Original Article

Human-Centered Design for a Women’s Health Screening Tool: Participant Experiences

Authors: Bayla Ostrach, MA, PhD

Abstract

Objectives: Screening is a priority in primary care and women’s health, and increasingly used for intimate partner violence. Integrating such routine screening into primary care screening may be challenging for clinicians. Human-centered design (HCD) is a participatory process emphasizing stakeholder input and is used increasingly in health care. A growing body of literature has examined the science of patient and community engagement in health research, yet few qualitative studies investigate how participants recruited to collaborate in designing screening tools perceive HCD processes. This study examined participants’ perceptions of an HCD process used as an engagement tool to inform the development of a women’s health screening tool.

Methods: Qualitative study using data collected from community members and providers and staff recruited through a southern Appalachian medical education center and network of family medicine clinics and in the surrounding community. Using opportunistic and key informant sampling, study participants (some of whom were also intimate partner violence survivors) were part of an earlier HCD process undertaken to redesign a women’s health/primary care screening tool and were invited to be interviewed about their perceptions of and experiences in the HCD process. Interviews were conducted using a semistructured guide. Interviews were audio-recorded, transcribed, hand-coded, and analyzed using modified grounded theory.

Results: All of the participants reported that they valued the opportunity to be part of the HCD process; however, they reported divergent views of the process itself. Some found it easy to engage, whereas others found it confusing or embarrassing. All valued the opportunity to be part of determining the best process for screening, yet concerns were expressed about access to and full participation in the process. Community members reported more concerns; providers and staff reported fewer concerns about their own involvement and participation, although some expressed doubts about community members’ full engagement.

Conclusions: Although a promising option and valuable process, the HCD process was not equally comfortable for or accessible to all participants. Community engagement beyond the clinical team is important for improving practices in health screening and health care, but it must be undertaken thoughtfully.
Posted in: Obstetrics and Gynecology77

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References

1. Bowman JA, Redman S, Dickinson JA, et al. The accuracy of Pap smear utilization self-report: a methodological consideration in cervical screening research. Health Serv Res 1991;26:97–107. 2. MacMillan HL, Wathen CN, Jamieson E, et al. Approaches to screening for intimate partner violence in health care settings: a randomized trial. JAMA 2006;296:530–536. 3. O’Campo P, Kirst M, Tsamis C, et al. Implementing successful intimate partner violence screening programs in health care settings: evidence generated from a realist-informed systematic review. Soc Sci Med 2011;72:855–866. 4. McCormack L, Treiman K, Bann C, et al. Translating medical evidence to promote informed health care decisions. Health Serv Res 2011;46:1200–1223. 5. Foley KA, Shelton J, Richardson E, et al. Primary care women's health screening: a case study of a community engaged human centered design approach to enhancing the screening process. Matern Child Health J 2019;23:1446–1458. 6. Matheson GO, Pacione C, Shultz RK, et al. Leveraging human-centered design in chronic disease prevention. Am J Prev Med 2015;48:472–479. 7. Mullaney T, Pettersson H, Nyholm T, et al. Thinking beyond the cure: a case for human-centered design in cancer care. Int J Design 2012;6:27–39. 8. Vechakul J, Shrimali BP, Sandhu JS. Human-centered design as an approach for place-based innovation in public health: a case study from Oakland, California. Matern Child Health J 2015;19:2552–2559. 9. Erwin K, Martin MA, Flippin T, et al. Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma. J Comp Eff Res 2016;5:17–30. 10. Gilliam ML, Martins SL, Bartlett E, et al. Development and testing of an iOS waiting room “app” for contraceptive counseling in a Title X family planning clinic. Am J Obstet Gynecol 2014;211:481.e1–481.e8. 11. Kia-Keating M, Santacrose DE, Liu SR, et al. Using community-based participatory research and human-centered design to address violence-related health disparities among Latino/a youth. Fam Community Health 2017;40:160–169. 12. Lyu M. When design encounters anthropology: study on approaches where anthropology gets involved in design. In: Advances in Affective and Pleasurable Design: Proceedings of the AHFE 2016 International Conference on Affective and Pleasurable Design, July 27–31, 2016, Walt Disney World, Florida, USA, Chung WJ, Shin CS, eds. New York: Springer; 2017: pp. 305–313. 13. Chang JC, Decker M, Moracco KE, et al. What happens when health care providers ask about intimate partner violence? A description of consequences from the perspectives of female survivors. J Am Med Womens Assoc (1972) 2003;58:76–81. 14. Miller E, McCaw B, Humphreys BL, et al. Integrating intimate partner violence assessment and intervention into healthcare in the United States: a systems approach. J Womens Health (Larchmt) 2015;24:92–99. 15. Kuzawa CW, Gravlee CC. Beyond genetic race: biocultural insights into the causes of racial health disparities. In: New Directions in Biocultural Anthropology, Zuckerman MK, Martin DL, eds. New York: John Wiley & Sons; 2016: chap. 5. 16. Charmaz K. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis, 1st ed. Thousand Oaks, CA: SAGE Publications; 2006. 17. Bryant A, Charmaz K. The SAGE Handbook of Grounded Theory. Thousand Oaks, CA: SAGE Publishing; 2010. 18. blinded for review.