McInnes D Keith, Dunlap Shawn, Fix Gemmae M, Foster Marva V, Conti Jennifer, Roncarati Jill S, Hyde Justeen K
Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States.
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States.
Front Digit Health. 2022 Aug 12;4:897288. doi: 10.3389/fdgth.2022.897288. eCollection 2022.
While Veteran homelessness has steadily declined over the last decade, those who continue to be unhoused have complex health and social concerns. Housing instability interferes with access to healthcare, social services, and treatment adherence. Preventing unwanted housing transitions is a public health priority. This study is the first phase of a larger research agenda that aims to test the acceptability and feasibility of smartphone-enabled data collection with veterans experiencing homelessness. In preparation for the development of the smartphone data collection application, we utilized ethnographic methods guided by user-centered design principles to inform survey content, approach to recruitment and enrollment, and design decisions.
We used a case study design, selecting a small sample ( = 10) of veterans representing a range of homelessness experiences based on risk and length of time. Participants were interviewed up to 14 times over a 4-week period, using a combination of qualitative methods. Additionally, 2 focus group discussions were conducted. Interviews were audio-recorded and transcribed. Data were synthesized and triangulated through use of rapid analysis techniques.
All participants had experience using smartphones and all but one owned one at the time of enrollment. Participants described their smartphones as "lifelines" to social network members, healthcare, and social service providers. Social relationships, physical and mental health, substance use, income, and housing environment were identified as being directly and indirectly related to transitions in housing. Over the course of ~30 days of engagement with participants, the research team observed dynamic fluctuations in emotional states, relationships, and utilization of services. These fluctuations could set off a chain of events that were observed to both help participants transition into more stable housing or lead to setbacks and further increase vulnerability and instability. In addition to informing the content of survey questions that will be programmed into the smartphone app, participants also provided a broad range of recommendations for how to approach recruitment and enrollment in the future study and design features that are important to consider for veterans with a range of physical abilities, concerns with trust and privacy, and vulnerability to loss or damage of smartphones.
The ethnographic approach guided by a user-centered design framework provided valuable data to inform our future smartphone data collection effort. Data were critical to understanding aspects of day-to-day life that important to content development, app design, and approach to data collection.
虽然退伍军人无家可归的情况在过去十年中稳步下降，但那些仍然无家可归的人有着复杂的健康和社会问题。住房不稳定会干扰获得医疗保健、社会服务以及坚持治疗。防止不必要的住房变迁是一项公共卫生优先事项。本研究是一个更大研究议程的第一阶段，该议程旨在测试对无家可归退伍军人使用智能手机进行数据收集的可接受性和可行性。在准备开发智能手机数据收集应用程序时，我们采用了以用户为中心的设计原则指导的人种学方法，以确定调查内容、招募和登记方式以及设计决策。
我们采用案例研究设计，根据风险和时长选择了一小群（(n = 10)）代表一系列无家可归经历的退伍军人。在为期4周的时间里，对参与者进行了多达14次访谈，采用了多种定性方法。此外，还进行了2次焦点小组讨论。访谈进行了录音并转录。通过使用快速分析技术对数据进行了综合和三角验证。
所有参与者都有使用智能手机的经验，除一人外，所有人在登记时都拥有一部智能手机。参与者将他们的智能手机描述为与社交网络成员、医疗保健和社会服务提供者联系的“生命线”。社会关系、身心健康、物质使用、收入和住房环境被确定为与住房变迁直接或间接相关。在与参与者接触的约30天时间里，研究团队观察到情绪状态、人际关系和服务利用方面的动态波动。这些波动可能引发一系列事件，观察发现这些事件既有助于参与者过渡到更稳定的住房，也可能导致挫折并进一步增加脆弱性和不稳定性。除了为将编入智能手机应用程序的调查问题内容提供信息外，参与者还就如何在未来研究中进行招募和登记以及对于具有各种身体能力、担心信任和隐私以及容易丢失或损坏智能手机的退伍军人而言重要的设计特征提供了广泛的建议。
以用户为中心的设计框架指导的人种学方法提供了有价值的数据，为我们未来的智能手机数据收集工作提供了信息。这些数据对于理解对内容开发、应用程序设计和数据收集方法至关重要的日常生活方面至关重要。
