Aschbrenner Kelly A, Haines Emily R, Kruse Gina R, Olugbenga Ayotola O, Thomas Annette N, Khan Tanveer, Martinez Stephanie, Emmons Karen M, Bartels Stephen J
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.
Dartmouth Health Merrimack Family Practice, 294 Daniel Webster Highway, Merrimack, NH, 03054, USA.
Implement Sci Commun. 2024 Sep 3;5(1):95. doi: 10.1186/s43058-024-00630-8.
Our research team partnered with primary care and quality improvement staff in Federally Qualified Community Health Centers (CHCs) to develop Partnered and Equity Data-Driven Implementation (PEDDI) to promote equitable implementation of evidence-based interventions. The current study used a human-centered design methodology to evaluate the usability of PEDDI and generate redesign solutions to address usability issues in the context of a cancer screening intervention.
We applied the Cognitive Walkthrough for Implementation Strategies (CWIS), a pragmatic assessment method with steps that include group testing with end users to identify and prioritize usability problems. We conducted three facilitated 60-min CWIS sessions with end users (N = 7) from four CHCs that included scenarios and related tasks for implementing a colorectal cancer (CRC) screening intervention. Participants rated the likelihood of completing each task and identified usability issues and generated ideas for redesign solutions during audio-recorded CWIS sessions. Participants completed a pre-post survey of PEDDI usability. Our research team used consensus coding to synthesize usability problems and redesign solutions from transcribed CWIS sessions.
Usability ratings (scale 0-100: higher scores indicating higher usability) of PEDDI averaged 66.3 (SD = 12.4) prior to the CWIS sessions. Scores averaged 77.8 (SD = 9.1) following the three CWIS sessions improving usability ratings from "marginal acceptability" to "acceptable". Ten usability problems were identified across four PEDDI tasks, comprised of 2-3 types of usability problems per task. CWIS participants suggested redesign solutions that included making data fields for social determinants of health and key background variables for identifying health equity targets mandatory in the electronic health record and using asynchronous communication tools to elicit ideas from staff for adaptations.
Usability ratings indicated PEDDI was in the acceptable range following CWIS sessions. Staff identified usability problems and redesign solutions that provide direction for future improvements in PEDDI. In addition, this study highlights opportunities to use the CWIS methodology to address inequities in the implementation of cancer screening and other clinical innovations in resource-constrained healthcare settings.
我们的研究团队与联邦合格社区健康中心（CHC）的初级保健和质量改进人员合作，开发了伙伴关系与公平数据驱动实施（PEDDI），以促进循证干预措施的公平实施。当前的研究采用了以人为本的设计方法，以评估PEDDI的可用性，并生成重新设计的解决方案，以解决癌症筛查干预背景下的可用性问题。
我们应用了实施策略认知走查法（CWIS），这是一种务实的评估方法，其步骤包括与最终用户进行小组测试，以识别可用性问题并确定其优先级。我们与来自四个CHC的最终用户（N = 7）进行了三次为期60分钟的CWIS会议，其中包括实施结直肠癌（CRC）筛查干预的场景和相关任务。参与者在录音的CWIS会议期间对完成每项任务的可能性进行评分，识别可用性问题，并提出重新设计解决方案的想法。参与者完成了对PEDDI可用性的前后调查。我们的研究团队使用共识编码来综合转录的CWIS会议中的可用性问题和重新设计解决方案。
在CWIS会议之前，PEDDI的可用性评分（范围为0 - 100：分数越高表明可用性越高）平均为66.3（标准差 = 12.4）。在三次CWIS会议之后，分数平均为77.8（标准差 = 9.1），将可用性评分从“勉强可接受”提高到了“可接受”。在PEDDI的四项任务中识别出了10个可用性问题，每项任务包含2 - 3种类型的可用性问题。CWIS参与者提出的重新设计解决方案包括在电子健康记录中使健康的社会决定因素的数据字段和用于识别健康公平目标的关键背景变量成为必填项，并使用异步通信工具从工作人员那里获取关于调整的想法。
可用性评分表明，在CWIS会议之后，PEDDI处于可接受范围内。工作人员识别出了可用性问题和重新设计解决方案，这为PEDDI未来的改进提供了方向。此外，本研究突出了利用CWIS方法来解决资源有限的医疗环境中癌症筛查及其他临床创新实施过程中不平等问题的机会。
