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Abstract：
BACKGROUND: As crises escalate worldwide, there is an increasing demand for innovative solutions to enhance humanitarian outcomes. Within this landscape, digital health tools have emerged as promising solutions to tackle certain health challenges. The integration of digital health tools within the international humanitarian system provides an opportunity to reflect upon the system\'s paternalistic tendencies, driven largely by Global North organisations, that perpetuate existing inequities in the Global South, where the majority of crises occur. The Participation Revolution, a fundamental pillar of the Localisation Agenda, seeks to address these inequities by advocating for greater participation from crisis-affected people in response efforts. Despite being widely accepted as a best practice; a gap remains between the rhetoric and practice of participation in humanitarian response efforts. This study explores the extent and nature of participatory action within contemporary humanitarian digital health projects, highlighting participatory barriers and tensions and offering potential solutions to bridge the participation gap to enhance transformative change in humanitarian response efforts.
METHODS: Sixteen qualitative interviews were conducted with humanitarian health practitioners and experts to retrospectively explored participatory practices within their digital health projects. The interviews were structured and analysed according to the Localisation Performance Measurement Framework\'s participation indicators and thematically, following the Framework Method. The study was guided by the COREQ checklist for quality reporting.
RESULTS: Varied participatory formats, including focus groups and interviews, demonstrated modest progress towards participation indicators. However, the extent of influence and power held by crisis-affected people during participation remained limited in terms of breadth and depth. Participatory barriers emerged under four key themes: project processes, health evidence, technology infrastructure and the crisis context. Lessons for leveraging participatory digital health humanitarian interventions were conducting thorough pre-project assessments and maintaining engagement with crisis-affected populations throughout and after humanitarian action.
CONCLUSIONS: The emerging barriers were instrumental in shaping the limited participatory reality and have implications: Failing to engage crisis-affected people risks perpetuating inequalities and causing harm. To advance the Participation Revolution for humanitarian digital health response efforts, the major participatory barriers should be addressed to improve humanitarian efficiency and digital health efficacy and uphold the rights of crisis-affected people.
METHODS: Sixteen qualitative interviews were conducted with humanitarian health practitioners and experts to retrospectively explored participatory practices within their digital health projects. The interviews were structured and analysed according to the Localisation Performance Measurement Framework\'s participation indicators and thematically, following the Framework Method. The study was guided by the COREQ checklist for quality reporting.
RESULTS: Varied participatory formats, including focus groups and interviews, demonstrated modest progress towards participation indicators. However, the extent of influence and power held by crisis-affected people during participation remained limited in terms of breadth and depth. Participatory barriers emerged under four key themes: project processes, health evidence, technology infrastructure and the crisis context. Lessons for leveraging participatory digital health humanitarian interventions were conducting thorough pre-project assessments and maintaining engagement with crisis-affected populations throughout and after humanitarian action.
CONCLUSIONS: The emerging barriers were instrumental in shaping the limited participatory reality and have implications: Failing to engage crisis-affected people risks perpetuating inequalities and causing harm. To advance the Participation Revolution for humanitarian digital health response efforts, the major participatory barriers should be addressed to improve humanitarian efficiency and digital health efficacy and uphold the rights of crisis-affected people.
摘要：
背景：随着全球危机升级，对创新解决方案的需求日益增加，以增强人道主义成果。在这个景观中，数字健康工具已经成为应对某些健康挑战的有希望的解决方案。数字医疗工具在国际人道主义系统中的整合提供了一个机会来反思系统的家长式倾向，主要由全球北方组织推动，使全球南方现有的不平等现象长期存在，大多数危机发生的地方。参与革命,本地化议程的基本支柱，寻求通过倡导受危机影响的人们更多地参与应对努力来解决这些不平等。尽管被广泛接受为最佳做法；参与人道主义应急工作的言辞和做法之间仍然存在差距。本研究探讨了当代人道主义数字健康项目中参与行动的程度和性质，强调参与障碍和紧张局势，并提供潜在的解决方案来弥合参与差距，以加强人道主义应急工作中的变革。
方法：对人道主义卫生从业人员和专家进行了16次定性访谈，以回顾性探索其数字卫生项目中的参与性做法。访谈是根据本地化绩效衡量框架的参与指标和主题进行结构化和分析的，遵循框架方法。该研究以COREQ清单为指导，以进行质量报告。
结果：各种参与式格式，包括焦点小组和访谈，在参与指标方面取得了适度进展。然而,受危机影响的人们在参与期间所拥有的影响力和权力在广度和深度方面仍然有限。参与障碍在四个关键主题下出现:项目进程、健康证据,技术基础设施和危机背景。利用参与性数字卫生人道主义干预措施的经验教训正在进行全面的项目前评估，并在人道主义行动期间和之后与受危机影响的人群保持接触。
结论：新出现的障碍有助于塑造有限的参与现实，并产生影响：未能参与受危机影响的人有可能使不平等现象长期存在并造成伤害。推进人道主义数字卫生应对工作的参与革命，应解决主要的参与障碍，以提高人道主义效率和数字卫生效力，并维护受危机影响者的权利。
方法：对人道主义卫生从业人员和专家进行了16次定性访谈，以回顾性探索其数字卫生项目中的参与性做法。访谈是根据本地化绩效衡量框架的参与指标和主题进行结构化和分析的，遵循框架方法。该研究以COREQ清单为指导，以进行质量报告。
结果：各种参与式格式，包括焦点小组和访谈，在参与指标方面取得了适度进展。然而,受危机影响的人们在参与期间所拥有的影响力和权力在广度和深度方面仍然有限。参与障碍在四个关键主题下出现:项目进程、健康证据,技术基础设施和危机背景。利用参与性数字卫生人道主义干预措施的经验教训正在进行全面的项目前评估，并在人道主义行动期间和之后与受危机影响的人群保持接触。
结论：新出现的障碍有助于塑造有限的参与现实，并产生影响：未能参与受危机影响的人有可能使不平等现象长期存在并造成伤害。推进人道主义数字卫生应对工作的参与革命，应解决主要的参与障碍，以提高人道主义效率和数字卫生效力，并维护受危机影响者的权利。
