Extending the trust-centered design framework to shared non-monetary healthcare transportation in resource-constrained communities: Mixed methods study (Preprint)

2026-02-10

<sec> <title>BACKGROUND</title> Technology-mediated ridesharing services have the potential to address healthcare access barriers for resource-constrained communities. However, cost and trust-related concerns about arriving safely, and on time, for appointments may thwart their success. Generalized favor exchange through non-monetary models like timebanking may address financial barriers, but they pose different considerations for facilitating trust than monetary-based ridesharing services. </sec> <sec> <title>OBJECTIVE</title> We investigated (a) how trust in transportation to healthcare appointments can be facilitated through the timebank; and (b) how a generalized favor-based ridesharing platform (GFRP) could be designed to facilitate trust between riders and drivers. </sec> <sec> <title>METHODS</title> Our trust-centered design involved applying Stzompka’s sociological trust theory as an extension to user-centered design. We conducted a 2-stage mixed methods study to gather feedback on trust-centered design ideas for a GFRP for healthcare appointments. First, focus groups with intermediaries from community-based organizations were conducted to understand contextual constraints, and to gather feedback on initial design ideas. Next, riders and drivers were asked to evaluate design ideas proposed in activity packets through surveys, and individual and group interviews. Descriptive statistics were compiled on the survey results. The transcribed interviews were coded based on the trust-centered design concept. Mixed analyses involved creating joint displays which summarized and compared the qualitative and quantitative data, and responses based on timebank membership and participant role. Metainferences were developed from the summaries recorded in the joint displays. </sec> <sec> <title>RESULTS</title> Focus groups with intermediaries (n=13) reinforced the current gaps in transportation and the importance of timebank for establishing trust amongst its members. Design sessions with riders (n=18) and drivers (n=16) revealed that features encouraging relationship-building were viewed as more favorable for promoting trust than ones that focused on accountability. Both riders and drivers felt that: (a) timebanks can help establish trust in exchanges through histories of reciprocation and social events; (b) endorsements about the driver may be an appropriate, fair and effective feature for establishing rider’s trust; (c) a shared checklist could foster riders and driver’s trust through reliable task performance and relationship building; (d) a “timebank buddy” is valued for monitoring the safe progress rides and additional opportunities for timebank participation; and (e) having timebank staff available to mediate conflicts makes trust in the transportation service easier. For riders who were not timebank members, understanding a driver’s goals and aspirations could help to facilitate trust through familiarity, relationship building, and reciprocity. Most riders noted how third-party tracking could protect them from safety risks, but drivers rejected perceived surveillance. </sec> <sec> <title>CONCLUSIONS</title> Through the application of trust theory, we offer future directions for developing trust-inducing cues for a generalized, favor-based ridesharing platform. Findings suggest new ways to facilitate trust through designing features focused on developing or enhancing trust-inducing situations that promote relationship building and accountability. </sec>

Embracing Chaos Again: Tracing Boundary Negotiating Artifacts in Knowledge Workers’ Data Practices for Collaborative Public Health Crisis Response

2026-04-13 · 1 citations

As knowledge workers, university personnel's data partnerships with government entities represent an emerging mode of collaboration for public health crisis response. However, little is known about how such collaborations unfold in non-routine, complex settings. This paper investigates a data partnership between a university research team and a state health department during the COVID-19 pandemic. Drawing on 15 interviews with university personnel, we analyzed their data practices using boundary negotiating artifacts (BNA) theory, identifying five key challenges and related artifacts. We found that the absence or breakdown of artifacts pushed university personnel toward ad hoc workarounds, while power dynamics complicated artifact creation and use. Consequently, collaboration relied more on broader sociotechnical arrangements than on artifacts themselves. These insights both enrich BNA theory's defining features of non-routine, complex collaborations and point to design opportunities for supporting knowledge workers engaged in crisis-driven data partnerships, which are often politically charged.

Community intermediary strategies and tactics to close digital divides and enhance equitable technology use in everyday life

Journal of the Association for Information Science and Technology · 2026-04-07

Abstract Online technologies are required for accessing essential services, such as healthcare, transportation, and education. Challenges to online technology access can prevent resource‐constrained communities from connecting to these services. Human intermediaries who act in the middle space between technology and the person using the technology may help to enhance access and use. Prior information science research has investigated formal intermediation offered by staff at community technology centers and public libraries. However, there is a lack of empirical and theoretical insight into how intermediaries help resource‐constrained communities with technology in the informal and semi‐formal settings of everyday life. Therefore, this study investigated how community intermediaries (i.e., friends, family members, and volunteers from resource‐constrained communities) assist with accessing and using technology. Interviews with community intermediaries ( n = 9) and those who received intermediary support (“beneficiaries,” n = 30) in a resource‐constrained American city were conducted. Results show that intermediary strategies address four digital access levels: relating to sociocultural and psychosocial motivators; acquiring basic internet and technology; developing and updating skills for ongoing use; and problem‐solving tasks for diverse use of evolving technology. Multiple tactics were used to implement these strategies. Findings can inform future training and infrastructure‐enhancement initiatives for informal and semi‐formal intermediaries from resource‐constrained communities.

Access to Technology-Mediated Community Mental Health Care Among Low-Socioeconomic Status Consumers With Serious Mental Illness: Qualitative Study

JMIR Formative Research · 2026-02-23

Background: Access to mental health care is critical for the effective management of serious mental illness (SMI), but consumers with low socioeconomic status (SES) have lower rates of service usage and worse retention in care. Digital technologies are often lauded as a way to bridge access gaps; however, little is known about how technology-mediated care may influence care access among low-SES consumers and how consumers use technology in care access. Objective: This study aimed to examine the applicability of Levesque et al's access framework to technology-mediated care for SMI and analyze how low-SES consumers use technology to facilitate care access. Furthermore, the study assesses whether and how technologies are involved in care access at multiple points within the process of accessing care. Methods: This study used 2 qualitative methods: ethnographic observations at a mental health treatment court and interviews with low-SES consumers with SMI using community mental health care (n=14) and key informant interviews with health and service providers working with this population (n=14). Observations occurred from July 2022 through September 2023, and interviews occurred between January 2022 and May 2024. Data analysis involved both inductive and deductive coding approaches. Data from both the interviews and observations were analyzed in NVivo and further triangulated through analytic memos. Results: Levesque et al's framework required several extensions to accommodate technology-mediated care related to SMI for low-SES consumers: (1) a cyclical rather than linear trajectory; (2) simultaneous care acquisition from multiple health and service providers; (3) staying in care long-term; (4) identification of both one-time and ongoing health needs; and (5) an emergency pathway for entering care. Consumers often faced challenges related to the varied digital requirements of each provider and a dearth of integrative, patient-facing tools like portals. Within this context, some consumers use mobile apps, communication, and telehealth technologies across various care access stages. Consumers used technology by figuring out how to navigate technology-mediated care, especially by leaning on others, such as case managers, for support. These others provided consumers with temporary technologies, showed them how to use technologies, and accompanied them through the process of using technology for accessing care. Conclusions: This study highlights that accessing care is iterative and ongoing, involving multiple forms of co-occurring service provision. A theoretical contribution of this work is its extension of Levesque et al's care access framework to better reflect technology-mediated care for SMI among low-SES consumers. This work also underscores ongoing challenges for accessing technology-mediated care and the importance of human support in addressing access difficulties. Clinical implications include incorporating digital readiness assessments and providing comprehensive guidance on how consumers can effectively use technologies for care. Future work should investigate how technology-mediated care can make care access easier rather than harder.

`I don't want to watch grown-up stuff': Children's and Parents' Perspectives and Recommendations for Health-Centered Digital Media Design

2025-04-24 · 3 citations

“Technology in some ways has been good, but it has also been very trying to figure it out”: A qualitative study of access to community mental health care among low-socioeconomic status consumers with serious mental illness (Preprint)

2025-06-24

<sec> <title>BACKGROUND</title> Access to mental healthcare is critical for the effective management of serious mental illness (SMI), but consumers with low-socioeconomic status have lower rates of service utilization and worse retention in care. Digital technologies are often lauded as a way to bridge access gaps; however, little is known about how technology-mediated care may influence care access among low SES consumers and how consumers use technology in care access. </sec> <sec> <title>OBJECTIVE</title> We examine the applicability of Levesque et al.’s access framework to technology-mediated care for SMI and analyze how low-SES consumers use technology to facilitate care access. </sec> <sec> <title>METHODS</title> Ethnographic observations at a mental health treatment court and interviews with low SES CMH consumers with SMI using CMH (n=14) and key informant interviews with health and service providers (HSPs) working with this population (n=14). </sec> <sec> <title>RESULTS</title> Levesque et al.’s framework required several extensions to accommodate care related to SMI for low-SES consumers: (1) a cyclical rather than linear trajectory; (2) simultaneous care acquisition from multiple HSPs; (3) staying in care long-term; and (4) identification of both one-time and ongoing health needs; and (5) an emergency pathway for entering care. Consumers often faced challenges related to the varied digital requirements of each provider and a dearth of integrative, patient-facing tools like portals. Within this context, some consumers use mobile apps, communication, and telehealth technologies across various care access stages. Consumers used technology by figuring out how to navigate technology-mediated care, especially by leaning on others, such as case managers, for support. These others provided consumers with temporary technologies, showed them how to use technologies, and accompanied them through the process of using technology for accessing care. </sec> <sec> <title>CONCLUSIONS</title> A theoretical contribution of this work is its extensions of Levesque et al.’s care access framework to better reflect technology-mediated care for SMI among low-SES consumers. This work also underscores ongoing challenges for accessing technology-mediated care and the importance of human support in addressing access difficulties. Clinical implications include incorporating digital readiness assessments and providing comprehensive guidance on how consumers can effectively use technologies for care. Future work should investigate how technology-mediated care can make care access easier rather than harder. </sec>

Comparing methods for determining home and work locations from geotagged social media data

2025-05-30

Geotagged social media data have emerged as a rich source of insight about spatial dimensions of social phenomena. This methodological article exploits a unique dataset that combines geotagged social media content and home and work locations collected from social media users through a survey to compare three methods of assigning home locations from geotagged social media: majority voting, time frame clustering, and a novel method using activity spaces created from users’ geotagged posts. Using exact match accuracy as the measure, the basic majority voting method achieved better high estimates for both current and previous home location predictions compared to the time frame clustering method. However, for work location prediction, time frame clustering showed better accuracy, and the activity space method contained 25.3% of true home and 44.4% of true work locations. The study found lower precision than others and highlights accuracy trade-offs among each option for assigning home or work locations from geotagged social media.

Individual and collective transitions: Changes in family information networks over time in life with chronic illness

Journal of the Association for Information Science and Technology · 2025-03-03

Abstract Chronic illness represents a transition for both patients and their family members although transitions and information behavior changes have largely been explored from an individual perspective. Illness‐related transitions may be undertaken individually or collectively, but little is known about how family information networks change in the face of either transition type. Therefore, we conducted a longitudinal, mixed‐methods study of information networks with 28 families managing HIV or diabetes. Methods included qualitative interviews, surveys, and social network analysis. Findings revealed that transitions were common among study families, with collective transitions more common than individual ones. Network size changed more among families undergoing collective transition versus those with individual or no transitions. Collective transition families experienced slightly more tie strength increases than individual transition families. More families undergoing collective transitions had illness peers in the family network than individual or no‐transition families. Reciprocal information sharing was also more common among illness peers. Findings support a distinction between individual and collective transitions and study of information network changes in each context. Future research should further characterize the drivers and dynamics of collective and individual transitions and related information behavior, while investigating how information systems and services can help.

After the disruptive innovation: How remote and digital services were embedded, blended and abandoned in UK general practice – longitudinal study

Health and Social Care Delivery Research · 2025-06-01 · 4 citations

Background: United Kingdom general practices transitioned rapidly to remote-by-default services in 2020 and subsequently considered whether and how to continue these practices. Their diverse responses provided a unique opportunity to study the longer-term embedding, adaptation and abandonment of digital innovations. Research questions: What was the range of responses to the expansion of remote and digital triage and consultations among United Kingdom general practices in the period following the acute phase of the coronavirus disease discovered in 2019 (COVID-19) pandemic? What can we learn from this example about the long-term impacts of crisis-driven sociotechnical change in healthcare settings? Methods: We collected longitudinal data from 12 general practices from 2021 to 2023, comprising 500 hours of ethnographic observation, 163 interviews in participating practices and linked organisations (132 staff, 31 patients), 39 stakeholder interviews and 4 multi-stakeholder workshops (210 participants), with additional patient and public involvement input. Data were de-identified, uploaded to NVivo (QSR International, Warrington, UK) and synthesised into case studies, drawing on theories of organisational innovation. Results: General practices' longitudinal progress varied, from a near-total return to traditional in-person services to extensive continuing use of novel digital technologies and pathways. Their efforts to find the right balance were shaped and constrained by numerous contextual factors. Large size, slack resources, high absorptive capacity, strong leadership and good intrapractice relationships favoured innovation. Readiness for remote and digital modalities varied depending on local tension for change, practice values and patient characteristics. Technologies' uptake and use were influenced by their material properties and functionality. Embedding and sustaining technologies required ongoing work to adapt and refine tasks and processes and adjust (or, where appropriate, selectively abandon) technologies. Adoption and embedding of technologies were affected by various staff and patient factors. When technologies fitted poorly with tasks and routines or when embedding efforts were unsuccessful, inefficiencies and 'techno-stress' resulted, with compromises to patient access and quality of care. Limitations: Sampling frame was limited to United Kingdom and patient interviews were relatively sparse. Conclusion: There is wide variation in digital maturity among United Kingdom general practices. Low use of remote and digital technologies and processes may be warranted and reflect local strategic choices, but it may also indicate lack of awareness and a reactive rather than strategic approach to digital innovation. We offer an updated typology of digital maturity in general practice with suggestions for tailored support. Future work: The typology of digital maturity could be applied further to identify in more detail the kind of support needed for practices that are at different stages of maturity and are serving different populations. The need for strategically traditional practices in deprived settings should also be explored. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132807.

The administrative burden of medication affordability resources: an environmental scan with implications for health informatics to advance health equity

Journal of the American Medical Informatics Association · 2025-06-18 · 1 citations

OBJECTIVE: To characterize and demonstrate how to reduce the administrative burden experienced by patients when navigating medication affordability resources in the United States. MATERIALS AND METHODS: Informed by administrative burden theory, we conducted an environmental scan of medication affordability resources for atrial fibrillation, and four common comorbidities (diabetes, heart failure, hypertension, and lipid disorder). We systematically searched for resources (eg, patient assistance programs, savings cards and nonprofit support) and extracted information about types, eligibility criteria, needed documentation, and application processes. RESULTS: We identified 66 resources across 12 categories across the five conditions. The resources' varied eligibility criteria, application processes, and requirements for providing sensitive financial documents could introduce multiple administrative costs for patients. DISCUSSION: The volume and complexity of medication affordability resources and related application processes may create substantial administrative burden for patients that could prevent their use-especially when prescribed multiple medications. CONCLUSION: Medication affordability resource informatics tools that reduce administrative burden could advance equitable medication access.