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This article presents the design process of innovative prototypes for cervical cancer prevention in primary care centers located in low-income settings in Cali, Colombia, using the Human-Centered Design (HCD). The project was developed in collaboration with a public healthcare network comprised of 38 urban and rural centers with women between the a...
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Cytology-based cervical cancer screening programs have been difficult to implement and scale up in developing countries. Thus, the World Health Organization recommends a ‘see and treat’ approach by way of hr-HPV testing and visual inspection. We aimed to evaluate concurrent HPV DNA testing and visual inspection in a real-world low-resource setting...
Citations
... Beacon Bluetooth [3], [1], [6], [7], [11], [8], [12], [9], [10] 9 Wi-Fi [3], [7], [11], [9], [10] 5 Near-field communication [11], [ ...
... This approach reframes a research question or behavior change from "what matters" to "what matters most, " allowing for solutions that are human centered and context specific [46,47]. Previous healthcare research supports the use of this approach, as participating in the co-design process increases self-efficacy for both patients and health care workers and leads to sustainable solutions to problems within the health system [48][49][50][51][52][53][54][55]. While HCD is an increasingly used approach to finding healthcare solutions, recent systematic reviews of HCD in healthcare have found discrepancies in the quality and methodological rigor of the studies [56,57]. ...
Background
Responsive and resilient strategies to reduce high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of the highest maternal and infant mortality rates globally. Group healthcare is a service delivery model that integrates these strategies. Although primarily implemented during the prenatal period, its potential for improving both maternal and infant health outcomes during the postpartum period has not been realized. The purpose of this study was to adapt and co-design the prototype for an evidence-based group care model for the postpartum period using a human-centered design approach with key stakeholders in Malawi.
Methods
We completed steps of a framework guiding the use of human-centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Qualitative methods were used to complete steps 2–4. In-depth interviews ( n = 24), and incubator sessions ( n = 6) that employed free listing, pile sorting and ranking were completed with key stakeholders. Data analysis consisted of content analysis of interviews and framework analysis for incubator sessions to produce the integrated group postpartum and well-child care model prototype. The fifth step is detailed in a separate paper.
Results
All stakeholders reported a desire to participate in and offer group care in the postpartum period. Stakeholders worked collaboratively to co-create the prototype that included a curriculum of health promotion topics and interactive activities and the service delivery structure. Health promotion topic priorities were hygiene, breastfeeding, family planning, nutrition, and mental health. The recommended schedule included 6 sessions corresponding with the child vaccination schedule over the 12-month postpartum period.
Conclusions
Using a human-centered design approach to adapt an evidence-based group care model in an LMIC, specifically Malawi, is feasible and acceptable to key stakeholders and resulted in a prototype curriculum and practical strategies for clinic implementation.
... Women demand the need to develop patient-centered care [36]. For this reason, the research team will continue to advance in the design of interventions in response to this need in the future [37]. ...
Background
Cervical cytology is essential for the early detection of cervical cancer. However, in Colombia, only 50% of women with subsidized health insurance were screened in 2019, compared to 100% of women with contributory insurance. This disparity highlights significant barriers that must be addressed. This study aimed to identify the factors that contribute to or hinder adherence to cervical cytology screening among low-income women with subsidized health insurance in a public primary care network in Cali, Colombia, from 2014 to 2018.
Methods
In a qualitative case study, the experience of women and health care and administrative personnel was recovered. Forty-seven women participated in seven focus group discussions. Five other women using the program participated in in-depth interviews. Finally, we interviewed eight people from the healthcare area and the health services administration. The qualitative data collected underwent content analysis, guided by the theoretical framework of Social Determinants of Health. Within this framework, five interconnected dimensions that influence adherence were incorporated.
Results
Adherence is a multifactorial phenomenon, and in relation to attendance at cervical cytology, the analysis delved into the mechanisms that affect it in a low-income context. Barriers to adherence were identified across multiple dimensions, including social and economic factors, health conditions, and patient-related factors, among both adherent and non-adherent women. Among adherent women, barriers and facilitators related to the healthcare team and system, as well as patient-related factors, were identified.
Conclusions
The findings of this research can be useful in developing personalized interventions and strategies to improve adherence and screening outcomes in low-income settings. It is necessary to increase the resources of health insurance entities to establish effective communication channels with women who attend the cervical cancer prevention program.
... Trying to close these gaps, the use of HPV self-sampling is likely to increase in the coming years [11,12] since it has been proven to be favorable for women, and its diagnostic accuracy has been confirmed for cervical intraepithelial neoplasia grade two or worse (CIN2+) [13][14][15]. Also, new screening devices have been developed in recent years such as the 'CITOBOT', which includes an AI-based system [16], 'Pocket Colposcope', a low-cost, transvaginal digital colposcope [17], and others like 'Gynius AB's Gynocular' [18,19] and 'MobileODT's EVA' [20,21]. These alternatives to improve diagnosis opportunityin primary care, particularly to reach under screened populations, are important to advance in the global initiative to eliminate cervical cancer as a public health problem in the 21st century [1]. ...
... This review provides a qualitative analysis of the Pap smear from women's most critical experiences. The results represent new interpretations that should be considered for the technology maturation and potential implementation of new screening devices [16] and services. We translated these interpretations into the following design requirements: ...
Global cervical cancer incidence and mortality have remained a major public health problem. Depending on the quality and coverage of preventive programs, and the capacity of health care systems, different screening tests are used, with the Pap smear being the most widely implemented. Several difficulties have been reported in accessing timely detection, causing late cervical cancer diagnosis. Trying to close these gaps, new screening devices have been developed in recent years; however, there is a lack of knowledge about whether or not women perspective has been included in the design process and technological development of these devices. This scoping review aimed to describe and synthesize scientific literature on women's critical experiences with Pap smears to prospectively contribute to the design, development, and scale-up of cervical cancer screening devices. The electronic databases Web of Science, Scopus, PubMed, PsycINFO and SciELO were searched for relevant studies published between 2012 and 2021; finally, 18 qualitative studies were included. Experiences were classified into four categories: fear and embarrassment, speculum pain and discomfort, outcome distress and health service barriers. Critical experiences before, during, and after the test were analyzed in turn. In particular, during the test, women reported pain associated with the use of the speculum. The acceptability of new screening devices will largely depend on comfort during the test and timely delivery of results. This review provides a useful qualitative synthesis, not only to advance the design of novel devices but also for future implementation research in cervical screening services.
... If the prototype is robust or mature enough to be deployed, it will be more clear and easy to use. Both patients and clinicians need easy access to the development team via a message module [40]. ...
Improving the quality of digital health care through information and communication technology can mainly contribute to the clinical, social, financial, and economic systems’ success, especially during the COVID-19 pandemic period. The co-design approach, which unleashes the end-user power, can contribute actively in improving the healthcare systems. It deals with understanding the user behaviors, requirements, and motivations through observation, inspection, task analysis, and feedback techniques. Consequently, both the co-design and digital technologies might empower the management of patients’ health and that of their families. The research strategy is based on a systematic literature review and meta-analysis to summarize how the co-design methodologies handled the existing technology-based health systems for their improvement. Based on the findings, we establish the following hypotheses: (i) A user-centered methodology for service implementation might offer a promising tool to enhance the healthcare services quality before they be launched; (ii) Several limitations can affect the co-design approach in digital health, such as a bias for a patients’ group. Efforts have been made to reduce this risk by identifying bias at an early stage, or different groups should be included in the test phase for example; (iii) Use decision-making devices that handle technologies for patient and clinical healthcare solution
... This diversity can be in their unmet or underserved needs, various problems they face, and their capabilities (Prahalad 2004). Whilst general characteristics of codesign methods have an influence on involvement of resource-constrained people in design projects, adapting methods to the specificities of a particular project or using suitable methods to address requirements and conditions of a specific context is essential to engage with resource-constrained people (Jagtap 2021a, b;Dayaratne 2016;Arrivillaga et al. 2020). For example, Dayaratne (2016) elaborates on the use of sorting and location tasks as methods in the design of a low-cost housing. ...
... For example, Dayaratne (2016) elaborates on the use of sorting and location tasks as methods in the design of a low-cost housing. Likewise, Arrivillaga et al. (2020) report use of various codesign methods adapted to the specificities of a healthcare project. ...
Codesign with resource-constrained people living in developing countries is crucial for sustained adoption and use of designed solutions. Several studies have investigated codesign with resource-constrained people. It is, therefore, important to understand what has been investigated and learnt so far as well as to plan for further scholarly exploration of this field. To address this, I applied a systematic literature review (SLR) approach to understand main sources, definitions, and theoretical perspectives regarding codesign with resource-constrained people. The SLR also aimed to understand inputs and outputs of codesign as well as factors influencing the codesign process. The findings portray a multifaceted picture regarding these aspects of codesign. I discuss implications of review findings for the practice of codesigning solutions with resource-constrained people, identify concerns that researchers should have about this field, and offer suggestions for future research in this field of codesign.
... The poor reporting on these components within all dimensions of the RE-AIM framework may contribute to the limited widespread dissemination of effective self-collection for HPV testing interventions in the region. As a result, efforts are needed to design self-collection for HPV testing strategies that are participatory, with end-users themselves guiding ways to expand the reach, adoption, and implementation of these interventions [53,78,79]. Such studies produce sustained and equitable outcomes that are adapted to the local contexts and needs of participants and community settings where the burden of cervical cancer remains high. ...
Introduction
Self-collection of samples for HPV testing may increase women’s access to cervical cancer screening in low- and middle-income settings. However, implementation remains poor in many regions. The purpose of this systematic review was to examine implementation data from randomized controlled trials evaluating human papillomavirus (HPV) self-collection testing among women in sub-Saharan Africa using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework.
Methods
We searched four electronic databases (PubMed, CINAHL, Web of Science, and Global Health) for pragmatic randomized controlled trials that promote HPV self-collection among women in sub-Saharan Africa. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist. Two researchers independently extracted information from each article using a RE-AIM data extraction tool. The reporting of RE-AIM dimensions was summarized and synthesized across included interventions.
Results
We identified 2008 citations, and eight studies were included. These reported on five unique interventions. The five interventions were conducted in five countries: Cameroon, Ethiopia, Kenya, Nigeria, and Uganda. Intervention reach (80%) was the most commonly reported RE-AIM dimension, followed by adoption (56%), efficacy/effectiveness (52%), implementation (47%), and maintenance (0%). All the interventions described increased uptake of HPV testing among study participants (effectiveness). However, the majority of the studies focused on reporting internal validity indicators such as inclusion criteria (100%) and exclusion criteria (100%), and few reported on external validity indicators such as participation rate (40%), intervention cost (40%), staff selection (20%), and cost of maintenance (0%).
Conclusions
Our review highlights the under-reporting of external validity indicators such as participation rate, intervention, and maintenance costs in studies of self-collection for HPV testing among women in SSA. Future research should focus on including factors that highlight internal validity factors and external validity factors to develop a greater understanding of ways to increase not only reach but also implementation and long-term maintenance of these interventions. Such data may advance the translation of HPV interventions into practice and reduce health disparities in SSA. Findings highlight the need for innovative tools such as participatory learning approaches or open challenges to expand knowledge and assessment of external validity indicators to ultimately increase the uptake of HPV testing among women in SSA.
... When the design solutions are finalized, those design solutions are evaluated in the last phase. [39], [40]. ...
Artificial intelligence (AI) is one of the emerging technologies. In recent decades, artificial intelligence (AI) has gained widespread acceptance in a variety of fields, including virtual support, healthcare, and security. Human-Computer Interaction (HCI) is a field that has been combining AI and human-computer engagement over the past several years in order to create an interactive intelligent system for user interaction. AI, in conjunction with HCI, is being used in a variety of fields by employing various algorithms and employing HCI to provide transparency to the user, allowing them to trust the machine. The comprehensive examination of both the areas of AI and HCI, as well as their subfields, has been explored in this work. The main goal of this article was to discover a point of intersection between the two fields. The understanding of Explainable Artificial Intelligence (XAI), which is a linking point of HCI and XAI, was gained through a literature review conducted in this research. The literature survey encompassed themes identified in the literature (such as XAI and its areas, major XAI aims, and XAI problems and challenges). The study’s other major focus was on the use of AI, HCI, and XAI in healthcare. The poll also addressed the shortcomings in XAI in healthcare, as well as the field’s future potential. As a result, the literature indicates that XAI in healthcare is still a novel subject that has to be explored more in the future.
... Although HCD is relatively new in global health research, there are now several examples of HCD-informed approaches in addressing implementation problems. In Kenya, Catalani et al used HCD to create a TB clinical decision support system to improve uptake of TB prevention therapy among people living with HIV [26], and a group in Colombia recently demonstrated the use of HCD to develop 4 novel prototypes to improve cervical cancer screening [44]. These examples, in addition to our work, add to the growing literature on the potential benefits of using the HCD approach in addressing implementation barriers. ...
Background
Digital adherence technologies have been widely promoted as a means to improve tuberculosis medication adherence. However, uptake of these technologies has been suboptimal by both patients and health workers. Not surprisingly, studies have not demonstrated significant improvement in treatment outcomes.
Objective
This study aimed to optimize a well-known digital adherence technology, 99DOTS, for end user needs in Uganda. We describe the findings of the ideation phase of the human-centered design methodology to adapt 99DOTS according to a set of design principles identified in the previous inspiration phase.
Methods
99DOTS is a low-cost digital adherence technology wherein tuberculosis medication blister packs are encased within an envelope that reveals toll-free numbers that patients can call to report dosing. We identified 2 key areas for design and testing: (1) the envelope, including the form factor, content, and depiction of the order of pill taking; and (2) the patient call-in experience. We conducted 5 brainstorming sessions with all relevant stakeholders to generate a suite of potential prototype concepts. Senior investigators identified concepts to further develop based on feasibility and consistency with the predetermined design principles. Prototypes were revised with feedback from the entire team. The envelope and call-in experience prototypes were tested and iteratively revised through focus groups with health workers (n=52) and interviews with patients (n=7). We collected and analyzed qualitative feedback to inform each subsequent iteration.
Results
The 5 brainstorming sessions produced 127 unique ideas that we clustered into 6 themes: rewards, customization, education, logistics, wording and imagery, and treatment countdown. We developed 16 envelope prototypes, 12 icons, and 28 audio messages for prototype testing. In the final design, we altered the pill packaging envelope by adding a front flap to conceal the pills and reduce potential stigma associated with tuberculosis. The flap was adorned with either a blank calendar or map of Uganda. The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment. Pill-taking order was indicated with colors, chevron arrows, and small mobile phone icons. Last, the call-in experience when patients report dosing was changed to a rotating series of audio messages centered on the themes of prevention, encouragement, and reassurance that tuberculosis is curable.
Conclusions
We demonstrated the use of human-centered design as a promising tool to drive the adaptation of digital adherence technologies to better address the needs and motivations of end users. The next phase of research, known as the implementation phase in the human-centered design methodology, will investigate whether the adapted 99DOTS platform results in higher levels of engagement from patients and health workers, and ultimately improves tuberculosis treatment outcomes.
Cervical cancer remains a leading cause of mortality in its invasive stages, presenting a significant global public health challenge, particularly in low- and middle-income countries. Despite technological advancements that have improved the quality of cervical images captured during visual inspections, several challenges persist. This article presents key findings from the CITOBOT-COL translational research project, a large-scale initiative focused on designing CITOBOT as a portable cervical cancer screening device. We detail the comprehensive technological development of CITOBOT, guided by a human-centered design approach, smart prototyping, and the integration of AI. Over four design iterations, we developed and refined CITOBOT v4, a portable device. Prototypes were validated through focus groups and testing by experts in cervical cancer prevention, gynecology, nursing, software, artificial intelligence, computer engineering, and public health, utilizing various anatomical models at the Simulated Hospital Laboratory of Pontificia Universidad Javeriana Cali, Colombia. Additionally, we developed AI algorithms using the Inception V3 network, optimized with Transfer Learning and Fine Tuning, for cervical image classification and offline-operating software that guides the physician through the examination and provides a risk assessment for cervical cancer. Feedback was crucial in assessing and refining the device's functionality, focusing on capturing high-quality cervical images. The development of CITOBOT v4 highlights the importance of fostering innovation in resource-limited settings, offering an effective solution to improve cervical cancer screening and potentially save lives in vulnerable communities.
