The need for feminist intersectionality in digital health

Figueroa, Caroline A.; Luo, Tiffany; Aguilera, Adrián; Lyles, Courtney R.

doi:10.1016/s2589-7500(21)00118-7

Cited by 99 publications

(80 citation statements)

References 54 publications

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“…To best meet the needs of older veterans, and older adults more generally, future research should utilize qualitative methods and co-design processes to ensure that interventions are solving mental health challenges in usable, meaningful, and engaging ways. Co-design can help address barriers that are specific to older adults (eg, [ 69 ]); ensure that the product is findable, accessible, usable, desirable, credible, useful, and valuable (eg, [ 70 ]); improve the overall quality of the product [ 71 ]; and promote equity and inclusion (eg, [ 72 , 73 ]). More research focused on effective dissemination and implementation strategies is also needed.…”

Section: Discussionmentioning

confidence: 99%

Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

Jaworski¹,

Taylor²,

Ramsey³

et al. 2022

JMIR Ment Health

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Background Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. Objective The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. Methods Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. Results We found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. Conclusions The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan.

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Section: Discussionmentioning

confidence: 99%

Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

Jaworski¹,

Taylor²,

Ramsey³

et al. 2022

JMIR Ment Health

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“…Commentaries: Six (n = 6) included papers were commentaries (Banks et al, 2021; Das et al, 2021; Figueroa et al, 2021; Goodsmith et al, 2021; Hinton et al, 2021; Richey & Pointer, 2021) (see Table 4).…”

Section: Resultsmentioning

confidence: 99%

“…A viewpoint paper (Figueroa et al, 2021) from the USA illustrated gender inequality issues in digital health at three levels: users, tools (i.e., mobile phone applications) and leadership.…”

Section: Resultsmentioning

confidence: 99%

What innovations can address inequalities experienced by women and girls due to the COVID-19 pandemic across the different areas of life/domains: work, health, living standards, personal security, participation and education?

Spencer

Hartfiel

Hendry

et al. 2022

Preprint

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Background / Aim of Rapid Review The COVID-19 pandemic has led to differential economic, health and social impacts illuminating prevailing gender inequalities (WEN Wales, 2020). This rapid review investigated evidence for effectiveness of interventions to address gender inequalities across the domains of work, health, living standards, personal security, participation, and education. Key Findings Extent of the evidence base 21 studies were identified: 7 reviews, 6 commentaries and 8 primary studies Limited evidence for the effectiveness of identified innovations in minority groups A lack of evaluation data for educational interventions A lack of evidence for cost-effectiveness of the identified interventions 14 additional articles were identified in the grey literature but not used to inform findings (apart from the Education domain, where there was a lack of peer-reviewed evidence). Recency of the evidence base All studies were published in 2020-2021 Summary of findings Some evidence supported interventions/innovations related to work: Permanent contracts, full-time hours, and national childcare programmes to increase income for women and thereby decrease the existing gender wage gap. More frequent use of online platforms in the presentation of professional work can reduce gender disparities due to time saved in travel away from home. Some evidence supported interventions/innovations related to health: Leadership in digital health companies could benefit from women developing genderfriendly technology that meets the health needs of women. Create authentic partnerships with black women and female-led organisations to reduce maternal morbidity and mortality (Bray & McLemore, 2021). Some evidence supported interventions/innovations related to living standards including: Multi-dimensional care provided to women and their children experiencing homelessness. Limited evidence supported interventions/innovations related to personal security including: Specific training of social workers, psychologists and therapists to empower women to use coping strategies and utilise services to gain protection from abusive partners. Helplines, virtual safe spaces smart phone applications and online counselling to address issues of violence and abuse for women and girls. Very limited evidence supported interventions/innovations related to participation including: Use of online platforms to reduce gender disparities in the presentation of academic/professional work. Ensuring equal representation, including women and marginalised persons, in pandemic response and recovery planning and decision-making. Limited evidence from the grey literature described interventions/innovations related to education including: Teacher training curricula development to empower teachers to understand and challenge gender stereotypes in learning environments. Education for girls to enable participation in STEM. Policy Implications This evidence can be used to map against existing policies to identify which are supported by the evidence, which are not in current policy and could be implemented and where further research/evaluation is needed. Further research is needed to evaluate the effectiveness of educational innovations, the effectiveness of the innovations in minority groups and the social value gained from interventions to address gender inequalities. Strength of Evidence One systematic review on mobile interventions targeting common mental disorders among pregnant and postpartum women was rated as high quality (Saad et al., 2021). The overall confidence in the strength of evidence was rated as low due to study designs. Searches did not include COVID specific resources or pre-prints. There may be additional interventions/innovations that have been implemented to reduce inequalities experienced by women and girls due to the COVID-19 pandemic but have not been evaluated or published in the literature and are therefore not included here.

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“…Similarly, our previous review on conversational agents for physical activity identified only a handful of conversational agents for mobile delivery through apps and text messaging, and no Spanish conversational agents ( 15 ). Further, digital solutions are not often specifically designed for women ( 18 ), especially ethnic minority women, who generally have worse health outcomes than white women ( 19 ). Ethnic minority women are underrepresented in the design and testing of digital health tools ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

“…Further, digital solutions are not often specifically designed for women ( 18 ), especially ethnic minority women, who generally have worse health outcomes than white women ( 19 ). Ethnic minority women are underrepresented in the design and testing of digital health tools ( 18 ). Because of this and the lack of adequate digital skills training, marginalized groups may underuse these interventions ( 20 ), even if health technologies target them.…”

Section: Introductionmentioning

confidence: 99%

Conversational Physical Activity Coaches for Spanish and English Speaking Women: A User Design Study

Figueroa

Luo

Jacobo

et al. 2021

Front. Digit. Health

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Introduction: Digital technologies, including text messaging and mobile phone apps, can be leveraged to increase people's physical activity and manage health. Chatbots, powered by artificial intelligence, can automatically interact with individuals through natural conversation. They may be more engaging than one-way messaging interventions. To our knowledge, physical activity chatbots have not been developed with low-income participants, nor in Spanish—the second most dominant language in the U.S. We recommend best practices for physical activity chatbots in English and Spanish for low-income women.Methods: We designed a prototype physical activity text-message based conversational agent based on various psychotherapeutic techniques. We recruited participants through SNAP-Ed (Supplemental Nutrition Assistance Program Education) in California (Alameda County) and Tennessee (Shelby County). We conducted qualitative interviews with participants during testing of our prototype chatbot, held a Wizard of Oz study, and facilitated a co-design workshop in Spanish with a subset of our participants.Results: We included 10 Spanish- and 8 English-speaking women between 27 and 41 years old. The majority was Hispanic/Latina (n = 14), 2 were White and 2 were Black/African American. More than half were monolingual Spanish speakers, and the majority was born outside the US (>50% in Mexico). Most participants were unfamiliar with chatbots and were initially skeptical. After testing our prototype, most users felt positively about health chatbots. They desired a personalized chatbot that addresses their concerns about privacy, and stressed the need for a comprehensive system to also aid with nutrition, health information, stress, and involve family members. Differences between English and monolingual Spanish speakers were found mostly in exercise app use, digital literacy, and the wish for family inclusion.Conclusion: Low-income Spanish- and English-speaking women are interested in using chatbots to improve their physical activity and other health related aspects. Researchers developing health chatbots for this population should focus on issues of digital literacy, app familiarity, linguistic and cultural issues, privacy concerns, and personalization. Designing and testing this intervention for and with this group using co-creation techniques and involving community partners will increase the probability that it will ultimately be effective.

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The need for feminist intersectionality in digital health

Cited by 99 publications

References 54 publications

Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

What innovations can address inequalities experienced by women and girls due to the COVID-19 pandemic across the different areas of life/domains: work, health, living standards, personal security, participation and education?

Conversational Physical Activity Coaches for Spanish and English Speaking Women: A User Design Study

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