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Because of the challenges that Veterans with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) experience when transitioning home after hospitalization, re-hospitalization rates are often high. Although researchers and clinicians have developed effective interventions to address these difficulties, they are often resource intensive. Leveraging a user-centered design (UCD) process that foregrounded the Veteran experience, our research team developed a technology-assisted care transition intervention including an onscreen virtual nurse relational agent to teach patients during their hospitalization about four key pillars of a care transition: understanding one’s condition, identifying red flag symptoms, learning medication self-management, and attending follow-up appointments.1 After discharge, the intervention used automated, interactive text messages to further promote engagement with these concepts.
Our UCD process involved two Veteran-focused phases. First, we gathered iterative feedback from Veterans through card-sorting exercises and semi-structured interviews about the intervention components, including the “look and feel” of the virtual nurse relational agent and the content presented to Veterans through the onscreen nurse and text messages. Key feedback about the characteristics of the relational agent included the importance of a persona that generated a sense of warmth and comfort with a professional demeanor. Important insights regarding the texting protocol included avoiding vague wording and removing prompts likely to elicit unactionable answers or negative emotions (e.g. “How are you feeling today?”). Second, we worked with Veterans to beta test initial versions of the intervention components. Based on beta testing, we shortened interaction with the onscreen nurse and added a “repeat what I just said” button; we also simplified the syntax required for text messaging responses and the messaging schedule.
Our UCD process drew from established practices to create a unique, technology-assisted intervention that strives to relate to the needs of Veterans with CHF and/or COPD. Iterative Veteran feedback was critical to identifying solutions to various concerns that our research team could not have anticipated and has directly informed the testing of our intervention in a recently completed randomized trial.
- Coleman EA, at al. “The Care Transitions Intervention: Results of a Randomized Controlled Trial,” Archives of Internal Medicine 2006; 166(17):1822-8