JMIR Publications

ABSTRACT

Background:

Migrants are disproportionately affected by HIV, HBV, and HCV. Clinicians, at-times, fail to offer rapid diagnostic testing (RDT) for these viruses when a language barrier exists in the patient-clinician relationship therefore creating missed testing opportunities. While their effectiveness has been demonstrated elsewhere, conventional, in-person interpreters are costly and underused in practice. Furthermore, clinicians often call upon ad hoc interpreters which introduce complexities in the clinical relationship. Digital solutions exist to diminish the burden of language barriers however the challenges of developing a multilingual and multicultural application have yet to be documented in respect to RDT in the non-Francophone migrant population in France.

Objective:

Our goal is to design a multilingual application to overcome language barriers, health literacy barriers, and fears related to being tested to promote rapid diagnostic testing of HIV, HBV, and HCV in the non-Francophone migrant population in France.

Methods:

A combination of qualitative methods, agile development, and user-centred design were used. We conducted two focus groups with 12 participants, including physicians, nurses, and social workers conducting RDT, and 1 modified Delphi survey with 68 participants including physicians and nurses. Focus groups explored the content (risk factors, medical history), functions (cultural adaptation, instant translation), and interface ergonomics (graphics, font) needed in the application. The Delphi presented 95 content items the researchers sought to include in the application.

Results:

Using focus groups to inform the Delphi survey, we scientifically determined the application’s content consisting of 95 items using expert consensus, developed a mock-up, and conducted initial user-testing. We created an application which contains both migrant and clinician interfaces, includes a sociodemographic questionnaire and risk assessment, health literacy, and testing barriers questionnaires available in 11 languages. Educational content is related to HIV, HBV, and HCV virus along with the ability to understand if the migrant agrees to be tested or not.

Conclusions:

This study allowed us to conceptualise a multilingual application that aims to increase acceptance of RDT for HIV, HBV, and HCV. The specific features of the AIDA application (Intelligent assistant for screening allophones) were designed to overcome testing barriers in the non-Francophone migrant population. The next phase will be an implementation study as we intend to validate our application.