Thais Favero Alves

Background: Childhood obesity remains a public health concern in the United States, disproportionately affecting Hispanic/Latino and rural populations. Despite this disparity, there is a lack of culturally relevant programs specifically designed to reach this population. To address this gap, our team culturally adapted a technology-based childhood obesity intervention, Hispanic Family Connections (HFC), targeting Hispanic/Latino families living in rural areas. The intervention comprises 2 main components: interactive voice response (IVR) calls and a workbook with at-home activities to promote family engagement. Objective: The objectives were to (1) evaluate the usability of the IVR calls and workbook included in the HFC intervention and (2) document and plan adaptations to these components using the FRAME (Framework for Reporting Adaptations and Modifications-Enhanced). Methods: We conducted 5 mixed methods, task-based usability tests (UTs) using the think-aloud procedure. All 5 participants were women, self-identified as Hispanic/Latino, and were Spanish literate. Each participant completed 3 think-aloud tasks designed to evaluate the usability of the IVR calls and workbook chapters. Usability was assessed using the After-Scenario Questionnaire (ASQ) at the end of each task and the System Usability Scale (SUS) at the end of the UT session. All sessions were recorded, and data were organized into two primary categories: (1) quantitative results (ASQ and SUS) and (2) qualitative data (participants’ comments and researchers’ observations). Findings were compiled and analyzed following the 8 main domains of FRAME. Results: For the workbook, ASQ scores showed a high level of ease in task completion (mean 1.1, SD 0.32), satisfaction with completion time (mean 1.0, SD 0.00), and satisfaction with support information (mean 1.5, SD 0.97). For the IVR calls, participants reported a higher level of ease in task completion (mean 1.0, SD 0.00), satisfaction with completion time (mean 1.0, SD 0.00), and satisfaction with support information (mean 1.2, SD 0.45). SUS results were positive for 80% (4/5) of participants, with an average usability score above the benchmark (mean 75.5, SD 15.04). Using FRAME, we identified and documented 30 suggestions for adaptations and improvements to the workbook and IVR calls. The majority of suggestions were content-related (n=26, 86.67%), with most focusing on tailoring/tweaking, or refining existing materials. Conclusions: The UT results, combined with systematic documentation using FRAME, allowed us to identify and prioritize the adaptations needed to improve the intervention materials. These refinements will prepare the HFC intervention for implementation in a subsequent feasibility study.

O uso de tecnologias móveis, como aplicativos e plataformas online, surge como uma ferramenta promissora na prevenção e enfrentamento da violência doméstica contra a mulher. Assim, objetivou-se identificar os aplicativos móveis desenvolvidos para prevenção e resposta à violência doméstica contra mulheres no Brasil. Trata-se de uma pesquisa qualitativa, do tipo prospecção tecnológica, realizada em abril de 2024, utilizando o termo “violência doméstica” nas lojas virtuais da Apple Store®, Google Play® e aplicativos Web via Google Chrome®. A análise de conteúdo foi empregada para avaliação dos achados. A busca inicial resultou em 378 aplicativos. Após a remoção dos duplicados e aplicação dos critérios de inclusão e exclusão, 33 aplicativos compuseram a amostra final. Os aplicativos identificados foram lançados entre 2017 e 2023, provenientes de 16 dos 27 estados brasileiros. A prospecção revelou um número expressivo de Apps disponíveis no Brasil, com recursos úteis, como acionamento do botão de pânico, informações sobre a Lei Maria da Penha, e acompanhamento profissional. Esses recursos podem servir como forma de empoderamento feminino na superação da violência, além de complementar o atendimento prestado pelos profissionais de saúde.

BACKGROUND Chatbots, a type of digital health intervention, are computer programs designed to simulate conversation with human users. Well-designed, evidence-based chatbots can provide patients with real-time, personalized health interactions and reliable support tailored to their individual needs and preferences. However, the development of chatbots that support specific disease states, such as breast cancer, is in its infancy, and more reliable evidence is needed for their use to successfully bridge the patient-provider communication gap and empower rural patients. OBJECTIVE The goal of the proposed project is to gather preliminary data on the modalities and applications in which chatbots have been utilized to support rural patients and to define the functionality and perceived usefulness of a chatbot design for rural Nebraskans with breast cancer. Our specific aims include 1) delineating rural breast cancer patients’ needs for nutrition, exercise, and education support for Chatbot content, and 2) developing a low-fidelity chatbot prototype for rural breast cancer patients to gather initial patient feedback. METHODS We will use a community-based participatory research study design, integrating with the user-centric Design Thinking Process. We will prospectively recruit a purposive sample of 33 participants, comprising 30 patients (15 English speakers and 15 Hispanic and Latino individuals) with breast cancer, and a sample of 3 patients with breast cancer living in rural areas to convene a community work group (CWG). Inclusion criteria are patients aged 19 years or older, English- and/or Spanish-literate, and living in rural Nebraska. The exclusion criteria comprise patients in hospice care. We will conduct interviews with study participants to understand their needs for nutrition, exercise, and educational support according to the phase/type of treatment and symptoms; their preferred communication methods; and their perceptions of receiving support through a chatbot. During the interviews, we will also administer the Breast Cancer Literacy Assessment Tool (Breast-CLAT) and the eHealth Literacy Scale (eHEALS) to measure participants’ health and technology literacy. With the CWG, we will conduct 4 brainstorming sessions to gather their feedback on study design adaptations, recruitment, and the chatbot content. Qualitative data will be recorded in their original language and will be analyzed using NVivo® software. The literacy questionnaires selected by the research team are standardized and validated in both languages, allowing meta-theme analysis and comparisons between the groups. RESULTS The results of this project inform the design, development, usability, and content validity of a chatbot for rural breast cancer patients in Nebraska and beyond for future study. CONCLUSIONS There is a critical need to identify the unique challenges rural breast cancer patients face due to their remote geographic proximity to timely oncology care. This proposal addresses an important scientific knowledge gap by designing a low-fidelity chatbot prototype that meets the needs of rural patients with breast cancer.

Community Health Workers (CHWs) play a pivotal role in the management of Type 2 Diabetes Mellitus (T2DM) within Primary Health Care settings. Adequate training is essential to strengthen their capacity to deliver care, particularly by fostering dialogue between the health team and the community. This study aimed to describe the co‐design process underlying the development of an educational technology (ET) intended to train CHWs in T2DM management in the Brazilian Amazon. This mixed‐methods study involved the development of video lectures and printed support materials through the following stages: identification of CHWs' primary training needs; definition of the ET structure; development of thematic content, scripts, and instructional materials; creation of interactive resources; expert review; preliminary presentation to CHWs; and final evaluation and validation by experts. Usability was assessed by CHWs using the System Usability Scale (SUS), with scores ≥72.74 considered indicative of acceptable usability. The 17 participating CHWs rated the ET positively, with a mean SUS score of 84 ± 11.1, reflecting high usability. The educational technology demonstrated strong usability and, given its collaborative and problem‐oriented development process, represents a promising tool to enhance CHWs’ performance in T2DM management.

Background: Hispanic and Latino individuals represent 14.6% of rheumatoid arthritis (RA) cases in the United States and experience significant disparities in access to rheumatologic care, disease management, and health outcomes. Mobile health (mHealth) apps are promising tools to improve patient-provider communication and self-management among populations with language and literacy barriers. However, few RA-focused digital health interventions (DHIs) have been culturally adapted for Spanish-speaking Hispanic and Latino individuals. Objective: This study aims to assess the health literacy, eHealth literacy, technology trust, and digital self-efficacy of Hispanic and Latino individuals with RA, and to evaluate the cultural relevance, usability, and patient satisfaction of the Spanish-language RunRA app. Additionally, it will explore health care providers’ perceptions of the app’s usefulness for clinical decision-making and communication with Hispanic and Latino patients. Methods: A prospective, iterative convergent mixed methods design integrated with the Framework for Reporting Adaptations and Modifications–Expanded (FRAME) will be used. We will recruit 25 Hispanic and Latino patients with RA and 7 Spanish-speaking health care professionals. Quantitative data will include standardized questionnaires (SAHL-S, eHEALS, Human-Computer Trust Scale, Digital Self-Efficacy Scale) and app analytics. Qualitative data will be collected via interviews and focus groups using the Cultural Relevance Questionnaire (CRQ), System Usability Scale (SUS), and Mobile Application Rating Scale (uMARS). Data will be analyzed using an independent intramethod strategy, with integration guided by FRAME to inform culturally relevant app modifications. Results: We anticipate enrolling 32 participants (25 patients and 7 providers). This study will be the first to evaluate the cultural relevance and usability of an mHealth app specifically designed for Spanish-speaking Hispanic and Latino individuals living with RA. Conclusions: Our long-term goal is to assess the potential for the mHealth app to act as a vehicle for the dissemination of accurate, useful, usable, and understandable health information to populations that experience health disparities and their health care providers. Findings will inform iterative refinements to RunRA and contribute to the development of culturally responsive DHIs aimed at improving communication, shared decision-making, and health outcomes in underserved populations.

Resumo Objetivos: Traduzir e adaptar transculturalmente, para o contexto brasileiro, a escala Organizational Readiness to Change Assessment. Métodos: O processo de tradução e de adaptação transcultural ocorreu em seis etapas: 1) anuência do autor da escala original; 2) duas traduções da escala para o português e síntese em uma versão; 3) retrotradução; 4) comitê de avaliação da versão inicial (dez participantes): clareza, compreensão e adequação ao contexto brasileiro; 5) avaliação de especialistas I (mesmos da etapa anterior): avaliação das equivalências semântica, idiomática, cultural e conceitual; 6) avaliação de especialistas II (sete especialistas: cinco regiões do Brasil): avaliação das equivalências semântica, idiomática, cultural e conceitual, considerando variações linguísticas do Brasil, e estabelecimento da versão final. Os especialistas das diferentes etapas eram profissionais com experiência acadêmica ou profissionais da saúde pública. Para as avaliações das etapas 5 e 6, utilizou-se o índice de validade de conteúdo, considerando-se como aceitável uma concordância de pelo menos 80,0% entre os especialistas. Resultados: As 20 questões da escala e seus itens adicionais (totalizando 74 itens para serem respondidos) foram traduzidos e adaptados conforme necessidades identificadas nas diferentes etapas do processo. Nas etapas 5 e 6, as questões dos três domínios da escala (evidência, contexto e facilitação) apresentaram adequada validade de conteúdo. Duas questões apresentaram índice de validade de conteúdo <80,0% em alguma das equivalências. Esses e outros itens com sugestões de alterações foram ajustados, gerando-se a versão final da escala. Conclusão: A escala foi traduzida e adaptada transculturalmente para o contexto brasileiro, apresentando adequada validade de conteúdo.

Objectives: To translate and culturally adapt the Organizational Readiness to Change Assessment scale to the Brazilian context. Methods: The translation and cross-cultural adaptation process took place in six stages: 1) authorization from the author of the original scale; 2) two translations of the scale into Brazilian Portuguese and synthesis into a single version; 3) back-translation; 4) evaluation of the initial version by a review committee (ten participants): clarity, comprehension, and suitability to the Brazilian context; 5) expert assessment I (same participants as the previous stage): evaluation of semantic, idiomatic, cultural, and conceptual equivalences; 6) expert assessment II (seven experts from five Brazilian regions): evaluation of semantic, idiomatic, cultural, and conceptual equivalences, considering linguistic variations in Brazil, and establishment of the final version. The experts involved in the different stages were professionals with academic experience or working in public health. For the assessments in stages 5 and 6, the content validity index was applied, considering agreement of at least 80.0% among experts as acceptable. Results: The 20 questions of the scale and their additional items (a total of 74 items to be answered) were translated and adapted according to the needs identified at different stages of the process. In stages 5 and 6, the questions of the three domains of the scale (evidence, context, and facilitation) demonstrated adequate content validity. Two questions presented a content validity index <80.0% in some equivalences. These and other items for which modifications were suggested were adjusted, resulting in the final version of the scale. Conclusion: The scale was translated and culturally adapted to the Brazilian context, demonstrating adequate content validity.

Food insecurity disproportionately affects Hispanic households in the US. This study examines food access perceptions among rural Latinos, acknowledging that food environments are complex systems influenced by factors such as availability, accessibility, affordability, acceptability, and accommodation. This phenomenological qualitative study was conducted with adult Latinas living in Nebraska’s rural areas. Data was collected through participatory mapping, semi-structured interviews guided by the five dimensions of food access, and demographic surveys. Eighteen women participated in in-person interviews, and 68.3% of participants met the criteria for food insecurity. While chain stores were the primary shopping option in rural areas, challenges included limited availability of foods that are culturally relevant and accommodate special dietary needs. Ethnic stores were valued for cultural relevance despite concerns about quality and pricing. Overall, affordability was a significant barrier due to high rural costs, worsened by challenges in navigating nutrition program benefits and documentation status. Research or interventions targeting improvements in rural food security must extend beyond mere store availability, focusing on economic development, policy reform, and enhanced education in assistance programs to address these complex challenges.

BACKGROUND Hispanics/Latinos (H/L) represent 14.6% of rheumatoid arthritis (RA) cases in the United States and experience significant disparities in access to rheumatologic care, disease management, and health outcomes. Mobile health (mHealth) apps are promising tools to improve patient–provider communication and self-management among populations with language and literacy barriers. However, few RA-focused digital health interventions (DHIs) have been culturally adapted for Spanish-speaking H/L individuals. OBJECTIVE This study aims to assess the health literacy, eHealth literacy, technology trust, and digital self-efficacy of H/L individuals with RA, and to evaluate the cultural relevance, usability, and patient satisfaction of the Spanish-language RunRA app. Additionally, it will explore healthcare providers’ perceptions of the app’s usefulness for clinical decision-making and communication with H/L patients. METHODS A prospective, Iterative Convergent Mixed Methods (ICMM) design integrated with the Framework for Reporting Adaptations and Modifications–Expanded (FRAME) will be employed. We will recruit 25 H/L patients with RA and 7 Spanish-speaking healthcare professionals. Quantitative data will include standardized questionnaires (SAHL-S, eHEALS, Human-Computer Trust Scale, Digital Self-Efficacy Scale) and app analytics. Qualitative data will be collected via interviews and focus groups using the Cultural Relevance Questionnaire (CRQ), System Usability Scale (SUS), and Mobile Application Rating Scale (uMARS). Data will be analyzed using an Independent Intramethod Strategy, with integration guided by FRAME to inform culturally relevant app modifications. RESULTS We anticipate enrolling 32 participants (25 patients and 7 providers). This study will be the first to evaluate the cultural relevance and usability of an mHealth app specifically designed for Spanish-speaking H/L individuals living with RA. CONCLUSIONS Our long-term goal is to assess the potential for the mHealth app to act as a vehicle for the dissemination of accurate, useful, usable, and understandable health information to populations that experience health disparities and their health care providers. Findings will inform iterative refinements to RunRA and contribute to the development of culturally responsive DHIs aimed at improving communication, shared decision-making, and health outcomes in underserved populations.

Food insecurity disproportionately affects Hispanic households in the US. This study examines food access perceptions among rural Latinos, acknowledging that food environments are complex systems influenced by factors such as availability, accessibility, affordability, acceptability, and accommodation. This phenomenological qualitative study was conducted with adult Latinas living in Nebraska’s rural areas. Data was collected through participatory GIS mapping, semi-structured interviews guided by the five dimensions of food access, and demographic surveys. Eighteen women participated in in-person interviews, and 68.3% of participants met the criteria for food insecurity. While chain stores were the primary shopping option in rural areas, challenges included limited availability of foods that are culturally relevant and accommodate special dietary needs. Ethnic stores were valued for cultural relevance despite concerns about quality and pricing. Overall, affordability was a significant barrier due to high rural costs, worsened by challenges in navigating nutrition program benefits and documentation status. Research or interventions targeting improvements in rural food security must extend beyond mere store availability, focusing on economic development, policy reform, and enhanced education in assistance programs to address these complex challenges.