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

这项快速研究将评估和开发针对低收入美国人的问题的补救措施，使用在线系统与临床医生沟通，并从他们那里获得准确和及时的医疗建议，在当前的危机中尤为关键。新冠肺炎疫情已导致医疗服务的正常运营中断。然而，这种服务现在比以往任何时候都更加重要；因此，许多组织迅速过渡到以数字方式提供这些服务。然而，由于缺乏预先存在的社会技术基础设施，这些努力受到阻碍。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着什么角色，以及他们是否可能从服务数字化中受益。在低收入社区，理解这一点至关重要，因为那里的许多居民使用宽带互联网和更新设备的机会有限，而且数字素养技能较少。因此，他们更有可能遇到使用数字服务的障碍。这是令人担忧的原因，因为卫生信息学研究表明，增加与卫生相关活动的努力的技术可能扩大卫生领域的社会经济不平等。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在低收入环境中缓解这种障碍。根据NSF的快速目标，这项研究将收集有关一批首次、低收入远程医疗用户面临的挑战的短暂数据。它还将收集有关这场危机期间技术中介的信息，包括可能很快就会消失或从记忆中消失的临时解决方案，并将迅速传播结果，以减少在这场健康危机中对低收入美国人的伤害。该项目旨在通过降低复杂性的社会技术设计，包括使用技术中介，解决这些困难并防止利益不平等。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、远程用户对低收入底特律大都会居民现有远程医疗服务的评估，以及“简化流程干预”的设计。目标2是开发一种获得基本远程医疗服务的新型干预措施，其中训练有素的硕士学生将作为联邦合格医疗中心(FQHC)患者获得远程医疗服务的中介-许多人是第一次获得远程医疗服务。这一干预措施的设计将建立在对底特律大都会居民的正式和非正式技术中介机构以及使用过中介机构的人的采访中的见解。目标3包括对目标1和目标2的干预措施进行试点评估。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。将使用电子健康记录和远程保健平台数据，以通话质量和通话时长的形式评估对保健服务获取的影响。这项研究还将根据患者的人口统计数据调查潜在的差异。该项目涉及大学研究人员、底特律一家拥有六个临床地点的大都会FQHC和一个专注于底特律居民经济机会的非营利性组织之间的合作。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

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.