Thesis: Ph. D., Harvard-MIT Program in Health Sciences and Technology, 2019 / Cataloged from student-submitted PDF version of thesis. / Includes bibliographical references. / As profiling the molecular states of cellular subpopulations has become increasingly important to understand complex systems in biology and medicine, considerable efforts are being made to develop multiplexed techniques. While current fluorescent probes play indispensable roles, their broad emission spectra (about 30-100 nm) limit multiplexing capability. Recently, optical probes emitting narrowband laser spectra (about 0.1-1 nm), called 'laser particles', has drawn attention. Semiconductor microdisk lasers fabricated by top-down lithography have shown potential for massive multiplexing of thousands to millions of samples. In the thesis, I investigated lead halide perovskites (LHP) as a novel material for scalable production of laser particles in a lab flask. I discovered a sonochemical method to produce a large quantity (10 billions/L) of high-quality LHP micro- and sub-micron particles in a polar solvent within minutes. This method enabled me to coat the surface of individual CsPbBr3 laser particles using poly-catecholamine and thereby to improve optical properties and material stability against moisture. With CsPbBr3 microparticles coated with nano-scatterers, I realized disordered lasing based on Anderson localization. In addition, by incorporating plasmonic materials, I demonstrated plasmonic-lasing particles as small as 580 nm. This work paves the way for highly multiplexable laser particles for biomedical applications. / by Sangyeon Cho. / Ph. D. / Ph.D. Harvard-MIT Program in Health Sciences and Technology

Thesis: Ph. D., Harvard-MIT Program in Health Sciences and Technology, February, 2021 / Cataloged from the official PDF version of thesis. / Includes bibliographical references (pages 133-148). / Interest in the use of exoskeletons (wearable robotic devices tightly-coupled to the user's body) for human gait augmentation has soared recently, with research flourishing in system design, control, and use efficacy. Use cases span many fields, from military (e.g. load carriage assistance) to medicine (e.g. gait rehabilitation or restoration) and industry (e.g. injury prevention). Evaluating the human factors of human-exoskeleton interaction is an essential step towards operationalization. Unexplained variation in gait strategy and adaptation observed across individual operators must be better understood to enable safe and effective exoskeleton use in real-life environments. Cognitive fit is an individuals' understanding and ability to operate a system. Exoskeletons and similar tightly-coupled lower-extremity (TCLE) systems entail new interaction modalities that may affect cognitive fit. / This thesis explores how cognitive factors and alternative interaction modalities impact individuals' gait and task performance. Two studies were conducted, one evaluating inhibitory control as measured by a modified Simon task using interaction modalities relevant to TCLE system use, i.e. tactile cues and lower-extremity responses. Second, the Human-Exoskeleton Strategy & Adaptation (HESA) study was implemented, in which individuals completed tasks assessing cognitive factors, i.e. inhibitory control and attention, then walked with an ankle exoskeleton. Evaluation of inhibitory control with tactile cues and lower-extremity responses resulted in slower response times and decreased response accuracy. A probe of attention in the HESA study, i.e. completion of a walking task on a self-paced treadmill, showed modified gait characteristics under increased attentional loads, particularly at slower walking speeds and with the addition of a secondary task. / Individualized variation in exoskeleton gait, quantified by spatiotemporal gait characteristics, was explicitly presented for the first time, showing that distinct individuals initially prioritize goals like stability and coordination with an ankle exoskeleton differently. Finally, select measures of cognitive function were found to be correlated to individuals' exoskeleton gait strategy. Individual differences in baseline factors like inhibitory control and ability to perform tasks under divided attention impact individuals' cognitive fit with exoskeleton systems. This individualized variation, as well as broader population patterns, should inform exoskeleton design and training by encouraging gait strategies that support desired exoskeleton use goals. For example, stroke patients using an exoskeleton to restore their gait and mitigate fall risk should prioritize stability during system use, while factory workers should prioritize system coordination to minimize injury risk. / This thesis provides foundational insights into human-exoskeleton interaction and gait strategy from a human factors perspective. / by Aditi Gupta. / Ph. D. / Ph.D. Harvard-MIT Program in Health Sciences and Technology

Abstract This study increases the understanding of young men’s everyday health information literacy and behaviour in relation to their health behaviour, physical health, and socio-demographic characteristics. The conceptual framework of the study builds upon theories of information behaviour, practices and literacy, and health behaviour change. The empirical data were collected with questionnaires (n = 3,293) and physiological measurements (n = 3,063) in 2010 to 2013 at the Finnish Defence Forces’ call-ups, where a population-based sample of young Finnish men could be reached. Everyday health information literacy was studied using a previously developed screening tool, and with a focus on its relationship with health behaviour and physical fitness. Information behaviour was investigated in the context of physical activity, and in relation to men’s readiness to change exercise behaviour according to the Transtheoretical Model. Statistical analyses of the data include multivariate regression analyses, and a critical realist approach was adopted in interpreting the results. The results show that general upper secondary education and higher socio-economic position of a parent increase the likelihood of good health information literacy. Health information literacy is positively associated with health-promoting behaviour and health independent of socio-economic position; confidence in one’s abilities to find, evaluate and use health information is associated with regular exercise and healthy eating habits, and good physical fitness, for example. In the context of physical activity, the practices used to acquire information are associated with the stage of exercise behaviour change. Men in the maintenance stage seek information most actively. Information avoidance, in turn, is connected to low health information literacy, not to the stage of change. The study provides novel knowledge on healthy young people’s everyday health information literacy and behaviour, and on their relationship. It is among the first to investigate health information behaviour in the stages of behaviour change and health information literacy in connection with objectively measured fitness. It proposes a framework for future studies on the relationship between health information literacy and behaviour, and health information outcomes. The results may be utilised when designing tailored health communications and health information literacy education. / Tiivistelmä Tutkimus lisää ymmärrystä siitä, millainen yhteys nuorten miesten arkielämän terveystiedon lukutaidolla ja terveystietokäyttäytymisellä on terveyskäyttäytymiseen, fyysiseen terveyteen ja sosiodemografisiin tekijöihin. Sen käsitteellinen viitekehys rakentuu tietokäyttäytymisen ja -käytäntöjen, terveystiedon lukutaidon sekä terveyskäyttäytymisen muutoksen teorioille. Tutkimuksen aineisto kerättiin kyselyillä (n = 3 293) ja fysiologisilla mittauksilla (n = 3 063) vuosina 2010–2013 Puolustusvoimien Oulun alueen kutsuntatilaisuuksissa, joissa oli mahdollista saavuttaa suomalaisten nuorten miesten väestöpohjainen otos. Terveystiedon lukutaitoa arvioitiin aiemmin kehitetyllä seulontavälineellä sekä suhteessa terveyskäyttäytymiseen ja fyysiseen kuntoon. Terveystietokäyttäytymistä tarkasteltiin liikunnan kontekstissa ja suhteessa transteoreettisen mallin mukaiseen liikuntakäyttäytymisen muutosvalmiuteen. Aineistot analysoitiin tilastollisesti monimuuttujamenetelmin, ja tuloksia tulkittiin kriittisen realismin näkökulmasta. Tulokset osoittavat, että lukiokoulutus ja korkeassa sosioekonomisessa asemassa oleva vanhempi lisäävät hyvän arkielämän terveystiedon lukutaidon todennäköisyyttä. Terveystiedon lukutaito on positiivisesti yhteydessä terveyttä edistäviin elintapoihin ja terveyteen sosioekonomisesta asemasta riippumatta. Luottamus omiin kykyihin löytää, arvioida ja ymmärtää terveystietoa on yhteydessä muun muassa säännölliseen liikuntaan ja terveellisiin syömistottumuksiin sekä hyvään fyysiseen kuntoon. Liikunnan kontekstissa terveystietokäytännöt kytkeytyvät käyttäytymisen muutosvaiheeseen. Aktiivisimmin liikuntatietoa hankkivat liikuntakäyttäytymisen ylläpitovaiheessa olevat. Tiedon välttäminen sen sijaan on yhteydessä alhaiseen terveystiedon lukutaitoon, ei muutosvaiheeseen. Tutkimus tuottaa uutta tietoa nuorten, terveiden ihmisten arkielämän terveystiedon lukutaidosta ja terveystietokäyttäytymisestä sekä niiden suhteesta toisiinsa. Uutta on myös terveystietokäytäntöjen tutkiminen terveyskäyttäytymisen muutosvaiheissa ja terveystiedon lukutaidon tarkastelu suhteessa objektiivisesti mitattuun fyysiseen kuntoon. Tutkimuksessa esitetään viitekehys tuleville tutkimuksille terveystiedon lukutaidon ja tietokäytäntöjen vaikutuksesta terveyteen. Tulokset ovat hyödynnettävissä räätälöidyn terveysviestinnän ja terveystiedon lukutaidon koulutuksen suunnittelussa.

Cette thèse aborde les processus nationaux d'Evaluation des Technologies de la Santé (HTA) en Europe, en Australie et au Canada, avec comme point de référence le processus proposé par le National Institute for Health and Care Excellence (NICE) en Angleterre. Une attention particulière est portée sur la façon dont les décisions sont prises dans la gestion des soins de santé, sur quelles considérations ces décisions sont fondées, et sur la valeur des différents éléments d'évidence disponibles pour correctement évaluer les implications d'une mise en oeuvre d'un point de vue pratique. Cette thèse analyse le développement de recommandations dans la gestion des soins de santé afin de permettre l'accès aux traitements les plus efficaces d'un point de vue clinique et économique. Ces recommandations sont réalisées à partir des meilleures évidences disponibles et d'un consensus entre cliniciens, scientifiques, économistes de la santé, gestionnaires des services de soin et patients. La pertinence d'une évaluation en continu des différentes étapes de la gestion d'un problème de santé est également abordée durant cette thèse. L'objectif serait de permettre la production optimale de bénéfices de santé publique en reliant l'évaluation des différents stades d'une maladie. Ainsi, on obtiendrait une appréciation générale qui prendrait en considération que certaines recommandations de soin peuvent appeler à plus de flexibilité ou de contraintes selon les différents stades d'une maladie. Appliquée à la gestion de la dépendance à l'alcool, les abus d'alcool et conséquences attribuables, cette thèse contextualise et analyse le développement optimal d'évidences d'efficacité, d'efficience et d'économie de la santé, le choix de méthodologies appropriées et la manière d'interpréter et d'analyser leurs résultats pour la production optimale de bénéfices de santé publique / The current thesis discusses national processes of Health Technology Assessment (HTA) in Europe, Australia and Canada, with a central reference to the one proposed by the National Institute for Health and Care Excellence (NICE) in England. This is with a focus on the manner decisions about healthcare technologies are taken, based on which considerations and evidence, and with which weight the evidence elements are interlinked with regard to public health implications. The thesis analyses the development of recommendations of care to allow access to the most clinicallyand cost-effective treatments available, based on the best and most up-to-date evidence, and on the consensus from collaboration between clinicians, scientists, health economists, health service managers, as well as patients. Additionally, is discussed the value of covering all components of a disease evolution in assessing in continuum the different steps of disease management. This aims to allow the optimal generation of public health benefits in interlinking appraisals across different stages of disease for a generalist assessment of care, considering that recommendations in some aspects of care can call for more flexibility or constraints in other aspects. With an application to the management of alcohol use disorders, alcohol dependence and attributable harmful consequences, the thesis contextualizes and analyses decisions in the development of health economics and outcomes research evidence, the choice of methodology and directions taken, and their interpretation for optimal generation of public health benefits

Research within the fields of women’s health and specifically women’s menstrual health and technology is limited. As of today, problems associated with menstrual health, such as pain, discomfort, cramps, bloating, anxiousness and irregular period are resolved by using contraceptive pills or painkillers. The solutions to use contraceptive pills or painkillers have not been beneficial for research nor development of helpful innovative solutions. This thesis evaluates and explore the possibilities to use soft robotics, Soma Design, and Shape Changing Materials (SCM) to develop interactive software programs used to ease menstrual pain in innovative, flexible and comfortable ways. The thesis delves and analyzes the potential opportunities to facilitate the experience of menstruation, to extend and improve the tools available to increase knowledge, awareness and understanding of the menstruating body with the assist of soft robotics and Soma Design principles. Through exploration, construction, development and testing hardware and software systems we were able to create ten software programs that induce pressure and movements in order to ease menstrual pain in comfortable and flexible ways. The programs were tested using a first-person test approach, providing us with the opportunity to develop specific systems for the person's needs on a personal and intimate level. This approach suited the purpose of exploring the possibilities of using modern technologies as a tool for easing menstrual pain. The applied research method was qualitative with an abductive approach and the collected data was analyzed based on predefined measures. The thesis proved that it is possible to ease menstrual pain with use of technologies. The research resulted in five major findings that we argue are important to take into consideration when developing soft robotics; level of interactivity, prototype placement on the body, physical position of body, noise released from hardware and utilization of external means. The discoveries of this thesis will contribute to increased research that utilizes modern technologies to find solutions that eases menstrual pain and increase knowledge regarding menstrual health. Lastly, this thesis highlights the possibilities of using modern technologies that have never to our knowledge been seen or explored before. / Forskning inom teknik i samband med kvinnors hälsa och särskilt menstruation är begränsad. Idag hanteras problem förknippade med menstruation som smärta, kramper, uppblåsthet, ångest eller obehag med hjälp av hormoner i form av p-piller eller andra preventivmedel, alternativt med smärtstillande tabletter. Användandet av dessa metoder har inte varit fördelaktiga för varken forskningen eller utvecklingen av hjälpfulla och innovativa lösningar. Därför kommer den här avhandlingen att utvärdera och utforska möjligheterna kring att använda olika tekniker som soft robotics, Soma Design och form ändrande material för att utveckla interaktiva mjukvaruprogram med anledning att minska menstruationssmärtor på ett innovativt, flexibelt och bekvämt sätt. Dessutom utforskas och analyseras de potentiella möjligheterna till att underlätta upplevelsen av menstruation genom att utvidga och förbättra de tillgängliga hjälpmedel som finns för att öka kunskapen, medvetenheten och förståelsen för den menstruerande kroppen med hjälp av soft robotics och principer från Soma Design. Genom utforskning, konstruktion, utveckling och testning av hårdvara och mjukvara var det möjligt att skapa tio olika program som inducerar tryck för att minska mensvärk på ett bekvämt och flexibelt sätt. De framställda programmen testades med en första persontestmetod vilket gjorde det möjligt att utveckla programmen till att bli formade efter testpersonens specifika behov på en personlig och intim nivå vilket passade syftet att undersöka om det går att minska menstruationsbesvär med moderna tekniker. Metoden som tillämpades var Forskning genom Design där data analyserades utefter förutbestämda krav. Studien gav svar på att det är möjligt att minska menstruationsbesvär med tekniker. Dessutom resulterade studien i fem principer som vi anser bör överses när man arbetar med soft robotics: nivå av interaktivitet, placering av prototypen på kroppen, kroppens fysiska position, ljud från hårdvara och utnyttjande av externa medel. Resultatet från avhandlingen kommer bidra till att öka kunskapen och forskningen kring menstruations hälsa och öka intresset i utveckling av tekniker som soft robotics eller form ändrande material som hjälpmedel i samband med menstruation. Resultatet belyser möjligheterna av att jobba med moderna tekniker, som så vitt vi vet, aldrig har gjorts eller utforskats förut.

Information and communication technology (ICT) can enhance communication among health care providers which may lead to various health system improvements, such as gains in efficiency. However, there is inadequate evidence regarding the extent to which ICT improves communication among specific groups of health care professionals. This dissertation incorporates a mix of methodological approaches across three interrelated research studies to address this gap. Study 1 consists of a systematic review which suggested that ICT can play an important role in enhancing health care related communication among physicians, but the extent of that benefit is influenced by: 1) the impact of ICT on existing work practices; 2) the availability of adequate resources for ICT implementation and use; and 3) the nature of institutional elements, such as privacy legislation. Study 2 consists of a document analysis that examined guidelines for health information protection when using ICT from the provincial regulatory colleges for physicians. These documents were notable for the considerable variation in the scope and detail of guidance provided, which may result in unequal and inequitable protection of health information across the provinces. Study 3 is a case study that examined the use of a relatively novel form of ICT, smartphones, for communication among postgraduate medical trainees (medical residents). Efficiency and convenience were identified as the main reasons that medical residents use smartphones to communicate health care related information with colleagues. In addition, by applying a neo-institutional perspective, it became clear that medical residents base their smartphone use primarily on normative elements (professional norms; what peers/staff are doing) and cultural-cognitive elements (beliefs/perceptions regarding facilitation of task completion). Regulative elements (guidelines/policies) around smartphone use play a smaller role in shaping behaviour, particularly when they: 1) lack clarity; 2) are not seen as credible/legitimate; or 3) are viewed as cumbersome and do not align with workflow needs. Taken together, these studies provide timely insights regarding the use of ICT by physicians, which can be drawn upon by a variety of decision-makers as efforts to improve health system performance continue. / Thesis / Doctor of Philosophy (PhD) / The goal of this doctoral dissertation was to develop a better understanding of how and why physicians are using information and communication technology (ICT) to exchange health care related information, along with the role of such communication in enhancing health system performance. Findings indicate that physicians use ICT in various circumstances as they perceive it to be more convenient and efficient. However, guidelines for the exchange of health information in digital/electronic format vary by jurisdiction and organization, which may result in different uses of ICT by physicians. Moreover, as these guidelines often lack clarity or are not seen as credible/legitimate, some physicians base their use of ICT primarily on what peers/colleagues are doing or by acting in a manner that they believe facilitates task completion and, hence, patient care. The insights gained from this work can be adopted by decision-makers to improve communication among physicians using ICT and, consequently, health system performance.

Health data requires context to be understood. I show how, by examining two areas: self-surveillance, with a focus on representation of bodily data, and mass-surveillance, with a focus on representing populations. I critically explore how Information and Communication Technology (ICT) can be made to represent individuals and populations, and identify implications of such representations. My contributions are: (i) the design of a self-tracking stress management system, (ii) the design of a mass-surveillance system based on mobile phone data, (iii) an empirical study exploring how users of a fitness tracker make sense of their generated data, (iv) an analysis of the discourse of designers of a syndrome surveillance system, (v) a critical analysis of the design process of a mass-surveillance system, and (vi) an analysis of the historicity of the concepts and decisions taken during the design of a stress management system. I show that producing health data, and subsequently the technological characteristics of algorithms that produce them depend on factors present in the ICT design process. These factors determine how data is made to represent individuals and populations in ways that may selectively make invisible parts of the population, determinants of health, or individual conception of self and wellbeing. In addition, I show that the work of producing data does not stop with the work of the engineers who produce ICT-based systems: maintenance is constantly required. / För att förstå hälsodata krävs sammanhang. Jag visar hur detta kan erhållas, genom två fallstudier: en om självövervakning, med fokus på representation av kroppsdata, samt en om massövervakning, med fokus på representation av populationer. Jag granskar kritiskt hur informationsteknologi (IT) kan fås att representera såväl individer som populationer och vilka följder det får. Mina bidrag är: (i) utformningen av ett självövervakningssystem för stresshantering, (ii) utformningen av ett massövervakningssystem baserat på data från mobiltelefonanvändning, (iii) en empirisk studie av hur användare av en hälsosensor begriper det data som sensorn genererar, (iv) en diskursiv analys av hur syndromövervakningssystem utformas, (v) en kritisk analys av processer kring att utforma ett massövervakningssystem, samt (vi) en analys av den historiska korrektheten i begrepp och beslutsfattande i samband med utformningen av ett stresshanteringssystem. Jag visar att produktion av hälsodata, liksom tekniska beskrivningar av de algoritmer som används i den processen, beror av faktorer som hänger samman med IT-utformningsprocessen. Dessa faktorer avgör sedan hur data kan fås att representera individer och populationer på sätt som kan rendera delar av en population, hälsodeterminanter, eller individens självuppfattning och förståelse av välmående osynliga. Jag visar också att arbetet med att producera data inte är avslutat i och med det ingenjörsarbete som krävs för att IT-systemen ska byggas: konstant underhåll krävs också. / <p>QC 20150114</p>

Health Care in developing countries faces many issues, ranging from overburden to lack of funding and poor infrastructure. The use of information and communications technology (ICT) in health care, eHealth, has been seen by many as the remedy to the ills befalling health care in developing countries. Uganda has been the host of a large number of eHealth projects the last couple of years. However, few seem to have taken the infrastructural issues plaguing Ugandan health care into consideration. This report presents the result of an ethnographically inspired field study and considers how the lack of infrastructure and computer training of the local medical staff impact the use of eHealth applications at three different clinics, two public and one private. The lack of Internet, secure storage locations and electricity severely impacts the sustainability of eHealth at the public institution, as does medical personnel’s’ lack of computer proficiency. However, these problems can be overcome with training and the right equipment. Due to the multitude of non-compatible eHealth projects in Uganda, the report calls for a consolidation of efforts and sharing of information amongst the eHealth application developers of Uganda. Also, it might be time to reconsider if the public sector is the best partner for eHealth application developers, maybe the private sector could have more use of and help develop more usable eHealth applications. / Sjukvård i u-länder står inför många utmaningar, allt från brist på resurser och dålig infrastruktur till överanvändning. Användningen av ICT inom sjukvården, eHealth, har setts av många som en lösning på de utmaningar som sjukvården i utvecklingsländerna står inför. Uganda har varit värd för ett stort antal av eHealth-projekt de senaste åren. Tyvärr verkar få ha tagit de infrastrukturproblem som präglar den Ugandiska sjukvården i beaktning. Denna rapport handlar om hur bristen på infrastruktur och datautbildning av den lokala sjukvårdspersonalen påverkar användningen av eHealth vid två offentliga vårdcentraler och en privat. Bristen på Internet, säkra lagringsutrymmen samt el påverkar allvarligt hållbarheten av eHealth vid offentliga institutioner, detsamma gäller den medicinska personalens bristande datorvana. Emellertid kan dessa problem lösas med utbildning och rätt utrustning. På grund av de många icke-kompatibla eHealth-projekt som genomförs i Uganda efterlyser rapporten en konsolidering av insatser och informationsspridning bland de hälsorelaterade applikationsutvecklarna i Uganda. Dessutom kan det vara dags att ompröva om den offentliga sektorn är den bästa partnern för eHealth-applikationsutvecklare, kanske den privata sektorn skulle ha mer användning av samt bidra mer till utveckling av mer användbara eHealthapplikationer.

Thesis: Ph. D. in Medical Engineering, Harvard-MIT Program in Health Sciences and Technology, 2016. / This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections. / Cataloged from student-submitted PDF version of thesis. / Includes bibliographical references (pages 115-124). / Clinical predictive models are useful in predicting a patient's risk of developing adverse outcomes and in guiding patient therapy. In this thesis, we explored two different ways to apply domain knowledge to improve clinical predictive models. We first applied knowledge about the heart to engineer better frequency-domain features from electrocardiograms (ECG). The standard frequency domain (in Hz) quantifies events that repeat with respect to time. However, this may be misleading because patients have different heart rates. We hypothesized that quantifying frequency with respective to heartbeats may adjust for these heart rate differences. We applied this beat-frequency to improve two existing ECG predictive models, one based on ECG morphology, and the other based on instantaneous heart rate. We then used machine learning to find predictive frequency bands. When evaluated on thousands of patients after an acute coronary syndrome, our method significantly improved prediction performance (e.g., area under curve, AUC, from 0.70 to 0.75). In addition, the same bands were found to be predictive in different patients for beat-frequency, but not for the standard frequency domain. Next, we developed a method to transfer knowledge from published biomedical articles to improve predictive models when training data are scarce. We used this knowledge to estimate the relevance of features to a given outcome, and used these estimates to improve feature selection. We applied our method to predict the onset of several cardiovascular diseases, using training data that contained only 50 adverse outcomes. Relative to a standard approach (which does not transfer knowledge), our method significantly improved the AUC from 0.66 to 0.70. In addition, our method selected 60% fewer features, improving interpretability of the model by experts, which is a key requirement for models to see real-world use. / by Yun Liu. / Ph. D. in Medical Engineering

Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, System Design and Management Program, 2019 / Cataloged from PDF version of thesis. / Includes bibliographical references (pages 77-79). / Patients with comorbid physical, behavioral, and social needs-often referred to as high-need patients-tend to be the most frequent utilizers of the health care system. The US health care system, with fragmented behavioral and medical health care sectors, is unable to effectively meet the complex needs of high-need patients. This results in high health care utilization, increased health care costs, and poor health outcomes among this population. Behavioral Health Integration in Primary Care (BHIPC) is widely promoted as a means to improve access, quality and continuity of health care services in a more efficient way, especially for people with complex needs. Hundreds of BHIPC programs are being implemented across health care settings in the US. However, the concept of BHIPC is wide-ranging, and it has been used as an overarching approach to describe integration efforts that vary in design, scope, and value. Research on how BHIPC is implemented in practice is limited. Practitioners and policymakers find it challenging to evaluate BHIPC programs and identify and scale-up its most critical elements. In this thesis, I develop a design-based framework that deconstructs the ambiguous concept of BHIPC into a set of tangible design elements and decisions. Furthermore, in order to inform how BHIPC is implemented in practice, I use this design-based framework to examine the behavioral health integration programs in four community health centers in Massachusetts. I found that by just comparing the underlying design elements, it is difficult to assess BHIPC programs and distinguish a successful program from an unsuccessful one. I therefore recommend and propose an outcomes-based framework for differentiating and evaluating BHIPC programs. I also recommend that future researchers refine and standardize the process measures I introduce so that they can be used as guideposts by primary care practitioners to develop their BHIPC programs. / by Anubhav Arora. / S.M. in Engineering and Management / S.M.inEngineeringandManagement Massachusetts Institute of Technology, System Design and Management Program