More than 80 million Americans lack adequate access to the healthcare they need.1 This lack of access directly translates to worse health outcomes.2 Despite the rapid expansion of device access and internet connectivity across the U.S., some regions are progressing faster than others in their capacity to leverage digital health services.3, 4 These ongoing inequities within the digital health landscape necessitate a mechanism for measuring a community’s suitability for digital health services, which is what the Digital Health Index (DHI) achieves. Yet, the DHI lacks a companion tool to operationalize the index, enhancing accessibility and enabling data visualization across geographic regions. Fortunately, the rise of digital health and online platforms (e.g., patient portals and GeoHealth web tools) has helped close the healthcare access gap by improving outcomes through greater access to personal health information. A key component of success with digital health technologies, specifically GeoHealth web tools, is the implementation of user-centered design principles,2, 5, 6 which improve user engagement, adherence, and outcomes.7, 8 However, poor user-centered design leads to lower user engagement,9, 10 resulting in the underutilization of online tools due to usability issues.9The purpose of this dissertation study is to leverage user-centered design principles to inform the design and development of the DHI GeoHealth web tool. Eligible participants (n=31) from two target audiences, the general population and healthcare professionals (i.e., researchers and providers), completed focus groups (7 groups of 3-5 participants each) to inform the design of the tool (Aim 1). A GeoHealth web tool prototype was developed based on the user needs assessment (Aim 2), which underwent formal usability testing with 15 participants (n=15) from the same population groups (Aim 3). The primary result of this study was a fully operationalized DHI GeoHealth web tool that is in production. This study also revealed key insights and perceptions from both user groups regarding their views of health-related information online (Aim 1), their perceptions of existing GeoHealth web tools (Aim 1), and the usability and satisfaction with the GeoHealth web tool prototype (Aim 3). Participant feedback from the user needs assessment (Aim 1) aligned with the findings from usability testing (Aim 3). For example, GeoHealth web tools should include customizable features (e.g., filtering and data export options, a chatbot, and be accessible on mobile platforms). These features and options were implemented in the tool’s development (Aim 2). However, healthcare professionals rated the prototype's usability and satisfaction higher than the general population. Additionally, this study found a strong desire for and value in chatbot-integrated platforms among both populations. The user-centered recommendations from this study have implications for GeoHealth and geospatial tools more broadly, particularly those with integrated chatbots. Suggestions for improving site feature discoverability (i.e., ability to locate site features such as a map or chatbot), interactive map navigation, and considerations for varying levels of digital literacy related to GeoHealth web tools were recommended. These findings address the need for user-centered design to improve user engagement and utilization within digital health and indicate the need for additional research to build on them.
John Geracitano (Fri,) studied this question.