The SmartSHOTS program, funded by the Tennessee Department of Health, aims to reduce health disparities in Tennessee through a digital aid for immunization that will help users find locations where they can receive care, assistance with identifying transportation options, and reminders for appointments. The SmartSHOTS team will develop and implement SmartSHOTS, an application utilizing SHOTS survey data, healthcare data, and location services to aid Tennessee parents and caregivers in reaching immunization conformance for children up to 24 months. The project is applying a user centered design approach to development so other features of the digital aid will be based on user feedback. Users include volunteers representing their county’s Community Health Council and residents of select counties across Tennessee.
The program includes an inter-professional team of nurses, industrial engineers, public health researchers, and designers, in collaboration with the Health Innovation Technology and Simulation Lab at the University of Tennessee, Knoxville. Project assessment will be done through Community Health Councils from seven regions across the State of Tennessee. These councils exist with funding and staffing support from Tennessee Department of Health.
The project team envisions a four-phase framework grounded in design thinking and systems theory to ensure a user-centered outcome. Design thinking is a sequenced creative problem-solving strategy that approaches complex problems with the needs of the end-user being front and center throughout the development process. Systems theory is the study and analysis of the interdependent relationships within a larger whole. When used together, these methods result in a comprehensive approach that allows for consideration of both the individual use and collective whole of the system. The key milestones of the four phases are listed as follows:
(1) Phase 1: Empathize and Define – A critical and thorough assessment of parent and community needs towards eradicating immunization barriers will serve as the foundation of the project. This will be accomplished through a series of project team engagements with Community Health Councils (CHCs) from 7 regions across the state of Tennessee. Health Councils exist in all 95 counties with funding and staffing support from the Tennessee Department of Health for 89 rural counties. Simultaneously, the research team will create evidence-based content to support the digital system, aggregating the links available for further educating the parents/families on overcoming obstacles. Content will then be validated by three subject matter experts (SMEs) who serve as consultants of the project. All inputs generated by these engagements will be analyzed and sorted for use in the following phases.
(2) Phase 2: Ideate & Design – At this stage, the project team will act on the outcome from the community engagement analysis and develop a detailed workflow, or user flow, of how the SmartSHOTS systems app would be executed. The project team will reengage the CHCs to receive feedback on the project architecture that will serve as the guiding map for the design execution. The research team will develop both the front-end and back-end of the SmartSHOTS systems app.
(3) Phase 3: Prototype & Test – A functional initial prototype, known as the alpha version, will be internally tested across the project team. This will be followed by a more robust beta version that will be user tested across 50 families in rural Tennessee communities. Beta-testing will include five focus groups. In addition to collecting data on the validity of the information provided to parents and improvements in immunization rates, we will assess the product’s usability by conducting interviews with a sub-set of parents. This iterative process will continue to affect the design and then be retested, ensuring user feedback remains central to the function of the systems app. During this phase, a Spanish translator serving as a consultant on this project will translate all content into Spanish resulting in both a Spanish and an English beta version of SmartSHOTS systems app. This is necessary because Spanish is the 2nd most common language spoken in Tennessee following English.
(4) Phase 4: Execute & Evaluate – Upon completion of the final prototype, the SmartSHOTS systems app will then be refined, published, and widely disseminated. The SmartSHOTS systems app will be deployed to Apple App Store and Google Play Store and be hosted as a web app for broader access. The SmartSHOTS systems app marketing plan will be executed by an outside agency with expertise in working with the identified populations. Evaluation and assessment will be conducted throughout the project phases through qualitative and quantitative data collection. However, the final assessment of the service will be conducted through the identified project team evaluator through a review of metrics concerned with user numbers, including sustained uptake and drop-off, feature usage, and appointment confirmation.