reforestation programme in an impacted community. The focus of the study, the Sagarmatha National Park Forestry Project (SNPFP), has operated in Khumbu, Nepal for thirty years. The overall performance and impacts of the SNPFP were assessed by interviewing key informants with regard to their experience and perceptions. Qualitative analysis revealed the gap in the involvement of multiple donors and identified how these gaps impacted on quality of foreign aid and NGO-led project. The implications of this study include the recommendation that the immediate stakeholders in a local area are a reliable source of information to measure the value of foreign aid and NGO performance. Furthermore, the future of natural resource conservation and rural development led by foreign aid and NGOs depends on collaboration between the local people, the NGOs, donors, and the government.

An Evaluation of the Sagarmatha National Park Forestry Project (Snpfp), Khumbu, Nepal: A Community Stakeholder Approach

This study adopts a community stakeholder approach to analyze the stakeholders' perceptions on foreign aid and NGO-driven reforestation programme in an impacted community. The focus of the study, the Sagarmatha National Park Forestry Project (SNPFP), has operated in Khumbu, Nepal for thirty years. The overall performance and impacts of the SNPFP were assessed by interviewing key informants with regard to their experience and perceptions. Qualitative analysis revealed the gap in the involvement of multiple donors and identified how these gaps impacted on quality of foreign aid and NGO-led project. The implications of this study include the recommendation that the immediate stakeholders in a local area are a reliable source of information to measure the value of foreign aid and NGO performance. Furthermore, the future of natural resource conservation and rural development led by foreign aid and NGOs depends on collaboration between the local people, the NGOs, donors, and the government.

Uncovering absences and gaps: using Ketso in qualitative research for accessible tourism

Engagement of stakeholders in the research process provides valuable insights around tourism issues yet can be fraught with challenges. Ketso is a toolkit that can help overcome these barriers to facilitate stakeholder inclusion and collaboration. Drawing on a study into accessibility and tourism, this paper provides critical reflections on the potential of Ketso as a qualitative method in bringing together diverse stakeholders for inclusive dialogue around social change. Ketso can develop opportunities for change in the tourism system by making the absences of knowledge and assumptions in the worldviews of powerful tourism stakeholders apparent. Our analysis revealed how Ketso enabled inclusive collaboration to engender both tacit and wider community stakeholder knowledge, building capacity for co-created solutions to make tourism more accessible (barrier-free) for travellers with disabilities.

Human-Centered Implementation Research: A New Approach to Develop and Evaluate Implementation Strategies for Strengthening Referral Networks for Hypertension in western Kenya

BackgroundHuman-centered design (HCD) is an increasingly recognized approach for engaging stakeholders and developing contextually appropriate health interventions. As a component of the ongoing STRENGTHS study (Strengthening Referral Networks for Management of Hypertension Across the Health System), we report on the process and outcomes of utilizing HCD to develop the implementation strategy prior to a cluster-randomized controlled trial.MethodsWe organized a design team of 15 local stakeholders to participate in an HCD process to develop implementation strategies. We tested prototypes for acceptability, appropriateness, and feasibility through focus group discussions (FGDs) with various community stakeholder groups and a pilot study among patients with hypertension. FGD transcripts underwent content analysis, and pilot study data were analyzed for referral completion and reported barriers to referral. Based on this community feedback, the design team iteratively updated the implementation strategy. During each round of updates, the design team reflected on their experience through FGDs and a Likert-scale survey.ResultsThe design team developed an implementation strategy consisting of a combined peer navigator and a health information technology (HIT) package. Overall, community participants felt that the strategy was acceptable, appropriate, and feasible. During the pilot study, 93% of referrals were completed. FGD participants felt that the implementation strategy facilitated referral completion through active peer engagement; enhanced communication between clinicians, patients, and health administrators; and integrated referral data into clinical records. Challenges included referral barriers that were not directly addressed by the strategy (e.g. transportation costs) and implementation of the HIT package across multiple health record systems. The design team reflected that all members contributed significantly to the design process, but emphasized the need for more transparency in how input from study investigators was incorporated into design team discussions.ConclusionsThe adaptive process of co-creation, prototyping, community feedback, and iterative redesign aligned our implementation strategy with community stakeholder priorities. We propose a new framework of human-centered implementation research that promotes collaboration between community stakeholders, study investigators, and the design team to develop, implement, and evaluate HCD products for implementation research. Our experience provides a feasible and replicable approach for implementation research in other settings.Trial registration: Clinicaltrials.gov, NCT02501746, registration date: July 17, 2015, https://clinicaltrials.gov/ct2/show/NCT02501746