针对小儿 1 型糖尿病的学校协作护理 (SPACE):与多系统社区合作伙伴开展虚拟干预的开发和可用性研究。

Q2 Medicine
JMIR Diabetes Pub Date : 2025-03-26 DOI:10.2196/64096
Christine A March, Elissa Naame, Ingrid Libman, Chelsea N Proulx, Linda Siminerio, Elizabeth Miller, Aaron R Lyon
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引用次数: 0

摘要

背景:学校合作干预可能改善1型糖尿病儿童的健康结果,尽管支持其有效性和可持续性的证据有限。家庭、学校或卫生系统因素可能会干扰干预措施的可用性和实施。目的:为了识别和解决干预开发过程中潜在的实施障碍,我们结合了以用户为中心的设计和实施科学的方法,将基于证据的社会心理干预,即协作护理模式,应用于学校和糖尿病医疗团队之间的1型糖尿病虚拟学校伙伴协作护理(SPACE)模式。方法:我们招募了患者、家庭、学校和卫生系统的合作伙伴(n=20),通过使用数字白板的迭代、基于网络的设计会议(阶段1)共同创建SPACE。以用户为中心的设计方法包括独立和小组活动,以产生想法、视觉投票和对不断发展的SPACE原型进行结构化批评。在第二阶段,对原型进行了基于证据的社会心理干预方法可用性评估。学校护士对认知演练中的原型和任务进行了回顾,并完成了干预可用性量表(IUS)。研究团队的两名成员独立地确定和优先级(1-3级)离散的可用性关注点。我们用Spearman相关性评估了优先级和报告每个可用性问题的护士百分比之间的关系。采用方差分析评估学校护士特征的IUS评分差异。结果:在设计阶段,合作伙伴为SPACE产生了90多个独特的想法,优先考虑了干预适应性、团队沟通和多维结果跟踪等因素。经过三次原型开发迭代,10名学校护士(n=10, 100%为女性;平均年龄48.5岁,标准差9.5岁),代表不同的地区和经验。护士确定了16个独立的可用性问题(每个问题由10%-60%的参与者报告)。获得最高优先级(3.0)的两个问题:访问虚拟平台的能力(n= 3,30%的参与者)和护士和提供者之间的数据共享机制(n= 6,60%的参与者)。优先级与报告每个问题的护士百分比之间存在中等相关性(ρ=0.63;P = . 01)。平均IUS评分(77.8,SD 11.1;100分制)表示适当的可用性。学校护士经验(P= 0.54)、学生病例量(P= 0.12)、覆盖的学校数量(P= 0.90)或先前患1型糖尿病的经历(P= 0.83)对IUS评分没有差异,这表明其他因素可能影响可用性。设计团队为SPACE的实施提出了克服高优先级问题的策略,包括培训用户使用视频会议应用程序,建立安全的学校数据报告表格,以及在SPACE会议期间实时共享葡萄糖数据。结论:跨部门干预是复杂的,感知可用性是实施的潜在障碍。与社区合作伙伴一起使用基于网络的共同创造方法,促进了与最终用户优先事项一致的高质量干预设计。定量和定性评估表明了适当程度的可用性,以便进行试点测试。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes: Development and Usability Study of a Virtual Intervention With Multisystem Community Partners.

Background: School-partnered interventions may improve health outcomes for children with type 1 diabetes, though there is limited evidence to support their effectiveness and sustainability. Family, school, or health system factors may interfere with intervention usability and implementation.

Objective: To identify and address potential implementation barriers during intervention development, we combined methods in user-centered design and implementation science to adapt an evidence-based psychosocial intervention, the collaborative care model, to a virtual school-partnered collaborative care (SPACE) model for type 1 diabetes between schools and diabetes medical teams.

Methods: We recruited patient, family, school, and health system partners (n=20) to cocreate SPACE through iterative, web-based design sessions using a digital whiteboard (phase 1). User-centered design methods included independent and group activities for idea generation, visual voting, and structured critique of the evolving SPACE prototype. In phase 2, the prototype was evaluated with the usability evaluation for evidence-based psychosocial interventions methods. School nurses reviewed the prototype and tasks in cognitive walkthroughs and completed the Intervention Usability Scale (IUS). Two members of the research team independently identified and prioritized (1-3 rating) discrete usability concerns. We evaluated the relationship between prioritization and the percentage of nurses reporting each usability issue with Spearman correlation. Differences in IUS scores by school nurse characteristics were assessed with ANOVA.

Results: In the design phase, the partners generated over 90 unique ideas for SPACE, prioritizing elements pertaining to intervention adaptability, team-based communication, and multidimensional outcome tracking. Following three iterations of prototype development, cognitive walkthroughs were completed with 10 school nurses (n=10, 100% female; mean age 48.5, SD 9.5 years) representing different districts and years of experience. Nurses identified 16 discrete usability issues (each reported by 10%-60% of participants). Two issues receiving the highest priority (3.0): ability to access a virtual platform (n=3, 30% of participants) and data-sharing mechanisms between nurses and providers (n=6, 60% of participants). There was a moderate correlation between priority rating and the percentage of nurses reporting each issue (ρ=0.63; P=.01). Average IUS ratings (77.8, SD 11.1; 100-point scale) indicated appropriate usability. There was no difference in IUS ratings by school nurse experience (P=.54), student caseload (P=.12), number of schools covered (P=.90), or prior experience with type 1 diabetes (P=.83), suggesting that other factors may influence usability. The design team recommended strategies for SPACE implementation to overcome high-priority issues, including training users on videoconferencing applications, establishing secure forms for school data reporting, and sharing glucose data in real-time during SPACE meetings.

Conclusions: Cross-sector interventions are complex, and perceived usability is a potential barrier to implementation. Using web-based cocreation methods with community partners promoted high-quality intervention design that is aligned with end-user priorities. Quantitative and qualitative assessments indicated appropriate degree of usability to move forward with pilot-testing.

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来源期刊
JMIR Diabetes
JMIR Diabetes Computer Science-Computer Science Applications
CiteScore
4.00
自引率
0.00%
发文量
35
审稿时长
16 weeks
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