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Caregiver strategy classification in pediatric rehabilitation contexts is strongly motivated by real-world clinical constraints but highly under-resourced and seldom studied in natural language processing settings. We introduce a large dataset of 4,037 caregiver strategies in this setting, a five-fold increase over the nearest contemporary dataset. These strategies are manually categorized into clinically established constructs with high agreement (𝜅=0.68-0.89). We also propose two techniques to further address identified data constraints. First, we manually supplement target task data with publicly relevant data from online child health forums. Next, we propose a novel data augmentation technique to generate synthetic caregiver strategies with high downstream task utility. Extensive experiments showcase the quality of our dataset. They also establish evidence that both the publicly available data and the synthetic strategies result in large performance gains, with relative F1 increases of 22.6% and 50.9%, respectively. 

Abstract BackgroundPractitioner and family experiences of pediatric re/habilitation can be inequitable. The Young Children’s Participation and Environment Measure (YC-PEM) is an evidence-based and promising electronic patient-reported outcome measure that was designed with and for caregivers for research and practice. This study examined historically minoritized caregivers’ responses to revised YC-PEM content modifications and their perspectives on core intelligent virtual agent functionality needed to improve its reach for equitable service design. MethodsCaregivers were recruited during a routine early intervention (EI) service visit and met five inclusion criteria: (1) were 18 + years old; (2) identified as the parent or legal guardian of a child 0–3 years old enrolled in EI services for 3 + months; (3) read, wrote, and spoke English; (4) had Internet and telephone access; and (5) identified as a parent or legal guardian of a Black, non-Hispanic child or as publicly insured. Three rounds of semi-structured cognitive interviews (55–90 min each) used videoconferencing to gather caregiver feedback on their responses to select content modifications while completing YC-PEM, and their ideas for core intelligent virtual agent functionality. Interviews were transcribed verbatim, cross-checked for accuracy, and deductively and inductively content analyzed by multiple staff in three rounds. ResultsEight Black, non-Hispanic caregivers from a single urban EI catchment and with diverse income levels (Mdn = $15,001–20,000) were enrolled, with children (M = 21.2 months,SD = 7.73) enrolled in EI. Caregivers proposed three ways to improve comprehension (clarify item wording, remove or simplify terms, add item examples). Environmental item edits prompted caregivers to share how they relate and respond to experiences with interpersonal and institutional discrimination impacting participation. Caregivers characterized three core functions of a virtual agent to strengthen YC-PEM navigation (read question aloud, visual and verbal prompts, more examples and/or definitions). ConclusionsResults indicate four ways that YC-PEM content will be modified to strengthen how providers screen for unmet participation needs and determinants to design pediatric re/habilitation services that are responsive to family priorities. Results also motivate the need for user-centered design of an intelligent virtual agent to strengthen user navigation, prior to undertaking a community-based pragmatic trial of its implementation for equitable practice.