"I'll tell you what's important to me…": lessons for women's health screening

Abstract

Background: Providers face increasing demands to screen for various health issues. Family medicine, primary care, and obstetric providers are encouraged to screen women universally for intimate partner violence, which could be challenging without comprehensive screening tools. The screening expectations and demands motivated providers and staff in south-central Appalachia (U.S.) to engage community members in streamlining women's health screening tools, and integrating intimate partner violence screening questions, through a Human-Centered Design (HCD) process. The objective of this article is to present participants' experiences with and perceptions of the HCD process for developing screening tools for women's health.

Methods: This was a qualitative, phenomenological study conducted with community members (n = 4) and providers and staff (n = 7) who participated in the HCD process. Sampling was purposive and opportunistic. An experienced qualitative researcher conducted open-ended, semi-structured interviews with participants. Interviews were transcribed and coded for thematic analysis.

Results: Community members reported that in the HCD sessions they wanted clinicians to understand the importance of timing and trust in health screening. They focused on the importance of taking time to build trust before asking about intimate partner violence; not over-focusing on body weight as this can preclude trust and disclosure of other issues; and understanding the role of historical oppression and racial discrimination in contributing to healthcare mistrust. Providers and staff reported that they recognized the importance of these concerns during the HCD process.

Conclusions: Community members provided critical feedback for designing appropriate tools for screening for women's health. The findings suggest that co-designing screening tools for use in clinical settings can facilitate communication of core values. How, when, and how often screening questions are asked are as important as what is asked-especially as related to intimate partner violence and weight.

Keywords: Appalachia; Community engagement; Human-centered design; Qualitative interviews; Screening; United States; Women’s health.