eHealth apps often fail to improve clinical outcomes due to poor integration with clinical workflow—the sequence and personnel needed to undertake a series of tasks for clinical care. Our central thesis is that eHealth interventions will be more effective if the clinical workflow is studied and taken into consideration for intervention implementation. This paper aims to provide an introductory tutorial on when and how to use a clinical workflow analysis to guide the implementation of eHealth interventions. The tutorial includes a step-by-step guide to conducting a clinical workflow analysis in planning for eHealth implementation. We began with a description of why a clinical workflow analysis is best completed before the implementation of eHealth interventions. Next, we described 4 steps needed to perform the clinical workflow analysis: the identification of discrete workflow components, workflow assessment, triangulation, and the stakeholder proposal of intervention implementation. Finally, we presented a case study of a clinical workflow analysis, which was conducted during patient visits of patients aged 11 or 12 years from 4 diverse pediatric or family medicine clinics to plan the implementation of a tablet-based app for adolescent vaccination. Investigators planning the implementation of new eHealth interventions in health care settings can use the presented steps to assess clinical workflow, thereby maximizing the match of their intervention with the clinical workflow. Conducting a prospective workflow study allows for evidence-based planning, identifying potential pitfalls, and increasing stakeholder buy-in and engagement. This tutorial should aid investigators in increasing the successful implementation of eHealth interventions.
Evidence suggests that narrative exposure therapy (NET) is an effective treatment to address trauma among diverse populations of adults who are refugees; however, less is known about the efficacy of NET to address trauma symptoms among children who are refugees. This review aimed to evaluate existing research on the effectiveness of NET for children and youth aged 18 years and younger who are refugees or migrants seeking shelter from violence. A review of the literature was conducted using the search terms “narrative exposure therapy or narrative exposure or narrative therapy” and “refugee children or migrant children” located in titles and abstracts. Methodological search filters were used to identify randomized controlled trials (RCTs). Publications were limited to English language journal articles published between January 2000 and December 2021. This search was initiated in February 2022 and completed in March 2022. Four RCT studies met the inclusion criteria. The identified studies were conducted using diverse samples of children. Significant posttreatment differences in posttraumatic stress disorder (PTSD) symptomology between NET and comparator groups were found in two of four studies. Two additional RCTs evaluating the effectiveness of NET on treating trauma among both children and young adults were included as supplemental evidence. Significant posttreatment differences were found in both studies. Considerations for clinical relevance and future research are discussed. In conclusion, these results highlight the limited number of RCTs available on this topic. There exists a need for rigorous research exploring the use of NET with children and youth who are refugees with a focus on decreasing posttraumatic stress disorder symptoms.
BACKGROUND To help guide implementation of eHealth interventions, we report a simple and easy-to-follow method to conduct a clinical workflow analysis before eHealth implementation including an example of our experience. OBJECTIVE This study aimed to analyze workflow before eHealth implementation to determine the best timing and personnel for implementation. METHODS Following an example from our own work, we describe the steps to create a planned implementation workflow of an eHealth application in primary care clinics. We describe and provide examples for four steps: a) identification of discrete workflow components, b) selection of appropriate measurement tools, c) direct observation of clinical workflow, and d) stakeholder engaged data analysis and synthesis. RESULTS Between August 2016 and March 2017, we observed 13 visits of 11- or 12-year-olds at four diverse Florida pediatric or family medicine clinics. We created a flowchart to display each clinic’s workflow. Across clinics, the general workflow process and patient flow was similar and allowed approximately 20-minutes for patients to complete intervention tasks prior to seeing their doctor. During semi-structured interviews, lead clinicians and medical staff at each clinic reviewed the flowchart and expressed that it accurately captured their work. Three of the four clinics suggested nearly identical implementation strategies for the eHealth application. By conducting workflow analysis prior to implementation of an eHealth intervention, we identified specific timing, staffing, and management processes for implementation, potential barriers, and increased stakeholder buy-in. CONCLUSIONS The easy-to-follow steps presented will help investigators plan implementation of new eHealth interventions in primary healthcare settings. Conducting a prospective workflow study allows for observation-based planning, identifying potential pitfalls, and increasing stakeholder buy-in.
ObjectivesWe evaluated the feasibility of conducting a 9-week long sexually transmitted infection (STI) prevention intervention, Angels in Action, within an alternative disciplinary school for adolescent girls.MethodsAll girls who were 16–18 years old, enrolled in the school and did not have plans to transfer from the school were eligible to participate. We measured process feasibility with recruitment, retention and participant enjoyment. Using a pretest-post-test design with a double post-test, we used χ² tests to estimate the intervention effect on participants’ sexual partner risk knowledge, intentions to reduce partner risk and sexual activities in the past 60 days with three behavioural surveys: prior to, immediately following and 3 months after the intervention.ResultsAmong the 20 girls who were eligible, 95% (19/20) of parents consented and all girls (19/19) agreed to participate. Survey participation was 100% (19/19) prior to, 76% (13/17) immediately following and 53% (9/17) 3 months after the intervention. The intervention was administered twice and a total 17 girls participated. Session attendance was high (89%) and most participants (80%) reported enjoying the intervention. The intervention increased the percentage of girls who could identify partner characteristics associated with increased STI risk: 38% before, 92% immediately following and 100% 3 months after the intervention (p=0.01). Girls also increased their intentions to find out four of the most highly associated partner characteristics (partner’s age, recent sexual activity and STI or jail history): 32% before to 75% immediately following (p=0.02) and 67% 3 months after the intervention (p=0.09).ConclusionsThis pilot study suggests girls at alternative disciplinary schools participated in and enjoyed a 9-week STI preventive intervention. Within alternative disciplinary schools, it is potentially feasible to increase girls’ consideration of partner risk characteristics as a means to enhance their STI prevention skills.
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