Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment

Abstract

Despite the proliferation of eHealth interventions, such as web portals, for health information dissemination or the use of mobile apps and wearables for health monitoring, research has shown that underserved groups do not benefit proportionately from these eHealth interventions. This is largely because of usability issues and the lack of attention to the broader structural, physical, and psychosocial barriers to technology adoption and use. The objective of this paper is to draw lessons from a decade of experience in designing different user-centered eHealth interventions (eg, web portals and health apps) to inform future work in leveraging technology to address health disparities. We draw these lessons from a series of interventions from the work we have done over 15 years in the Viswanath laboratory at the Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, focusing on three projects that used web portals and health apps targeted toward underserved groups. The projects were the following: Click to Connect, which was a community-based eHealth intervention that aimed to improve internet skills and health literacy among underserved groups by providing home access to high-speed internet, computer, and internet training classes, as well as a dedicated health web portal with ongoing technical support; PLANET MassCONECT, which was a knowledge translation project that built capacity among community-based organizations in Boston, Lawrence, and Worcester in Massachusetts to adopt evidence-based health promotion programs; and Smartphone App for Public Health, which was a mobile health research that facilitated both participatory (eg, surveys) and passive data (eg, geolocations and web-browsing behaviors) collection for the purpose of understanding tobacco message exposure in individuals’ built environment. Through our work, we distilled five key principles for researchers aiming to design eHealth interventions for underserved groups. They are as follows: develop a strategic road map to address communication inequalities (ie, a concrete action plan to identify the barriers faced by underserved groups and customize specific solutions to each of them), engage multiple stakeholders from the beginning for the long haul, design with usability—readability and navigability—in mind, build privacy safeguards into eHealth interventions and communicate privacy–utility tradeoffs in simplicity, and strive for an optimal balance between open science aspirations and protection of underserved groups.

An Assessment of Perspectives and Concerns Among Research Participants of Childbearing Age Regarding the Health-Relatedness of Data, Online Data Privacy, and Donating Data to Researchers: Survey Study

“…Ironically, however, these events and our findings indicate that ResearchMatch participants are likely incorrect in their assumptions that ride-sharing history and geolocation data are not health-related. Moving forward, it will be critical to identify and implement resources to educate ResearchMatch participants and others about cases that demonstrate the contextual health-relatedness of ride-sharing history and geolocation data [ 33 - 37 ]. It will also be critical for data companies, app developers, and their collaborators to provide and support research and education about privacy-invasive software development kits and application programming interfaces that collect geolocation data.…”

Social-Cultural Factors in the Design of Technology for Hispanic People with Stroke

“…Offering to go to them and being flexible with timing are essential. Looking at the healthcare experience of medically underserved Hispanics shows that no or lower quality insurance, a lack of Spanish-speaking providers or providers with cultural awareness, minimal non-urgent or nonemergent medical care, difficulty paying out of pocket, and negative family pressures can all play an adverse role in the healthcare experience and in the use of any potential stroke technology [31], [33], [34], [44], [47].…”

“…Building Trust: First, challenges can arise from reservations that Hispanic people have towards research participation [47], [51] and fears based on immigration status [34]. Some of this hesitancy stems from historically experienced ill treatment from researchers who have taken from these communities without giving back.…”

“…We must work to earn back the trust that we have lost. During recruitment, some researchers have found it helpful to give a face to a name by putting a picture of the their face on recruitment material and visiting community meetings in person [47]. In the early stage of studies, researchers have built trust by acknowledging personal and institutional histories of misconduct and offering a platform for frank truth-telling about these traumas.…”

An Assessment of Perspectives and Concerns Among Research Participants of Childbearing Age Regarding the Health-Relatedness of Data, Online Data Privacy, and Donating Data to Researchers: Survey Study (Preprint)

“…Ironically, however, these events and our findings indicate that ResearchMatch participants are likely incorrect in their assumptions that ride-sharing history and geolocation data are not health-related. Moving forward, it will be critical to identify and implement resources to educate ResearchMatch participants and others about cases that demonstrate the contextual health-relatedness of ride-sharing history and geolocation data [33][34][35][36][37]. It will also be critical for data companies, app developers, and their collaborators to provide and support research and education about privacy-invasive software development kits and application programming interfaces that collect geolocation data.…”