Extending the trust-centered design framework to shared non-monetary healthcare transportation in resource-constrained communities: Mixed methods study (Preprint)

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BACKGROUND Technology-mediated ridesharing services have the potential to address healthcare access barriers for resource-constrained communities. However, cost and trust-related concerns about arriving safely, and on time, for appointments may thwart their success. Generalized favor exchange through non-monetary models like timebanking may address financial barriers, but they pose different considerations for facilitating trust than monetary-based ridesharing services. OBJECTIVE We investigated (a) how trust in transportation to healthcare appointments can be facilitated through the timebank; and (b) how a generalized favor-based ridesharing platform (GFRP) could be designed to facilitate trust between riders and drivers. METHODS Our trust-centered design involved applying Stzompka’s sociological trust theory as an extension to user-centered design. We conducted a 2-stage mixed methods study to gather feedback on trust-centered design ideas for a GFRP for healthcare appointments. First, focus groups with intermediaries from community-based organizations were conducted to understand contextual constraints, and to gather feedback on initial design ideas. Next, riders and drivers were asked to evaluate design ideas proposed in activity packets through surveys, and individual and group interviews. Descriptive statistics were compiled on the survey results. The transcribed interviews were coded based on the trust-centered design concept. Mixed analyses involved creating joint displays which summarized and compared the qualitative and quantitative data, and responses based on timebank membership and participant role. Metainferences were developed from the summaries recorded in the joint displays. RESULTS Focus groups with intermediaries (n=13) reinforced the current gaps in transportation and the importance of timebank for establishing trust amongst its members. Design sessions with riders (n=18) and drivers (n=16) revealed that features encouraging relationship-building were viewed as more favorable for promoting trust than ones that focused on accountability. Both riders and drivers felt that: (a) timebanks can help establish trust in exchanges through histories of reciprocation and social events; (b) endorsements about the driver may be an appropriate, fair and effective feature for establishing rider’s trust; (c) a shared checklist could foster riders and driver’s trust through reliable task performance and relationship building; (d) a “timebank buddy” is valued for monitoring the safe progress rides and additional opportunities for timebank participation; and (e) having timebank staff available to mediate conflicts makes trust in the transportation service easier. For riders who were not timebank members, understanding a driver’s goals and aspirations could help to facilitate trust through familiarity, relationship building, and reciprocity. Most riders noted how third-party tracking could protect them from safety risks, but drivers rejected perceived surveillance. CONCLUSIONS Through the application of trust theory, we offer future directions for developing trust-inducing cues for a generalized, favor-based ridesharing platform. Findings suggest new ways to facilitate trust through designing features focused on developing or enhancing trust-inducing situations that promote relationship building and accountability.

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