Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Aug 16, 2019
Date Accepted: Jun 3, 2020
The Artful Synthesis of Opposing Needs: Designing an Information and Communications Technology Tool with Victims of Violence and their Case Managers in San Francisco
ABSTRACT
Background:
Violence is a public health crisis. Hospital-based violence intervention programs (HVIPs), such as the San Francisco Wraparound Project (WAP), have been shown to reduce future violent injury. The WAP model employs culturally competent case managers who enroll violently injured patients to become WAP clients. Client acceptance of the WAP intervention is variable and program success depends on streamlined, timely communication and access to resources. The high rates of smartphone usage among populations using the Emergency Department and among individuals at highest risk of experiencing violence create an opportunity for information and communication technology (ICT) to be a promising tool in violence intervention.
Objective:
Current evidence shows that ICT tools developed in the healthcare space may not be successful in engaging vulnerable populations. The goal of this study is to use the human-centered design methodology (HCD) to identify the unique communication needs of the clients and case managers at WAP to design a mobile ICT.
Methods:
We conducted 14 semi-structured interviews with clients, their friends and families, case managers, and other stakeholders in violence intervention and prevention. Using HCD methodology, we conducted thematic analysis to identify themes in the qualitative data, which were extrapolated to insight statements and then reframed into design opportunities. Wireframes of potential ICT mobile app screens were developed to depict these opportunities.
Results:
HCD methodology identified tensions within the needs of our different stakeholders and led to the following insight statements: 1) A successful relationship is both professional and personal, clients need this around the clock, whereas case managers can only support this while on the clock; 2) Communications need to feel personal, but they don’t all need to be personal; 3) Social networks need to provide peer support for healing, not peer pressure to propagate violence; 4) Healing is a journey of skill development and lifestyle changes that must be acknowledged, monitored and rewarded. These insights resulted in the following design opportunities: 1) Maximize personal connection while controlling access; 2) Support clients while fostering independence; 3) Build a connected, yet confidential community; 4) Hold clients accountable to progress and reward achievements.
Conclusions:
HCD methodology enabled us to identify unique opportunities for design in the creation of a mobile ICT tool for clients and their case managers.
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