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

RAPID COVID-19：社会技术系统和复杂性降低：在公共卫生危机期间增强低收入社区获得数字基本服务的机会

• 批准号: 2031662
• 负责人: Tiffany Veinot
• 金额: $ 19.99万
• 依托单位: Regents of the University of Michigan - Ann Arbor
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=2031662&HistoricalAwards=false
• 关键词: RAPID; COVID; 19; Sociotechnical; Systems

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.

这项RAPID研究将评估和开发低收入美国人使用在线系统与临床医生沟通并从他们那里获得准确及时的医疗建议的问题的补救措施，在当前的危机中尤其重要。 COVID-19疫情导致医疗服务的日常运作中断。然而，这些服务现在比以往任何时候都更加重要;因此，许多组织已经迅速过渡到以数字方式提供这些服务。然而，这些努力由于缺乏预先存在的社会技术基础设施而受到阻碍。目前还不清楚任务、系统、资源需求和整体流程的复杂性在低收入用户使用此类服务的能力中扮演什么角色，以及他们是否可以从服务数字化中受益。这对于了解低收入社区至关重要，因为许多居民对宽带互联网和更新设备的访问有限，并且数字扫盲技能较少。因此，他们更有可能遇到使用数字服务的障碍。这一点令人关切，因为卫生信息学研究表明，增加卫生相关活动努力的技术可能扩大卫生方面的社会经济不平等。然而，过去的人机交互研究表明，非营利组织和家庭成员等中介机构可以减轻低收入环境中的此类障碍。 根据NSF RAPID的目标，该研究将收集关于首次使用远程保健的低收入用户所面临挑战的短暂数据。它还将收集有关这场危机期间技术中介的信息，包括可能很快消失或从记忆中消失的临时和临时解决方案，并将迅速传播结果，以减少在这场健康危机期间对低收入美国人的伤害。该项目旨在解决这些困难，并通过减少复杂性的社会技术设计，包括使用技术中介，防止利益不平等。研究目标1是评估底特律大都市区低收入居民远程医疗服务的复杂性，并创建简化方法。这将涉及启发式评估，对低收入底特律人现有远程医疗服务的远程用户评估，以及设计“简化过程干预”。“目标2是开发一种新的干预措施，以获得基本的远程保健服务，其中受过培训的硕士生将作为联邦合格的健康中心（ECOHC）患者的中介，因为他们访问远程保健-许多是第一次。这项干预措施的设计将建立在与底特律大都会的正式和非正式技术中介机构以及使用过中介机构的人进行访谈的基础上。目标3涉及对目标1和2的干预措施进行试点评价。访谈、观察和调查将评估患者对干预措施和中介工作的反应。电子健康记录和远程医疗平台数据将用于评估对医疗服务的影响，包括通话质量和通话时长。该研究还将调查基于患者人口统计学的潜在差异。该项目涉及大学研究人员、底特律大都会地区的一家拥有六个临床地点的CNOHC和一家专注于底特律居民经济机会的非营利组织之间的合作。该奖项反映了NSF的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。