Diversified caregiver input to upgrade the Young Children's Participation and Environment Measure for equitable pediatric re/habilitation practice.
Diversified caregiver input to upgrade the Young Children's Participation and Environment Measure for equitable pediatric re/habilitation practice.
复制标题
DOI：
10.1186/s41687-023-00627-2
复制
发表时间：
2023-08-28
影响因子：
2.7
通讯作者：
中科院分区：
文献类型：
--
作者：
儿科康复/康复的从业者和家庭经历可能是不公平的。幼儿参与和环境测量 (YC-PEM) 是一种循证且有前景的电子患者报告结果测量，专为护理人员设计并用于研究和实践。本研究考察了历史上少数群体护理人员对修订后的 YC-PEM 内容修改的反应，以及他们对提高公平服务设计范围所需的核心智能虚拟代理功能的看法。护理人员是在常规早期干预 (EI) 服务访视期间招募的，并满足五个纳入标准：(1) 年龄在 18 岁以上； (2) 被认定为参加 EI 服务 3 个月以上的 0-3 岁儿童的父母或法定监护人； (3) 英语读、写、说； (4) 有互联网和电话接入； (5) 被确定为黑人、非西班牙裔儿童的父母或法定监护人或被公共保险。三轮半结构化认知访谈（每轮 55-90 分钟）使用视频会议来收集护理人员在完成 YC-PEM 时对选择内容修改的反应的反馈，以及他们对核心智能虚拟代理功能的想法。访谈内容逐字记录，交叉检查准确性，并由多名工作人员分三轮对内容进行演绎和归纳分析。来自单一城市 EI 辖区且收入水平不同 (Mdn = $15,001–20,000) 的 8 名黑人、非西班牙裔护理人员被纳入其中，其中儿童 (M = 21.2 个月，SD = 7.73) 被纳入 EI。护理人员提出了三种提高理解力的方法（澄清项目措辞、删除或简化术语、添加项目示例）。环境项目编辑促使护理人员分享他们如何联系和应对影响参与的人际和机构歧视的经历。护理人员描述了虚拟代理的三个核心功能，以加强 YC-PEM 导航（大声朗读问题、视觉和口头提示、更多示例和/或定义）。结果表明，YC-PEM 内容将通过四种方式进行修改，以加强提供者如何筛选未满足的参与需求和决定因素，以设计响应家庭优先事项的儿科康复/康复服务。结果还激发了以用户为中心设计智能虚拟代理的需求，以加强用户导航，然后再对其实施进行基于社区的务实试验，以实现公平实践。在线版本包含可在 10.1186/s41687-023-00627-2 获取的补充材料。
Practitioner and family experiences of pediatric re/habilitation can be inequitable. The Young Children’s Participation and Environment Measure (YC-PEM) is an evidence-based and promising electronic patient-reported outcome measure that was designed with and for caregivers for research and practice. This study examined historically minoritized caregivers’ responses to revised YC-PEM content modifications and their perspectives on core intelligent virtual agent functionality needed to improve its reach for equitable service design. Caregivers were recruited during a routine early intervention (EI) service visit and met five inclusion criteria: (1) were 18 + years old; (2) identified as the parent or legal guardian of a child 0–3 years old enrolled in EI services for 3 + months; (3) read, wrote, and spoke English; (4) had Internet and telephone access; and (5) identified as a parent or legal guardian of a Black, non-Hispanic child or as publicly insured. Three rounds of semi-structured cognitive interviews (55–90 min each) used videoconferencing to gather caregiver feedback on their responses to select content modifications while completing YC-PEM, and their ideas for core intelligent virtual agent functionality. Interviews were transcribed verbatim, cross-checked for accuracy, and deductively and inductively content analyzed by multiple staff in three rounds. Eight Black, non-Hispanic caregivers from a single urban EI catchment and with diverse income levels (Mdn = $15,001–20,000) were enrolled, with children (M = 21.2 months, SD = 7.73) enrolled in EI. Caregivers proposed three ways to improve comprehension (clarify item wording, remove or simplify terms, add item examples). Environmental item edits prompted caregivers to share how they relate and respond to experiences with interpersonal and institutional discrimination impacting participation. Caregivers characterized three core functions of a virtual agent to strengthen YC-PEM navigation (read question aloud, visual and verbal prompts, more examples and/or definitions). Results indicate four ways that YC-PEM content will be modified to strengthen how providers screen for unmet participation needs and determinants to design pediatric re/habilitation services that are responsive to family priorities. Results also motivate the need for user-centered design of an intelligent virtual agent to strengthen user navigation, prior to undertaking a community-based pragmatic trial of its implementation for equitable practice. The online version contains supplementary material available at 10.1186/s41687-023-00627-2.