(S)hameful, (D)epressed, (H)opeless – Did someone just say SDH?

(S)hameful, (D)epressed, (H)opeless – Did someone just say SDH?

Meaghan Hudak | Reading time: 4 minutes

In 2022, Advance Equity became the first pillar of the Centers for Medicare & Medicaid Services (CMS) Strategic Plan. This strategy aims to advance health equity by addressing the health disparities that underlie our health system. This is accomplished through stakeholder engagement and incorporating the Advance Equity pillar into the core functions of CMS. SDH  is one of the key aspects that aligns with the Biden-Harris Administration’s commitment in this area. A strong body of evidence demonstrates that addressing SDH within health care systems advances outcomes such as cancer treatment adherence. To achieve this, we need to collect SDH data, however, the traditional approach is not the most effective. This session will share how an HCD approach can help Health Equity and SDH based on an NIH SBIR awarded project. 

 Attendees learned:

• What SDH is, and
• How a Human-Centered Design approach can improve both Health Equity and SDH. 

What is SDH? 

Cupid explains that social determinants of health refers to a situation that is health affecting, but not directly related to our health. For example, where we live, where we work, where we are born, or where we grow up. These are examples of circumstances that contribute to SDH.  

What can affect SDH? Financial strain, housing instability, transportation barrier and food insecurity. Cupid asked the audience to think about how SDH is really impacting our health. If we ask the SDH problem another problem will arise. We learned that asking about ADH can trigger feelings of shame. If you think about it, a stranger is asking embarrassing questions of the patient in an unfamiliar place. These questions are not always easily answered. When collecting SDH data, we can help the patient. So, how does HCD help? Cupid explains that we must go through the three of the HCD phases to arrive at the patient solution: Empathy, Ideation and Implementation.  

Hypothesis

Cupid explains that patients are more willing to provide answers wherever they feel comfortable, wherever and whenever they want. Patients can use 'me-time' to complete the SDH survey. The goal is to provide flexibility for the patient. This makes them more will to provide the information. They don’t have to answer questions to strangers – they have private time to do so. Keeping in mind a human-centered approach, it is important to remember that patients should be honored. 

Graphic: SDH Journey and Research 

Pistevo Decision was able to test the hypothesis: Small Business Innovation Research (SBIR) NIH/NCI 423 – Software to Address Social Determinants of Health in Oncology Patients. This research was patient centered and evidence based research. Pistevo Decision launched pilot in three oncology practices: head and neck cancer, prostate cancer and breast cancer. HCD should not only apply to one certain cancer but a variety of cancers.

Pistevo Decision went through the i-Corps program. "The U.S. National Science Foundation's Innovation Corps (I-Corps™) program was launched to support NSF's mission through experiential learning using the customer discovery process — allowing teams to quickly assess their inventions' market potential. I-Corps prepares scientists and engineers to extend their focus beyond the laboratory to increase the economic and societal impact of NSF-funded and other basic research projects." The program is not only technical but it taught the team how to bring the product into the market to really fit the patients needs. The i-Corps program discussed understanding and knowing technology doesn’t mean you can create a product to fit a customers need. It's imperative to match the customer need with the technology. At the end of the i-Corps program, you cannot graduate until you present what you learned and produce a video. The results of program included:

• 6 weeks of intensive training on business models
• 500+ interview requests attempts
• 110+ actual interviews
• 1 “Best in Show” award

Graphic: Patient Facing app and Provider Portal 

Through patient and doctor interviews, Cupid learned that people are feeling shameful, depressed and uncertain. Even, as basic as day-today care of one’s own health. We need to think of a creative solution for SDH before the patient shows up in the clinic. Through the app, patients are feeling satisfied. It fulfills the need and removes the blocks for people to get the right treatment. Next, how can me implement and match expectation? How do we eliminate the hopelessness from the patient? Providing actionable help directly and proactively once the need is identified. The results: 

• Phase 1 concluded
• Positive feedback from both patients and doctors
• Prepare for phase 2 to fully productionize the platform

Cupid leaves us with this food for thought,

"If we use an HCD approach, we are hopeful we can transform the shameful, depressed and hopeless experience into a satisfied, doable and honorable product to patients." 

Cupid Chan has presented at CCSQ World Usability Day three years in a row. If you missed Cupids’s presentation, check out the transcript and recording on the CCSQ World Usability Day page. This page also includes an archive of transcripts and recordings of speaker presentations, session materials, and event photos. For more information about the Human-Centered Design Center of Excellence, refer to the HCD CoE Confluence page.