Using Human-Centered and Co-Design Methodology to Enhance the Family Strengthening Intervention

Approach

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. We engage our CCDT in every aspect of application development. 

Project Timeline & Goals:

1. 2019-2023 - Digital Tool Development of FSI-R - Through support from computer science students and staff/faculty, we will develop a beta version of the FSI-R digital tool through Adobe, ReactNative, and GitHub. The digital tool will include the text based features of the current paper manuals and added technological features such as training videos, interactive elements of design, and other visuals, diagrams, and pictures to enhance the learning process of the material for both community interventionists and families. 
2. 2019-2023 - Community Co Design Engagement - Through an interactive process of app development, we will engage community members in every aspect of our digital development through interactive community co-design teams (CCDTs). Our research builds on local capacity and contributes to community engagement. We involve community members in each aspect of our FSI-R, including community advisory boards. 
3. 2022-2023 - Refinement of UI/UX Design - Our multidisciplinary team, including co-investigator Sunand Bhattacharya, Associate Vice Provost of Design & Innovation, began a re-haul of our beta application in 2022 to enhance the UI/UX principles of the application to increase the user experience and app functionality. We partnered with a consultancy group to further this innovation through digital cartoon videos describing challenges, resilience, and family struggles that many refugee families experience. This UI/UX design will stregthen our application for program delivery. 
4. 2023-2025 - Pilot Testing of Digital FSI-R - Prior grants have positioned the research team to complete a beta version of the digital tool to support delivery of the FSI-R, an evidence-based home-visiting intervention led by refugees, for refugees to support new refugee families as they navigate their life under resettlement. This initial “theater test” of the intervention with four families will allow us to collect data on feasibility, acceptability, and satisfaction with the intervention as supported by use of the digital tool. This data can then be compared to prior data on feasibility, acceptability, and satisfaction with the intervention as delivered in the standard fashion using paper-based manuals and workbooks. 
5. Future Scale Up - This project will position the program to apply for outside federal and external sponsored research funding sources to examine the effectiveness of the intervention as delivered with digital tools in order to further to enhance fidelity and engagement compared to standard delivery in a well-powered larger randomized controlled trial. We are currently expanding our FSI-R work across the U.S.

Research Guiding this work: Previous NIMH-funded Study

The standard FSI-R intervention was co-created with Somali Bantu and Bhutanese refugee partners in Chelsea and Springfield, MA, and in Lewiston, ME, with funding from the National Institute on Minority Health and Health Disparities (NIMHD) (R24MD008057-03S1). Following a first planning grant from NIMH using community-based participatory research (CBPR) approaches to co-develop and pilot the intervention, we conducted a Hybrid Type II effectiveness trial of the standard FSI-R from 2019-2022 with a second grant from the NIMHD (R01MD010613-06). Our research to date demonstrates strong feasibility and acceptability of this intervention. In addition, our published intervention results indicate that school-aged children in families who received FSI-R reported less traumatic stress reactions and caregivers reported fewer child depression symptoms. The intervention showed feasibility with a retention rate of 82.5% and acceptability with 81.5% of participants reporting satisfaction with the FSI-R overall (Betancourt et al., 2019). We are curently expanding our FSI-R work across the U.S. with additional stakeholders and refugee service organizations.