RAPID COVID-19: Sociotechnical Systems and Complexity Reduction: Enhancing Access to Digital Essential Services for Low-Income Communities during a Public Health Crisis

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This RAPID research will assess and develop remedies for the problems low-income Americans have using online systems for communicating with clinicians and getting accurate and timely medical advice from them, especially crucial during the current crisis. The COVID-19 pandemic has resulted in disruptions in the usual operations of healthcare services. However, such services are more essential now than ever; consequently, many organizations have rapidly transitioned to providing them digitally. Yet, these efforts are impeded by the lack of preexisting socio-technical infrastructures. It is also unclear what role the complexity of tasks, systems, resource requirements, and overall processes plays in the ability of low-income users to use such services, and whether they may benefit from service digitization. This is critical to understand in low income communities where many residents have limited access to broadband Internet and newer devices, and have fewer digital literacy skills. Consequently, they are more likely to experience barriers to digital service use. This is cause for concern since health informatics research has shown that technologies that increase effort for health-related activities can widen socioeconomic inequalities in health. However, past human-computer interaction research suggests that intermediaries such as non-profit organizations and family members can mitigate such barriers in low-income contexts. In line with NSF RAPID goals, the study will gather ephemeral data concerning the challenges faced by a cadre of first-time, low-income telehealth users. It will also gather information concerning technology intermediation during this crisis, including ad-hoc and temporary solutions that may soon disappear or fade from memory, and will disseminate results quickly in order to reduce harm to low-income Americans during this health crisis. This project aims to address these difficulties and prevent unequal benefit through sociotechnical design for complexity reduction, including use of technology intermediaries. Study Aim 1 is to assess the complexity of telehealth services for low-income residents of the Detroit metropolitan area, and create methods for simplification. This will involve heuristic evaluation, remote user evaluation of existing telehealth services with low-income Metro Detroiters, and design of a "simplified process intervention." Aim 2 is to develop a novel intervention for access to essential telehealth services in which trained masters students will serve as intermediaries for federally-qualified health center (FQHC) patients as they access telehealth - many for the first time. Design of this intervention will build on insights from interviews with formal and informal technology intermediaries for Metro Detroiters, and people who have used intermediaries. Aim 3 involves a pilot evaluation of the interventions from Aims 1 and 2. Interviews, observations, and surveys will assess patient response to the interventions, and intermediary work. Electronic health record and telehealth platform data will be used to evaluate impact on health care access in the form of call quality and length. The research will also investigate potential differences based on patient demographics. This project involves collaborations among university researchers, a Metropolitan Detroit-based FQHC with six clinical locations, and a nonprofit organization focused on economic opportunity for Detroit residents.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.