BACKGROUND Health outcomes are significantly influenced by unmet social needs. Although screening for social needs has become common in health care settings, there is often poor linkage to resources after needs are identified. The structural barriers (eg, staffing, time, and space) to helping address social needs could be overcome by a technology-based solution. OBJECTIVE This study aims to present the design and evaluation of a chatbot, DAPHNE (Dialog-Based Assistant Platform for Healthcare and Needs Ecosystem), which screens for social needs and links patients and families to resources. METHODS This research used a three-stage study approach: (1) an end-user survey to understand unmet needs and perception toward chatbots, (2) iterative design with interdisciplinary stakeholder groups, and (3) a feasibility and usability assessment. In study 1, a web-based survey was conducted with low-income US resident households (n=201). Following that, in study 2, web-based sessions were held with an interdisciplinary group of stakeholders (n=10) using thematic and content analysis to inform the chatbot’s design and development. Finally, in study 3, the assessment on feasibility and usability was completed via a mix of a web-based survey and focus group interviews following scenario-based usability testing with community health workers (family advocates; n=4) and social workers (n=9). We reported descriptive statistics and chi-square test results for the household survey. Content analysis and thematic analysis were used to analyze qualitative data. Usability score was descriptively reported. RESULTS Among the survey participants, employed and younger individuals reported a higher likelihood of using a chatbot to address social needs, in contrast to the oldest age group. Regarding designing the chatbot, the stakeholders emphasized the importance of provider-technology collaboration, inclusive conversational design, and user education. The participants found that the chatbot’s capabilities met expectations and that the chatbot was easy to use (System Usability Scale score=72/100). However, there were common concerns about the accuracy of suggested resources, electronic health record integration, and trust with a chatbot. CONCLUSIONS Chatbots can provide personalized feedback for families to identify and meet social needs. Our study highlights the importance of user-centered iterative design and development of chatbots for social needs. Future research should examine the efficacy, cost-effectiveness, and scalability of chatbot interventions to address social needs.
In a previous report on the gender distribution of authors of articles published in leading pediatric journals, researchers found disparities in the proportion of articles written by women relative to men, with some closing of the gender gap from 2001 to 2016.1 In 2016, 63% of pediatricians were women; 58% of the publications had a female first author, but only 38% had a female senior author.1,2 Additionally, reports have found that female first authors are associated with female authors in the senior author position and female gender of the first or senior author is associated with a higher number of collaborating departments and institutions.1,3–6 However, to our knowledge, this report is the only study on this topic in the field of pediatrics, assessing authorship gender distribution in 5-year intervals through 2016.1The Pediatrics editorial board is committed to addressing underrepresentation of all types, including gender differences in authorship. To begin to understand this issue, we evaluated regular articles published in Pediatrics within the past 4.5 years for female representation in authorship, the degree to which the gender of first and senior author is correlated, and other measures of collaboration (eg, the number of participating institutions and total number of authors). Regular articles are defined as "original research contributions that aim to inform clinical practice or the understanding of a disease process…includ[ing] but are not limited to clinical trials, interventional studies, cohort studies, case-control studies, epidemiological assessments, and surveys."7 These more recent findings will be used to inform future journal policies to address implicit bias in the review process and inform academic departments about the need to support women in academics.We reviewed research articles published in Pediatrics from January 2015 to July 2019, extracting the number of authors and institutions. The gender of the first and senior author was determined from the following sources, in sequence: the author's institutional Web site, ResearchGate, LinkedIn, or Doximity. Only 1 affiliation was counted per author. Differences in categorical variables were evaluated with χ2 tests, and median values of nonparametrically distributed continuous variables were compared by using Mann–Whitney U tests. P < .05 was considered statistically significant.From January 2015 to July 2019, there were 1231 published research articles, involving 9444 authors. Overall, 61% (756) had a female first author, and 44% (547) had a female senior author. Gender could not be identified in 2% (22) of the first authors and 1% (13) of the senior authors. The gender distribution of first and senior authors over the study period is shown in Fig 1. There was no change in the proportion of female first or senior authors over the study period (P = .25 and P = .63, respectively). The number of coauthors (median: 7 [interquartile range (IQR) 5–9]) and number of collaborating institutions (median: 3 [IQR 2–4]) per article did not change over the study period (P = .90 and P = .70, respectively).First authors were more likely to be female in articles with female senior authors than in those with male senior authors (69% [377 of 547] vs 56% [375 of 671]; P < .001). Senior authors were more likely to be female in articles by female first authors than in articles by male first authors (50% [377 of 756] vs 36% [164 of 453]; P < .001).Female first authors wrote articles involving a lower number of collaborating institutions compared with male first authors (median: 2 [IQR 1–4] vs 3 [IQR 2–4]; P = .03). Female senior authors also wrote articles with a lower number of collaborating institutions compared with male senior authors (median: 2 [IQR 1–4] vs 3 [IQR 2–4]; P = .02). There was no difference in the median number of collaborating authors on the basis of the gender of first or senior authors (P = .62 and P = .98, respectively)We noted 2 important findings regarding articles published in Pediatrics: articles with female first authors were more likely to have female senior authors, and articles with female first or senior authors had fewer collaborating institutions.The proportion of female first authors publishing in Pediatrics over the past several years appears representative of the proportion of female physicians in the field of pediatrics overall.1,8,9 In contrast, the proportion of female senior authors is lower than the proportion of female physicians in the field. This may be related to factors discussed in past reports including, but not limited to, fewer women in senior positions, such as division chiefs or leaders of academic collaboratives, implicit gender bias in grant awarding, and midcareer burnout.10–12 Nonetheless, the pipeline of future female senior academic pediatricians is promising on the basis of our first author findings, if we can preserve the successful transition of these first authors to the senior authorship role. Our finding that articles with a female first author were more likely to have a female senior author is consistent with previous publications.1,3–5 This may highlight the importance of female research guidance for female young investigators, promoting what may be an important strategy for supporting more junior female faculty. Our finding that articles with a female first or senior author involve fewer centers is in contrast with a previous report regarding radiologists.6 Future work is needed to better understand if female pediatricians have less opportunity for multisite collaboration.This study is limited by the restriction to a 4.5-year study period in a single journal, and only published original investigations. We assumed first authors are junior and senior authors serve as mentors. We did not consider authors' subspecialty of practice. The submission platform during the study period did not elicit information about sex, gender, or race and/or ethnicity. We categorized author gender on the basis of the pronouns used in their profiles on institutional or professional Web sites but were not able to assess whether specific gender preferences were accurately represented. We were also not able to ascertain the gender for 1.4% of the authors. The intersectionality of race and ethnicity and gender identification likely adds additional complex layers into the role bias may be playing in these findings.With this study, we suggest that the current pool of junior faculty publishing as first authors in Pediatrics is representative of the current percentage of women pediatricians in the United States. With the findings, we underscore the importance of ensuring that female junior faculty progress in their career pathway to increase the pool of female physicians in academic leadership roles and expand the number of female senior authors engaged in research and subsequent publications.
Designed to accompany the Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition, this manual provides authoritative, evidence-based guidance about the most effective ways to deliver preventive services. Ideal for pediatric practice professionals, and as a teaching tool for medical students, residents, and all health professionals who provide well child care. Nationally renowned experts reviewed the scientific medical literature and authored the content which is organized into 4 main sections: History, Observation, and Surveillance Physical Exam Screening Anticipatory Guidance
To review the performance characteristics of the instruments most commonly used to measure clinical outcomes in juvenile idiopathic arthritis (JIA), including global assessments, articular indices, functional/disability assessments, and quality of life measures.As part of an Agency for Healthcare Research and Quality comparative effectiveness review of antirheumatic drugs, we explored the characteristics of commonly used outcome measures for JIA. English-language studies of children with JIA were identified from Medline and Embase. Two independent reviewers screened titles and abstracts, with subsequent full-text review of studies selected based on predetermined criteria.We included 35 publications describing 34 unique studies and involving 14,831 patients. The Childhood Health Assessment Questionnaire (C-HAQ) was the most extensively studied instrument and had high reliability, but only moderate correlations with other indices of disease activity and poor responsiveness to change in disease status. The physician global assessment of disease activity (PGA) and articular indices had the strongest association with disease activity and were the most responsive to change. Measures of psychosocial function and quality of life were moderately associated with measures of disease activity, but were less responsive to changes in disease status.In children with JIA, no single instrument was superior in reliability or validity or in describing the impact of JIA. Although the C-HAQ has been extensively evaluated, the PGA and articular indices appear to have the highest responsiveness to change and, therefore, the highest potential for detecting important differences in treatment response.
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