With support from Boston College Internal Funding – Academic Technology Innovation Grant (ATIG), the project, Using Human-Centered Design and Co-Design Methodology to Engage Resettled Refugee Communities in Developing a Digital App for the Family Strengthening Intervention for Refugees, is focused on administering a digital application of our Family Strengthening Intervention for Refugees (FSI-R) for the Somali Bantu and Bhutanese communities in New England. The FSI-R consists of ten modules designed to build communication and family relationships, illuminate and engage in problem-solving regarding concerns about children, and help families plan for a future together. The aims of the FSI-R are to improve family-child relationships, empower children and families with tools to be resilient, improve the mental health for school-aged youth, and reduce existing mental health disparities. The proposed project leverages progress over the last two years to digitally adapt the FSI-R in order to: 1) increase functionality and interactivity of our digital apps; 2) conduct co-design with end-users to increase culturally- and linguistically- appropriate features for the client-facing app; and 3) conduct theater testing with a small sample of families from each community. Our ATIG funding has enabled us to support a multidisciplinary team of Boston College students which includes undergraduate computer science students, masters in social work project managers, graphic designers, and faculty to digitally adapt the manual used in the delivery of the FSI-R, replacing the paper manual that our CHWs currently use to deliver the intervention with families.
A central feature in the development of the family-facing version of the FSI-R application involves the application of human-centered design principles and co-design methodology. Our target populations experience low tech literacy, low language literacy (even in the native languages), and cultural differences, so engaging end-users in the development of the digital components and imagery of the FSI-R apps has been a priority to maximize engagement, buy-in, and sustainability of digital engagement in the FSI-R. Community members, including male and female adults and youth from each community, are invovled in the application development by partaking in “Community Co-Design Teams” (CCDTs) to collaboratively yield culturally-relevant imagery and intervention content highly acceptable by the two communities. Sunand Bhattacharya, Associate Vice Provost for Design and Innovation Strategies at Boston College, provides ongoing coaching and guidance on best practices for employing co-design and design thinking methodology. Our co-design methodology involves an iterative process beginning with idea generation, elaboration, and refinement. CCDTs share thoughts, personal images, written text, and images from Google searches to visually construct a variety of concepts ranging from concrete (e.g., refugee camp) to more abstract (e.g., wellness). Through group discussion and story-telling, key elements of images are highlighted. The group then votes on their preferred image concept, which is then further refined through additional discussion and image search.
Our continued work to develop and test the two digital FSI-R apps will move through the following phases from June 2021-May 2023:
- Finalizing App Development – We will use the skills of computer science and design students to help us create and embed culturally and linguistically tailored training videos and tutorials, links to resources and additional information, and additional interactive features of the apps, such as the ability for CHWs to highlight and take notes on their own digital manual.
- The use of Interface/User Experience Testing - We will engage in user interface (UI) and user experience (UX) testing to get community member feedback of the suggested prototyped components of the digital FSI-R that integrate live video capture, replay features, and adaptive content.
- Continued engagement of Community Co-Design Teams (CCDTs) - We will continue to convene Community Co-Design Teams with each of the Bhutanese and Somali Bantu community members to enable us to build and refine imagery that is rich and relevant to the concepts and themes of the FSI-R.
- Pilot testing with 4 refugee families, 2 families at each site (Lewiston, Maine for the Somali Bantu and Springfield, Massachusetts for the Bhutanese) - We will be conducting with two selected families from each community. These families will be selected as newcomers who have not been formally enrolled in our previous NIMHD-funded FSI-R study. We will use the digital prototype to investigate the experience of families and refugee home visitors in delivery the FSI-R apps and use quantitative (i.e. satisfaction checklists) and qualitative data (i.e. UI/UX data collection) to unpack the experience of both the families receiving the intervention and the refugee home visitors.
- Evaluation and Manuscript – CHW, community co-design team, and family feedback will be collected, analyzed, synthesized, and shared with team members to assess feasibility, acceptability, and usability of the apps. These quantitative and qualitative data will be summarized in team discussions and reports to address any remaining needs and to prepare for grant applications to support scale up of this project. We plan to submit a mansuscript on these findings, lead author will be a student at Boston College School of Social Work.
Prior NIMH-funded R01 Study
For 15 years, Dr. Theresa Betancourt has worked with refugees in the New England Area through Cross-cultural application of community-based participatory research (CBPR) methods. Using a CBPR approach, a family based prevention model, the Family Strengthening Intervention for Refugees (FSI-R) was adapted from a tested model used in Africa and designed for delivery by refugee community health workers with through a process involving stakeholder consultation and local refugee Community Advisory Board input. Pilot data on the FSI-R demonstrated that a family home-visiting interventionadministered by refugees for refugees using a CBPR approach is feasible and acceptable. The retention rate of 82.50% is comparable to retention rates of other refugee interventions. From 2019-2022, we ran a Hybrid Type 2Effectiveness-Implementation Design (families with children aged 7-17 in a two-arm randomized controlled trial); (2) identify barriers and facilitators to implementation of the FSI-R by community health workers by conducting a process evaluation concurrent with the delivery of the intervention; and (3) strengthen the science of community engagement to address health disparities by fortifying CBPR-based pathways of change via collaborative partnerships between refugee communities, service providers, and academic stakeholders. We are currently analyzing this data.
For more information on this prior study, please contact our Post Doctoral Fellow, Dr. Euijin Jung.
This project has support Boston College Academic Technology Innovation Grant.
Jewish Family Services (JFS), Maine Immigrant and Refugee Services (MEIRS).