Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study.

BACKGROUND: Sexual pain is a common but neglected disorder that affects approximately 3% to 18% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients. OBJECTIVE: The purpose of this study was to understand patients' perspectives on how sexual pain-related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions. METHODS: Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis. RESULTS: The findings revealed 4 overarching themes that represented participants' perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain. CONCLUSIONS: This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions.

The quality, suitability, and readability of web-based resources on endometriosis-associated dyspareunia: A systematic review.

People commonly and increasingly rely on the internet to search for health information, including those related to endometriosis-associated dyspareunia. Yet the content of such websites may be of variable accuracy and quality. This review aims to evaluate the quality, readability, and suitability of web-based resources on endometriosis-associated dyspareunia for patients. We searched 3 databases - Google, Bing, and Yahoo - to identify websites related to endometriosis-associated dyspareunia. Two independent reviewers screened the search results against inclusion and exclusion criteria. Another set of two reviewers evaluated the selected websites using validated measurement instruments. Out of 450 websites, 21 met the inclusion criteria and were evaluated. More than half of the websites had information on content updates, reported on authorship, or disclosed sponsorship information. The mean quality and suitability scores were 47.5 (SD = 13.3) and 65.2 (SD = 13.6) respectively, thus suggesting generally adequate quality and suitability levels. However, the mean readability scores exceeded the recommended level for health-related websites. The poor readability of the websites might limit accessibility for a significant proportion of patients with low educational levels. The findings of this review have implications for designing high-quality, readable and up-to-date web interventions for people who rely on web platforms as an alternative or complementary source of health information on dyspareunia.

Defining destigmatizing design guidelines for use in sexual health-related digital technologies: A Delphi study.

OBJECTIVE: Stigma has been recognized as a significant issue in sexual health, yet no specific guidelines exist to support digital health development teams in creating stigma-alleviating sexual health digital platforms. The purpose of this study was to develop a set of design guidelines that would serve as a reference point for addressing stigma during the design of sexual health-related digital platforms. MATERIALS AND METHODS: We conducted a 3-round Delphi study among 14 researchers in stigma and sexual health. A preliminary list of 28 design guidelines was generated from a literature review. Participants appraised and critiqued the clarity and usefulness of the preliminary list and provided comments for each item and for the overall group of items at each round. At each round, a content validity index and an interquartile range were calculated to determine the level of consensus regarding the clarity and usefulness of each guideline. Items were retained if there was high consensus or were dropped if there was no consensus after the three rounds. RESULTS: Nineteen design guidelines achieved consensus. Most of them were content-related guidelines and sought to address the emotional concerns of patients that could potentially aggravate stigma. The findings also reflected modern stigma management strategies of making stigma a societal attribute by challenging, exposing, and normalizing stigma attributes via web platforms. CONCLUSION: To address stigma via digital platforms, developers should not just concentrate on technical solutions but seriously consider content-related and emotional design components that are likely to result in stigma.

Trauma-Informed Care in Digital Health Technologies: Protocol for a Scoping Review.

BACKGROUND: The use of digital health technologies is becoming increasingly common across the globe as they offer immense potential to enhance health care delivery by promoting accessibility, flexibility, and personalized care, connecting patients to health care professionals, and offering more efficient services and treatments to remote residents. At the same time, there is an increasing recognition of how digital health can inadvertently foment psychological trauma. This phenomenon has led to the adoption of trauma-informed care in designing and deploying digital health technologies. However, how trauma-informed care is defined and characterized, and the various trauma-informed care strategies used in designing and deploying digital health technologies remain unexplored. OBJECTIVE: This scoping review aims to explore and synthesize the literature on how trauma-informed care is defined and characterized in digital health and the various trauma-informed care principles, strategies, or recommendations used in designing and deploying digital health. METHODS: This review will draw on the Joanna Briggs Institute's updated methodological guidance for scoping reviews. A search will be conducted on CINAHL, PubMed, Embase, Compendex Engineering Village, Web of Science, Scopus, and PsycINFO. This review will consider published research studies and unpublished work (gray literature). Studies will be included if they applied trauma-informed care in designing or deploying digital health for patients across all geographical locations or provide trauma-informed recommendations on how web developers should develop digital health. Studies will be limited to publications within the past 10 years and studies in all languages will be considered. Two independent reviewers will screen the titles and abstracts, and then perform a full-text review. Data will be extracted into a data extraction tool developed for this study. RESULTS: The scoping review was undergoing a full search as of April 2023. The main results will synthesize the peer-reviewed and gray literature on adopting trauma-informed care practices in digital health research and development. The study is expected to be completed by December 2023 and the results are expected to be published in a peer-reviewed journal. CONCLUSIONS: This review is expected to provide the knowledge base on the adoption of trauma-informed care in designing and deploying digital health. This knowledge can lead to more engaging, and likely, more effective digital health interventions that have less potential for harm. A synthesis of the various trauma-informed care strategies in digital health will also provide a trauma-informed language by enabling researchers and digital health developers to consider trauma as a critical factor in each stage of the design process. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46842.

Developing an Educational Website for Women With Endometriosis-Associated Dyspareunia: Usability and Stigma Analysis.

BACKGROUND: Endometriosis is a chronic condition that affects approximately 10% of women worldwide. Despite its wide prevalence, knowledge of endometriosis symptoms, such as pelvic pain, and treatments remains relatively low. This not only leads to a trivialization of symptoms and delayed diagnosis but also fuels myths and misconceptions about pain symptoms. At the same time, the use of web-based platforms for information seeking is particularly common among people with conditions that are perceived as stigmatizing and difficult to discuss. The Sex, Pain, and Endometriosis website is an educational resource designed to provide evidence-based information on endometriosis and sexual pain to help people understand the condition, feel empowered, dispel myths, and destigmatize endometriosis-associated sexual pain. OBJECTIVE: The study objective is to evaluate the usability of the website and assess for destigmatizing properties of sexual health-related web-based resources. METHODS: We conducted a usability analysis by using a think-aloud observation, a postsystem usability questionnaire, and follow-up interviews with 12 women with endometriosis. The think-aloud data were analyzed using the framework by Kushniruk and Patel for analyzing usability video data, the questionnaire data were analyzed using descriptive statistics, and the follow-up interviews were analyzed using simple content analysis. We conducted a usability assessment by deductively analyzing the interview data via a trauma-informed care framework and a content analysis approach. RESULTS: Through usability analysis, we found the website to be simple, uncluttered, satisfying, and easy to use. However, 30 minor usability problems related to navigation; website response; the comprehension of graphics, icons, and tabs; the understanding of content; and mismatch between the website and users' expectations were reported. In our stigma analysis, we found the web content to be nonstigmatizing. The participants suggested ways in which websites could be designed to address stigma, including ensuring privacy, anonymity, inclusiveness, and factual and nonjudgmental content, as well as providing opportunities for web-based engagement. CONCLUSIONS: Overall, the participants found the website to be useful, easy to use, and satisfying. The usability problems identified were largely minor and informed the website redesign process. In the context of the limited literature on stigma and website design, this paper offers useful strategies on how sexual health-related websites can be designed to be acceptable and less stigmatizing to individuals with sensitive health issues.

Stigmatizing and de-Stigmatizing Properties of Web Apps for Sexual Health-Related Conditions: A Scoping Review.

Objective: To review the literature that has examined stigma in relation to the design, impact, and ways web apps can alleviate or aggravate sexual health-related stigma. Methods: Six databases were searched and 17 studies met the inclusion criteria. Results: While two studies were randomized controlled trials, most studies were descriptive or qualitative. Stigma may be alleviated in web apps through sharing stigma-related experiences, receiving emotional support, and providing anonymous virtual connections Yet, stigma may be aggravated by implied disclosure, inappropriate content, and stigma by association. Conlcusions: While web apps were able to address stigma to some extent, some strategies employed inadvertently aggravated stigma.

Application of Anti-Stigma Design Heuristics for Usability Inspection.

User interface evaluation has become important in developing usable health care technologies. Although usability engineering methods have been applied in the design and evaluation of health care software, available heuristics focus on task-work aspects and do not address stigma associated with many health conditions. We used a previous set of heuristics and propose a new set of anti-stigma heuristics to evaluate stigmatization in health care websites. The extended set of heuristics were concurrently applied in a heuristic evaluation and a cognitive walkthrough to evaluate an endometriosis and sexual pain website. The walkthrough involved 5 tasks that required 21 actions to execute. Twenty-six usability problems were identified and recommendations for re-design were made to the design team before end-user testing. The anti-stigma heuristics received worse ratings than the traditional heuristics, resulting in several design changes that might otherwise have been missed. Thus, the new anti-stigma heuristics were a valuable contribution.

COVID-19 information-related digital literacy among online health consumers in a low-income country.

BACKGROUND: The internet has become an important source of health information among people across the globe. However, the novel coronavirus outbreak has led to a broader dissemination of fake and misleading health information. While health professionals may be able to critically evaluate internet-based information, the skills at finding, appraising, and using COVID-19-related online information may be problematic for laypeople in low-income countries. The purpose of this study was to examine the digital literacy of lay consumers of online COVID-19-related information in Ghana. METHOD: A cross-sectional survey was conducted among online health consumers across five regions in Ghana. Participants were conveniently recruited through social media, and the survey was based on the eHealth Literacy Scale (eHeals) and administered through Qualtricsxm software. We calculated the overall mean eHeals score to determine the literacy levels and performed descriptive statistics to describe the characteristics of the sample. Linear regression analysis was performed to determine the factors associated with respondents' digital literacy. RESULT: Out of 700 respondents sent with a survey link, 325 responded (46.4 % response rate). The majority of the respondents were: younger than 31 years (M = 28.42, SD = 6.98), males (59.7 %), use the internet daily (94.4 %), engaged in social media activities (65 %), and frequently search the internet for information related to COVID-19. The overall eHealth literacy was quite high (M = 4.01, SD = 0.95), but respondents' scores on items 1 and 6 were relatively low. Sex, age, frequently searching the internet for COVID-19 information, using the internet for educational purposes, and having a little/adequate knowledge of COVID-19 was predictive of digital literacy. CONCLUSION: The study revealed a high overall digital literacy as well as sex and age differences in literacy levels among online health consumers in Ghana. However, respondents' ability to locate COVID-19 related informaion and their skills in differentiating scientific from unscientific internet-based information remain relatively low. These findings offer useful insight that can inform the design of inclusive internet-based preventive resources that would be accessible and understandable to laypeople across all age groups and sexes in low-income countries.

Health providers' readiness for electronic health records adoption: A cross-sectional study of two hospitals in northern Ghana.

INTRODUCTION: Electronic Health Records are receiving considerable attention as a valuable tool for managing clinical information. Despite the prospects of Electronic Health Records in developing countries, many pre-implementation assessments target organizational, managerial, and infrastructural readiness, but barely include a detailed examination of health provider readiness. Meanwhile, health provider readiness is a critical success factor for electronic health records in settings where the majority of the workforce is less likely to have basic computer skills. We sought to assess the readiness of health providers for electronic health records in Ghana. MATERIALS AND METHOD: An institutional-based cross-sectional study was conducted among 350 health providers in northern Ghana from June-September 2019. Data were collected using a modified questionnaire on provider readiness. The mean overall readiness was calculated for each respondent. Providers with readiness score below the overall mean score were categorized as not being ready while those at or above the mean score were considered ready. Multiple linear regression was conducted to determine the factors that determine provider readiness. RESULTS: Two hundred and nine health providers responded to the questionnaire (59.7 response rate). The mean overall readiness was 3.61 (SD = .76), mean core readiness was 3.74 (SD = .80), and mean engagement readiness was 3.47 (SD = .67). Using the average overall readiness score as the cut-off for determining being ready and not ready for electronic health records, overall readiness was 54.9%, core readiness was 67.2%, while engagement readiness was 43.1%. Age, sex, old employees compared to new employees, computer literacy, and knowledge of electronic health records were significant determinants of health providers' readiness to adopt electronic health records. CONCLUSION: We observed that health providers were marginally ready for electronic health records adoption. While participants might have expressed dissatisfaction with paper-based records and expressed a desire for electronic health records, they expressed fear of the potential impact of computerized records. We proposed a robust informatics curriculum and capacity building workshops for improving provider readiness for electronic health records.