RAPID COVID-19: Sociotechnical Systems and Complexity Reduction: Enhancing Access to Digital Essential Services for Low-Income Communities during a Public Health Crisis
The COVID-19 pandemic has resulted in disruptions in the economy, and usual operations of healthcareservices. 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 pre-existing socio-technical infrastructures. It is also unclear what role the complexity of tasks, systems, resourcerequirements, andoverall 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 such as Metropolitan Detroit, Michigan, where many residents have limited access to broadbandInternet 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. Moreover, Metropolitan Detroitresidentshavea high COVID-19 burden. However, past human-computer interaction (HCI) research suggests that intermediaries such as non-profit organizations and family members can mitigate such barriers in low-income contexts. We aim to address these difficulties and prevent unequal benefit through sociotechnical design for complexity reduction, including use of ?warm experts? as technology intermediaries. Study Aim 1 is to assess the complexity of telehealthservices for low-income Metro Detroiters, and create methods for simplification. This will involve heuristicevaluation,remote user evaluation of existing telehealth serviceswith low-income Metro Detroiters, and designof 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 intermediarywork. Electronic health record and telehealth platform data will be used to evaluate impact on health careaccess in the form of call qualityand length. We will also investigate potential differences based onpatient demographics.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.
National Science Foundation
Funding Period: 6/15/2020 to 5/31/2021